Socioeconomic inequalities in hypertension in Kenya: a decomposition analysis of 2015 Kenya STEPwise survey on non-communicable diseases risk factors

Samwel Maina Gatimu,Thomas Wiswa John

doi:10.1186/s12939-020-01321-1

Samwel Maina Gatimu, Thomas Wiswa John

Open Access

https://doi.org/10.1186/s12939-020-01321-1

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Abstract

BackgroundOne in four Kenyans aged 18–69 years have raised blood pressure. Despite this high prevalence of hypertension and known association between socioeconomic status and hypertension, there is limited understanding of factors explaining inequalities in raised blood pressure in Kenya. Hence, we quantified the socioeconomic inequality in hypertension in Kenya and decomposed the determinants contributing to such inequality.MethodsWe used data from the 2015 Kenya STEPwise survey for non-communicable diseases risk factors. We included 4422 respondents aged 18–69 years. We estimated the socioeconomic inequality using the concentration index (C) and decomposed the C using Wagstaff decomposition analysis.ResultsThe overall concentration index of hypertension in Kenya was − 0.08 (95% CI: − 0.14, − 0.02; p = 0.005), showing socioeconomic inequalities in hypertension disfavouring the poor population. About half (47.1%) of the pro-rich inequalities in hypertension was explained by body mass index while 26.7% by socioeconomic factors (wealth index (10.4%), education (9.3%) and paid employment (7.0%)) and 17.6% by sociodemographic factors (female gender (10.5%), age (4.3%) and marital status (0.6%)). Regional differences explained 7.1% of the estimated inequality with the Central region alone explaining 6.0% of the observed inequality. Our model explained 99.7% of the estimated socioeconomic inequality in hypertension in Kenya with a small non-explained part of the inequality (− 0.0002).ConclusionThe present study shows substantial socioeconomic inequalities in hypertension in Kenya, mainly explained by metabolic risk factors (body mass index), individual health behaviours, and socioeconomic factors. Kenya needs gender- and equity-focused interventions to curb the rising burden of hypertension and inequalities in hypertension.

Highlights

One in four Kenyans aged 18–69 years have raised blood pressure
Sample characteristics Out of the 4500 eligible participants, 4422 respondents were included in the analysis after excluding 15 respondents aged below 18 years or above 69 years and 63 who had missing or incorrect data on blood pressure
Similar to other studies in Low- and middle-income countries (LMICs) [8, 29, 49, 50], our findings indicate the presence of inequalities in hypertension disfavouring the poor population

Summary

Introduction

One in four Kenyans aged 18–69 years have raised blood pressure. Despite this high prevalence of hypertension and known association between socioeconomic status and hypertension, there is limited understanding of factors explaining inequalities in raised blood pressure in Kenya. High blood pressure is one of the risk factors of NCDs [2]. It affects about a third of the global population and causes an estimated 7.6 million premature deaths [1]. Hypertensive disease is associated with a high burden of out of pocket expenditure to patients and family with an annual cost of US$477 and contributing to 59% of the catastrophic healthcare costs [6]

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