Socioeconomic Inequalities In Hypertension Research Articles

Twelve–year (2008–2019) trends in socioeconomic inequalities in cardiovascular risk factors in a Swiss representative survey of the general population

ObjectiveWe assessed trends in socioeconomic inequalities in cardiovascular risk factors prevalence among Swiss adults from 2008 to 2019. MethodsUsing data from the Bus Santé study, an annual survey of adults living in Geneva, Switzerland, we calculated the prevalence per period and by demographic and socioeconomic indicators, assessing inequality trends using the relative index of inequality (RII) and the slope index of inequality (SII). ResultsAmong 10,739 participants, most CVD risk factors decreased over time, while diabetes, obesity, and smoking prevalence remained steady. In 2017–2019, prevalence of most CVD risk factors was higher in socioeconomically disadvantaged groups. Relative and absolute inequalities decreased over time, but mostly remained, for hypertension [in 2017–2019, education-RII (95 % CI) = 1.27 (1.12–1.46), income-RII = 1.27 (1.10–1.47)], hypercholesterolemia [education-RII = 1.15 (1.00–1.32)], and sedentarity [education-RII = 1.95 (1.52–2.51), income-RII = 1.69 (1.28–2.23)], and appeared to have reversed for hazardous alcohol use [income-RII = 0.75 (0.60–0.93)]. Substantial and persistent relative and absolute inequalities in diabetes prevalence were observed [education-RII = 2.39 (1.75–3.27), income-RII = 3.18 (2.25–4.48), and subsidy-RII = 2.77 (1.89–4.05)]. Inequalities were also marked across all socioeconomic indicators for obesity prevalence [education-RII = 3.32 (2.63–4.19), income–RII = 2.37 (1.85–3.04), subsidy-RII = 1.98 (1.48–2.66)] and for smoking [education-RII = 2.42 (2.06–2.84), income-RII = 2.37 (1.99–2.84), subsidy-RII = 1.91 (1.56–2.35)]. ConclusionsOver 12 years in Geneva, Switzerland, socioeconomic inequalities in hypertension, hypercholesterolemia, hazardous alcohol use, and sedentarity decreased but persist, while substantial inequalities in diabetes, obesity, and smoking remained unchanged.

District-Level Inequalities in Hypertension among Adults in Indonesia: A Cross-Sectional Analysis by Sex and Age Group.

Background: An estimated 1.28 billion adults 30–79 years old had hypertension globally in 2021, of which two-thirds lived in low- and middle-income countries (LMICs). Previous studies on geographic and socioeconomic inequalities in hypertension among adults have limitations: (a) most studies used individual-level data, while evidence from locality-level data is also crucial for policymaking; (b) studies from LMICs are limited. Thus, our study examines geographic and socioeconomic inequalities in hypertension among adults across districts in Indonesia. Methods: We combined geospatial and quantitative analyses to assess the inequalities in hypertension across 514 districts in Indonesia. Hypertension data were obtained from the Indonesian Basic Health Survey (Riskesdas) 2018. Socioeconomic data were obtained from the World Bank. Six dependent variables included hypertension prevalence among all adults (18+ years), male adults, female adults, young adults (18–24 years), adults (25–59 years), and older adults (60+ years). Results: We also found significant geographic and socioeconomic inequalities in hypertension among adults across 514 districts. All hypertension indicators were higher in the most developed region than in the least developed region. Districts in the Java region had up to 50% higher prevalence of hypertension among all adults, males, females, young adults, adults, and older adults. Notably, districts in the Kalimantan region had the highest prevalence of hypertension, even compared to those in Java. Moreover, income level was positively associated with hypertension; the wealthiest districts had higher hypertension than the poorest districts by up to 30%, but only among males and older adults were statistically significant. Conclusions: There were significant inequalities in hypertension among adults across 514 districts in the country. Policies to reduce such inequalities may need to prioritize more affluent urban areas and rural areas with a higher burden.

Socioeconomic inequalities in the risk factors of noncommunicable diseases (hypertension and diabetes) among Bangladeshi population: Evidence based on population level data analysis.

Noncommunicable diseases (NCDs) such as hypertension and diabetes are among the most fatal disease and prevalent among the adult population worldwide, including Bangladesh, and pose a public health threat. Understanding the socioeconomic inequalities linked to NCD risk factors can aid in the development of effective strategies to reduce the disease's recurrence. However, the literature on socioeconomic inequalities in hypertension and diabetes prevalence in Bangladesh is scant. Therefore, this study seeks to assess the inequality in hypertension and diabetes prevalence and to identify factors that may contribute to socioeconomic inequalities in Bangladesh. The current study incorporated data from a recent round of Bangladesh Demographic and Health Survey (BDHS 2017-18). The age-standardized prevalence rates of hypertension and diabetes were reported, and the log-binomial regression technique was used to identify the relevant confounders. Additionally, socioeconomic inequalities were quantified using a regression-based decomposition technique in which the concentration index (CIX) and Concentration curve were produced to determine the socioeconomic factors contributing to inequality. Hypertension and diabetes were shown to have an age-standardized prevalence of (11.29% 95% CI: 11.13-11.69) and (36.98% 95% CI: 36.79-37.16), respectively. Both hypertension and diabetes were shown to be pointedly linked to the respondents' age, wealth status, being overweight or obese, and a variety of respondents' administrative divisions (p <0.001). In Bangladesh, household wealth status accounted for approximately 25.71% and 43.41% of total inequality in hypertension and diabetes, respectively. While BMI played a significant role in the emergence of inequality, the corresponding percentages for diabetes and hypertension are 4.95 and 83.38, respectively. In addition, urban areas contributed 4.56% inequality to increase diabetes among Bangladeshi inhabitants while administrative region contributed 4.76% of the inequality of hypertension. A large proportion of Bangladesh's adult population suffers from hypertension and diabetes. It is critical to recognize the value of equity-based initiatives in order to optimize the benefit-risk ratio and cost effectiveness of preventive health programmes. Integrating equity considerations into interventions is critical for policies and programmes to achieve their objectives. As a result, these findings can be taken into account when making existing and prospective policy decisions, as well as following its progression with economic development of Bangladesh.

Trends and Regional Variation in Prevalence of Cardiovascular Risk Factors and Association With Socioeconomic Status in Canada, 2005-2016

Cardiovascular disease remains the second leading cause of death in Canada. Monitoring and tracking the trends and disparities in major cardiovascular risk factors could provide benchmarks for future cardiovascular health strategies. To investigate the temporal trends, regional variations, and socioeconomic disparities in major cardiovascular risk factors in Canada from 2005 to 2016. This repeated cross-sectional survey study included adults aged 20 years and older from 6 Canadian Community Health Survey cycles between 2005 and 2016. Cardiovascular risk factors included hypertension, diabetes, obesity, and current smoking. Socioeconomic status was measured using equivalized household income. Data analysis was performed from September 2019 to April 2020. A total of 112 health regions and socioeconomic status. Age- and sex-adjusted prevalence of hypertension, diabetes, obesity, and current smoking by year; health regions; and socioeconomic status. Absolute numbers were rounded to base 100 for confidentiality purposes, and percentages were based on weighted numbers. Slope index of inequality (SII) and relative index of inequality (RII) were calculated to assess absolute and relative socioeconomic inequalities, respectively. A total of 670 000 respondents (329 000 [49.1%] men; 341 000 [50.9%] women) aged 20 years and older from 6 survey cycles were enrolled for this study. The largest age group was those aged 40 to 59 years (eg, 2005 cycle: 40.2% [95% CI, 39.9%-40.6%]). In the 2015/2016 cycle, the overall age- and sex-adjusted prevalence rates of hypertension, diabetes, obesity, and current smoking were 20.7% (95% CI, 20.4%-21.1%), 7.2% (95% CI, 7.0%-7.5%), 20.1% (95% CI, 19.7%-20.6%), and 17.8% (95% CI, 17.4%-18.2%), respectively. From 2005 to 2016, there was a significant increase in the prevalence of hypertension, diabetes, and obesity (eg, prevalence of diabetes in both sexes, 2005: 5.8% [95% CI, 5.6%-6.0%]; 2015/2016: 7.2% [95% CI, 7.0%-7.5%]; P < .001) but a significant decrease in the prevalence of current smoking (both sexes, 2005: 22.1% [95% CI, 21.7%-22.5%]; 2015/2016: 17.8% [95% CI, 17.4%-18.2%]; P < .001). The prevalence of all the risk factors varied widely across health regions (eg, obesity, Vancouver Health Service Delivery Area: 6.7% [95% CI, 4.5%-9.0%]; Miramichi Area: 36.8% [95% CI, 27.3%-46.3%]). In addition to obesity among men, all risk factors tended to be more common among those with lower income (eg, prevalence of hypertension in both sexes, 2015/2016, lowest income group: 23.2% [95% CI, 22.4%-24.0%]; highest income group: 18.4% [95% CI, 17.7%-19.1%]). The SII and RII indicated consistent absolute and relative socioeconomic inequalities in hypertension, diabetes, and current smoking over time (eg, RII for hypertension in both sexes, 2005: 1.25; 95% CI, 1.18-1.33; 2015/2016: 1.34; 95% CI, 1.26-1.43). However, the phenomenon of absolute and relative socioeconomic inequalities in obesity was only observed among women (eg, RII for 2015/2016 for obesity in women; 1.74 (95% CI, 1.56-1.93); men: 1.09; 95% CI, 0.99-1.21). During the study period, the prevalence of hypertension, diabetes, and obesity significantly increased, while the prevalence of current smoking significantly decreased. Geographic and socioeconomic gaps should be considered and addressed in future interventions and policies targeted at reducing these cardiovascular risk factors in Canada.

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

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.

The accuracy of self-report versus objective assessment for estimating socioeconomic inequalities in disease prevalence in Indonesia

ObjectivesTo estimate socioeconomic inequalities in hypertension and asthma prevalence in Indonesia, to compare estimates based on self-report (SR) to those based on objective assessment (OA), and to assess the role of sensitivity and specificity of SR.MethodsWe used data from the 2014 Indonesia Family Life Survey (n = 34,257). We measured inequalities in hypertension and asthma prevalence in relation to educational level and income, using standardised prevalence rate and the relative index of inequality (RII). Using OA as standard, we calculated the sensitivity and specificity of SR.ResultsFor hypertension, reversed inequalities were found when estimated by SR instead of OA (RII for education 0.86, 95% CI 0.74–0.99 vs. RII 1.29, 95% CI 1.16–1.44). For asthma, a similar but even larger reversal of inequalities was found. The sensitivity of SR was low overall, and especially for the lowest education or income group.ConclusionsResults imply that the use of SR may lead to underestimation of socioeconomic inequalities in disease prevalence in a low-income country such as Indonesia. The use of OA is recommended for monitoring inequalities in non-communicable disease prevalence.

Trends in Socioeconomic Inequalities in Hypertension in Ontario, Canada, 2000-2012

IntroductionHypertension is leading risk factor for cardiovascular disease and mortality. Low socioeconomic position (e.g., income or high material deprivation) is an important risk factor for hypertension. However, there is limited evidence monitoring the extent to which socioeconomic inequalities in hypertension exist and are changing over time in Ontario.&#x0D; Objectives and ApproachThe study objective was to estimate socioeconomic trends in prevalent hypertension by household income and material deprivation in Ontario from 2000 to 2012. A pooled cross-sectional study was conducted using data from 6 Canadian Community Health Surveys linked to the Discharge Abstract Database and Ontario Health Insurance Plan data (n=121,390 over 35 years, 54\% female). Relative-weighted Poisson regression models were used to estimate hypertension rates (adjusted for age, sex, ethnicity and immigration) across quintiles of equivalized household income and area-level material deprivation. Socioeconomic inequalities were estimated using the slope index of inequality (SII) and relative index of inequality (RII).&#x0D; ResultsSocioeconomic inequalities in hypertension were observed across income quintiles on both absolute (SII: 1428 per 10,000, 95\%CI:1126,1730) and relative (RII:1.74, 95\%CI:1.53,1.94) scales in 2000, decreasing by 2012 (SII:297 per 10,000, 95%CI: -82,676; RII:1.19, 95%CI:0.93,1.45). A similar pattern was observed across material deprivation quintiles, however with smaller inequalities in 2000 (SII:595 per 10,000, 95%CI:306,884; RII:1.25, 95%CI:1.11,1.39) and 2012 (SII:389 per 10,000, 95%CI:17,761; RII:1.24, 95%CI:0.99,1.49).&#x0D; Conclusion/ImplicationsSocioeconomic inequalities in hypertension were observed in Ontario, with decreasing trends between 2000 and 2012. Area-level material deprivation underestimated individual-level socioeconomic inequalities in hypertension.

Socioeconomic inequality in hypertension in Iran.

Hypertension covers a large portion of burden of diseases, especially in the developing countries. The unequal distribution of hypertension in the population may affect 'health for all' goal. This study aimed to investigate the socioeconomic inequality of hypertension in Iran and to identify its influencing factors. We used data from Iran's surveillance system for risk factors of noncommunicable diseases which was conducted on 89 400 individuals aged 15-64 years in 2005. To determine the socioeconomic status of participants, a new variable was created using a principal component analysis. We examined hypertension at different levels of this new variable and calculated slop index of inequality (SII) and concentration index (C) for hypertension. We then applied Oaxaca-Blinder decomposition analysis to determine the causes of inequality. The SII and C for hypertension were -32.3 and -0.170, respectively. The concentration indices varied widely between different provinces in Iran and was lower (more unequal) in women than in men. There was significant socioeconomic inequality in hypertension. The results of decomposition indicated that 40.5% of the low-socioeconomic group (n = 18190) and 16.4% of the high-socioeconomic group (n = 16335) had hypertension. Age, education level, sex and residency location were the main associated factors of the difference among groups. According to our results, there was an inequality in hypertension in Iran, so that individuals with low socioeconomic status had a higher prevalence of hypertension. Age was the most contributed factor in this inequality and women in low-socioeconomic group were the most vulnerable people for hypertension.

Explaining Socioeconomic Inequalities in Childhood Blood Pressure and Prehypertension

Much remains to be understood about the socioeconomic inequalities in hypertension that continue to exist. We investigated the association of socioeconomic status with blood pressure and prehypertension in childhood. In a prospective cohort, 3024 five- to six-year–old children had blood pressure measurements and available information on potential explanatory factors, namely birth weight, gestational age, smoking during pregnancy, pregnancy-induced hypertension, familial hypertension, maternal body mass index, breastfeeding duration, domestic tobacco exposure, and body mass index. The systolic and diastolic blood pressures of children from mid-educated women were 1.0-mm Hg higher (95% CI, 0.4–1.7) and 0.9-mm Hg higher (95% CI, 0.3–1.4), and the blood pressures of children with low-educated women were 2.2-mm Hg higher (95% CI, 1.4–3.0) and 1.7-mm Hg higher (95% CI, 1.1–2.4) compared with children with high-educated women. Children with mid- (odds ratio, 1.50; 95% CI, 1.18–1.92) or low-educated mothers (odds ratio, 1.80; 95% CI, 1.35–2.42) were more likely to have prehypertension compared with children with high-educated mothers. Using path analyses, birth weight, breastfeeding duration, and body mass index were determined as having a role in the association of maternal education with offspring blood pressure and prehypertension. The socioeconomic gradient in hypertension appears to emerge from childhood as the results show a higher blood pressure and more prehypertension in children from lower socioeconomic status families. Socioeconomic disparities could be reduced by improving 3 factors in particular, namely birth weight, breastfeeding duration, and body mass index, but other factors might also play a role.