Social Determinants Status and Hypertension: Results from the China Hypertension Survey

Abstract

Background: The prevalence of hypertension (HTN) continues to increase in developing countries including China. Several reviews assessed the effects of social determinants status on the HTN epidemic, however, it is unclear throughout China. We explored the association between unbalanced social determinants status and HTN in China. Methods: Of the China Hypertension Survey (CHS) study participants, those (n=299,220) who were aged ≥18 years from 181 districts and 31 provinces were eligible for the finally analysis. Data on demographic and other factors was recorded by a standardized questionnaire. Social determinants status were measured with: (1) district-level:Per capita GDP (Per_GDP), the number of hospital beds per 1000 residents (Per1000_bed) and tertiary industry added value (TIA); (2) individual-level: education and employment conditions. Findings: Overall, HTN prevalence(r=0.16), awareness (r=0.29) and treatment(r=0.19) rates were correlated positively with the Per_GDP of district, all P<0.05. In the multivariable analysis, compared with the poorest level of Per_GDP, the middle and richest group had higher risk of HTN [OR, 95%CI: 1.12(1.09-1.14) and 0.99(0.96-1.02)] and higher possibility of HTN awareness, treatment and control. Higher risk of HTN and lower possibility of awareness, treatment and control were associated with elevated Per1000_bed (Ptrend <0.05). Higher possibility of HTN control was associated with the higher TIA (Ptrend <0.001). Compared to participants with primary education, those with middle (OR, 95%CI: 0.86, 0.84-0.88) and senior (OR, 95%CI: 0.72, 0.69-0.76) education had a decreased risk of HTN and higher HTN control possibility. And those in retirement or unemployment conditions had a higher risk of HTN and higher possibility of HTN awareness, treatment and control compared with the job-holders. Interpretation: People with a higher economic area living, lower level of education and retirement/ unemployment conditions have a higher incidence of HTN, especially for male or rural residents. However, individuals have a higher possibility of HTN awareness, treatment, and control if they are living in a better environment of economic development and medical treatment. Funding Statement: The Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences (grant 2017-I2M-1-004) and the Chinese National Science & Technology Pillar Program during the Twelfth Five-year Plan Period (No.: 2011BAI11B01). Declaration of Interests: The authors stated: None. Ethics Approval Statement: All participant provided informed written consent. The protocol and operational procedures of the CHS study were approved by the Fuwai Hospital (Beijing, China) Ethics Committee.