Abstract
In Poland, there is no data on parental socioeconomic status (SES) as a potent risk factor in adolescent elevated blood pressure, although social differences in somatic growth and maturation of children and adolescents have been recorded since the 1980s. This study aimed to evaluate the association between parental SES and blood pressure levels of their adolescent offspring. A cross-sectional survey was carried out between 2009 and 2010 on a sample of 4941 students (2451 boys and 2490 girls) aged 10–18, participants in the ADOPOLNOR study. The depended outcome variable was the level of blood pressure (optimal, pre- and hypertension) and explanatory variables included place of residence and indicators of parental SES: family size, parental educational attainments and occupation status, income adequacy and family wealth. The final selected model of the multiple multinomial logistic regression analysis (MLRA) with backward elimination procedure revealed the multifactorial dependency of blood pressure levels on maternal educational attainment, paternal occupation and income adequacy interrelated to urbanization category of the place of residence after controlling for family history of hypertension, an adolescent’s sex, age and weight status. Consistent rural-to-urban and socioeconomic gradients were found in prevalence of elevated blood pressure, which increased with continuous lines from large cities through small- to medium-sized cities to villages and from high-SES to low-SES familial environments. The adjusted likelihood of developing systolic and diastolic hypertension decreased with each step increase in maternal educational attainment and increased urbanization category. The likelihood of developing prehypertension decreased with increased urbanization category, maternal education, paternal employment status and income adequacy. Weight status appeared to be the strongest confounder of adolescent blood pressure level and, at the same time, a mediator between their blood pressure and parental SES.Conclusion: The findings of the present study confirmed socioeconomic disparities in blood pressure levels among adolescents. This calls for regularly performed blood pressure assessment and monitoring in the adolescent population. It is recommended to focus on obesity prevention and socioeconomic health inequalities by further trying to improve living and working conditions in adverse rural environments. What is known: • Socioeconomic gradient exists in adolescent blood pressure levels. • Adolescents from lower SES families are at greater risk of hypertension. What is new: • Urbanization levels of residence area affect adolescent blood pressure by parental socioeconomic status. • Socioeconomic inequalities in adolescent hypertension may be modulated through effects of body weight.
Highlights
The rate of diagnosis and prevalence of hypertension (HTN) in children and adolescents appear to show a steady upward trend
Weight status appeared to be the strongest confounder of adolescent blood pressure level and, at the same time, a mediator between their blood pressure and parental socioeconomic status (SES)
UB/PTJ/pension/others unemployment benefits/part-time job/life annuity/all others a First-degree family history of hypertension: maternal and/or paternal hypertension b A category that includes people who voluntarily remain out of the active workforce, those raising a family at home and/or those who are unemployed c An ordinal measure of more than enough, just enough or not enough money to cover expenses each month reported by study participants’ parents d Family affluence evaluated by adolescent participants in the study having fewer than 12 years of schooling (53.8 %) and mothers with 12 years of schooling (40.7 %), without financial strain, i.e., with income adequacy (51.3 % with more than enough income)
Summary
The rate of diagnosis and prevalence of hypertension (HTN) in children and adolescents appear to show a steady upward trend. Persistent elevation of arterial blood pressure (BP) is an independent risk factor for myocardial infarction and heart failure, stroke and end-stage renal disease. Hypertension and specific morbid sequelae have emerged as leading causes of premature death among adults worldwide [1]. There is evidence that high BP in young age is associated with early markers of cardiovascular abnormalities such as left ventricular hypertrophy and atherosclerosis [3, 6, 28]. The main complication of persistent high blood pressure in young age is its progress to adulthood, making it the greatest cardiovascular disease risk [4]. Several lines of evidence suggest that young people who enter adulthood with higher BP parameters are more likely than their normotensive peers to be affected with HTN and its morbidity sequelae [19, 36]. Earlier stages of life seem to be critical to HTN [20]
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