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Banchani E, Tenkorang EY, Midodzi W. Examining the effects of individual and neighbourhood socioeconomic status/wealth on hypertension among women in the Greater Accra Region of Ghana. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:714-725. [PMID: 33016517 DOI: 10.1111/hsc.13185] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 09/03/2020] [Accepted: 09/08/2020] [Indexed: 06/11/2023]
Abstract
Hypertension is one of the leading causes of morbidity and mortality among women in sub-Saharan Africa. Although research on the relationship between individual-level socioeconomic status (SES) and hypertension exists, to the best of our knowledge, limited empirical studies examined the effects of neighbourhood-level SES/wealth on the risks of living with hypertension in Ghana. Using data from the 2009 Women's Health Study of Accra (WHSA-II), and applying multilevel logistic regression, this study investigates the effects of both individual and neighbourhood wealth status on hypertension among women in the Greater Accra Region of Ghana. The results show that individual-level SES/wealth is a significant determinant of hypertension among Ghanaian women in Accra. Specifically, wealthy women are more likely to be hypertensive compared to poorer women. However, the effect of neighbourhood SES/wealth was attenuated after adjusting for individual-level SES/wealth. These findings suggest that it is important to develop health promotion programs targeted at a segment of SES group in the prevention, control and management of hypertension among women in the Greater Accra Region of Ghana.
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Affiliation(s)
| | - Eric Y Tenkorang
- Department of Sociology, Memorial University, St. John's, Canada
| | - William Midodzi
- Division of Community Health and Humanities, Faculty of Medicine, Memorial University, St. John's, Canada
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2
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Stroke Disparities. Stroke 2022. [DOI: 10.1016/b978-0-323-69424-7.00015-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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3
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Mourtzinis G, Manhem K, Kahan T, Schiöler L, Isufi J, Ljungman C, Andersson T, Hjerpe P. Socioeconomic status affects achievement of blood pressure target in hypertension: contemporary results from the Swedish primary care cardiovascular database. Scand J Prim Health Care 2021; 39:519-526. [PMID: 34818121 PMCID: PMC8725880 DOI: 10.1080/02813432.2021.2004841] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To assess the relation between socioeconomic status and achievement of target blood pressure in hypertension. DESIGN Retrospective longitudinal cohort study between 2001 and 2014. SETTING Primary health care in Skaraborg, Sweden. SUBJECTS 48,254 patients all older than 30 years, and 53.3% women, with diagnosed hypertension. MAIN OUTCOME MEASURES Proportion of patients who achieved a blood pressure target <140/90 mmHg in relation to the country of birth, personal disposable income, and educational level. RESULTS Patients had a lower likelihood of achieving the blood pressure target if they were born in a Nordic country outside Sweden [risk ratio 0.92; 95% confidence interval (CI) 0.88-0.97], or born in Europe outside the Nordic countries (risk ratio 0.87; 95% CI 0.82-0.92), compared to those born in Sweden. Patients in the lowest income quantile had a lower likelihood to achieve blood pressure target, as compared to the highest quantile (risk ratio 0.93; 95% CI 0.90-0.96). Educational level was not associated with outcome. Women but not men in the lowest income quantile were less likely to achieve the blood pressure target. There was no sex difference in achieved blood pressure target with respect to the country of birth or educational level. CONCLUSION In this real-world population of primary care patients with hypertension in Sweden, being born in a foreign European country and having a lower income were factors associated with poorer blood pressure control.KEY POINTSThe association between socioeconomic status and achieving blood pressure targets in hypertension has been ambiguous.•In this study of 48,254 patients with hypertension, lower income was associated with a reduced likelihood to achieve blood pressure control.•Being born in a foreign European country is associated with a lower likelihood to achieve blood pressure control.•We found no association between educational level and achieved blood pressure control.
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Affiliation(s)
- Georgios Mourtzinis
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg; and Sahlgrenska University Hospital, Gothenburg, Sweden
- CONTACT Georgios Mourtzinis Department of Medicine and Emergency, Sahlgrenska University Hospital, Göteborgsvägen 31, Mölndal, 431 80, Sweden
| | - Karin Manhem
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg; and Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Thomas Kahan
- Division of Cardiovascular Medicine, Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden
| | - Linus Schiöler
- Occupational and Environmental Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Jetish Isufi
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg; and Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Charlotta Ljungman
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg; and Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Tobias Andersson
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Närhälsan Norrmalm Health Centre, Skövde, Sweden
| | - Per Hjerpe
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Närhälsan Norrmalm Health Centre, Skövde, Sweden
- R&D Centre Skaraborg Primary Care, Skövde, Sweden
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Ragavan RS, Joshi R, Evans RG, Riddell MA, Thankappan KR, Chow CK, Oldenburg B, Mahal AS, Kalyanram K, Kartik K, Suresh O, Thomas N, Mini GK, Srikanth VK, Maulik PK, Alim M, Guggilla RK, Busingye D, Thrift AG. Additive association of knowledge and awareness on control of hypertension: a cross-sectional survey in rural India. J Hypertens 2021; 39:107-116. [PMID: 32833918 DOI: 10.1097/hjh.0000000000002594] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine whether there is an interaction between knowledge about hypertension and awareness of hypertension on the treatment and control of hypertension in three regions of South India at different stages of epidemiological transition (see Video, Supplemental Digital Content 1, http://links.lww.com/HJH/B426). METHODS Using a cross-sectional design, we randomly selected villages within each of rural Trivandrum, West Godavari, and Chittoor. Sampling was stratified by age group and sex. We measured blood pressure and administered a questionnaire to determine knowledge and awareness of hypertension. Logistic regression was used to assess associations of awareness and knowledge about hypertension with its treatment and control in participants with hypertension, while examining for statistical interaction. RESULTS Among a total of 11 657 participants (50% male; median age 45 years), 3455 had hypertension. In analyses adjusted for age and sex, both knowledge score [adjusted odds ratio (aOR) 1.14 [95% confidence interval (CI) 1.12--1.17)] and awareness [aOR 104 (95% CI 82--134)] were associated with treatment for hypertension. Similarly, both knowledge score [aOR 1.10; 95% CI (1.08--1.12)] and awareness [aOR 13.4; 95% CI (10.7--16.7)], were positively associated with control of blood pressure in those with hypertension, independent of age and sex. There was an interaction between knowledge and awareness on both treatment and control of hypertension (P of attributable proportion <0.001 for each). CONCLUSION Health education to improve knowledge about hypertension and screening programs to improve awareness of hypertension may act in an additive fashion to improve management of hypertension in rural Indian populations.
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Affiliation(s)
| | - Rohina Joshi
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
- George Institute for Global Health, Delhi, India
| | - Roger G Evans
- Cardiovascular Disease Program, Biomedicine Discovery Institute and Department of Physiology, Monash University, Melbourne, Australia
| | - Michaela A Riddell
- School of Clinical Sciences at Monash Health, Monash University, Melbourne
| | - Kavumpurathu R Thankappan
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum
- Department of Public Health & Community Medicine, Central University of Kerala, Kasaragod, Kerala, India
| | - Clara K Chow
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
- Westmead Applied Research Centre, The University of Sydney, Sydney, New South Wales
- Department of Cardiology, Westmead Hospital, Sydney
| | - Brian Oldenburg
- Melbourne School of Population and Global Health, University of Melbourne
| | - Ajay S Mahal
- School of Public Health and Preventive Medicine, Monash University
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Kartik Kalyanram
- Rishi Valley Rural Health Centre, Chittoor District, Andhra Pradesh
| | - Kamakshi Kartik
- Rishi Valley Rural Health Centre, Chittoor District, Andhra Pradesh
| | - Oduru Suresh
- School of Clinical Sciences at Monash Health, Monash University, Melbourne
- Rishi Valley Rural Health Centre, Chittoor District, Andhra Pradesh
| | - Nihal Thomas
- Department of Endocrinology, Diabetes & Metabolism, Christian Medical College, Vellore, Tamil Nadu
| | - Gomathyamma K Mini
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum
- Global Institute of Public Health, Ananthapuri Hospitals and Research Institute, Trivandrum, Kerala, India
| | - Velandai K Srikanth
- School of Clinical Sciences at Monash Health, Monash University, Melbourne
- Peninsula Clinical School, Central Clinical School, Monash University, Frankston, Australia
| | - Pallab K Maulik
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
- George Institute for Global Health, Delhi, India
- George Institute for Global Health -- Oxford University, Oxford, UK
| | - Mohammed Alim
- George Institute for Global Health, Delhi, India
- Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Rama K Guggilla
- Department of Population Medicine and Civilization Diseases Prevention, Faculty of Medicine with the Division of Dentistry and Division of Medical Education in English, Medical University of Bialystok, Bialystok, Poland
| | - Doreen Busingye
- School of Clinical Sciences at Monash Health, Monash University, Melbourne
| | - Amanda G Thrift
- School of Clinical Sciences at Monash Health, Monash University, Melbourne
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Souza NPD, Cesse EÂP, Souza WVD, Fontbonne A, Barreto MNSDC, Goff ML, Batista Filho M, Féart C, Lira PICD. Temporal variation in prevalence, awareness and control of hypertension in urban and rural areas in Northeast Brazil between 2006 and 2016. CAD SAUDE PUBLICA 2020; 36:e00027819. [PMID: 32321071 DOI: 10.1590/0102-311x00027819] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 09/23/2019] [Indexed: 11/22/2022] Open
Abstract
To assess the evolution in prevalence, awareness and control of hypertension for over 10 years in Pernambuco State, Northeast Brazil, two cross-sectional studies were conducted based on random samples of households in urban and rural areas, in 2006 and 2015/2016, involving adults aged 20 years or older. Hypertension was defined as systolic blood pressure of at least 140mmHg or diastolic blood pressure of at least 90mmHg as well as the reported use of antihypertensive medication. A logistic regression analysis was conducted to estimate the influence of the social, behavioral and anthropometric determinants on hypertension. Although social and behavioral factors improved in this 10-year period, overweight and abdominal obesity increased. Approximately one third of the adult population of Pernambuco had hypertension in 2006 and this prevalence was maintained in 2015/2016. In rural areas, awareness concerning hypertension rose from 44.8% in 2006 to 67.3% in 2015/2016, and control from 5.3% to 27.1%, so that awareness and control were similar in urban and rural areas in 2015/2016. After an adjustment for potential confounding factors, the likelihood of having hypertension more than doubled among men (OR = 2.03; p < 0.001), middle (OR = 4.41; p < 0.001) and old-age subjects (OR = 14.44; p < 0.001), and those who had abdominal obesity (OR = 2.04; p < 0.001) in urban areas and among middle-aged (OR = 2.56; p < 0.001), less educated individuals (OR = 2.21; p = 0.006) and those who were overweight (OR = 2.23; p < 0.001) in rural areas. Despite the favorable evolution in the management of hypertension in Pernambuco, public health measures focused in vulnerable populations are still required, mainly in rural areas, to improve primary prevention and decrease the disease rate.
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Affiliation(s)
- Nathália Paula de Souza
- Instituto Aggeu Magalhães, Fundação Oswaldo Cruz, Recife, Brasil.,Centro Acadêmico de Vitória, Universidade Federal de Pernambuco, Vitória de Santo Antão, Brasil
| | | | | | - Annick Fontbonne
- Centre de Recherche en Epidémiologie et Santé des Populations, INSERM, Villejuif, France
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Huynh Q, Venn AJ, Marwick TH. Socioeconomic Disadvantage and Days at Home After Hospital Discharge of Patients with Heart Failure. Am J Cardiol 2018; 122:616-624. [PMID: 29960665 DOI: 10.1016/j.amjcard.2018.04.051] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Revised: 04/24/2018] [Accepted: 04/30/2018] [Indexed: 10/28/2022]
Abstract
The risk of heart failure (HF) readmission may be reduced by disease management programs, but the resource-intensive nature of these requires targeting to the greatest need. As socioeconomic status (SES) is related to other health outcomes, we sought whether regional markers of SES were associated with days at home (alive and out of hospital) after discharge. This study used statewide data of 1,391 HF patients who had their first ever HF admission to a public hospital in Tasmania (Australia) during 2009 to 2012. Measurements of residential SES included four indexes and a remoteness index generated by the Australian Bureau of Statistics. The primary outcome was days at home. Secondary outcomes included 30- and 90-day readmission or death, number of readmissions, and days to first readmission. Our HF patients had a median of 352 days at home [interquartile range 167, 361]. All four SES indexes and the remoteness index (p <0.001) were adversely associated with days at home, independent of other clinical and nonclinical factors. Findings for readmission at 30 and 90 days of discharge were inconsistent; the index of Relative Socioeconomic Advantage and Disadvantage (but not other SES indexes) was independently associated with 30-day readmission (odds ratio 1.58, p = 0.008) and remoteness index was significantly associated with 90-day readmission (odds ratio = 1.99, p = 0.009). Analyzing days to first readmission did not show any significant differences among categories of SES (log-rank test p = 0.81) or remoteness index (log-rank test p = 0.47). Thus, residential SES is associated with adverse outcome in HF, and might be useful in planning services to reduce HF readmission.
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The Effects of Socioeconomic Determinants on Hypertension in a Cardiometabolic At-Risk European Country. Int J Hypertens 2017; 2017:7107385. [PMID: 28932598 PMCID: PMC5592416 DOI: 10.1155/2017/7107385] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2017] [Revised: 07/18/2017] [Accepted: 07/30/2017] [Indexed: 11/23/2022] Open
Abstract
Background A relationship has been established between socioeconomic status and hypertension. The aim of this study was to determine the prevalence of hypertension and to explore the links between hypertension and socioeconomic factors in the adult population of Malta. Methods A national representative cross-sectional health examination study was performed between 2014 and 2016. Sociodemographic and medical history data was gathered by validated questionnaires while blood pressure was measured. Prevalence rates of known hypertension, newly hypertension, and global hypertension were calculated. Associations between sociodemographic characteristics and hypertension were identified through logistic regression models. Results Hypertension contributed to 30.12% (CI 95%: 28.71–31.57) of the study population, with a male preponderance. The majority was known hypertensive (73.59% CI 95%: 71.01–76.02), with only three-quarters on medication. Multivariant analyses showed that increasing age and body mass index, male gender, and living in Gozo, Western district, and Northern Harbour district were associated with having hypertension. Conclusion Hypertension is a problem in Malta especially in the male population and with increasing age and body mass index. Education did not exhibit any associated risk for having hypertension, which is inconsistent with the literature, while habitat localities played a role in hypertension development.
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Zhang K, Eastwood D, Ertl K, Whittle J. Educational attainment does not modify the effect of educational interventions on blood pressure control: a secondary analysis of data from a randomised trial. JRSM Open 2016; 7:2054270416654359. [PMID: 27540491 PMCID: PMC4973411 DOI: 10.1177/2054270416654359] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES To assess whether the effects of community-based educational interventions to improve blood pressure, weight and health behaviours benefit participants with lower educational levels more than those with higher educational levels. DESIGN Secondary data analysis. SETTING Two 12-month community-based educational interventions, one led by trained peers and one delivered by health professionals. PARTICIPANTS A total of 403 hypertensive individuals, grouped by education (high school or less; 1-3 years college; 4 + years college). MAIN OUTCOME MEASURES Blood pressure, weight, physical activity and fruit and vegetable intake. RESULTS We found that changes in blood pressure, weight and physical activity were similar across education levels; college graduates consumed more daily servings of fruits and vegetables at baseline (3.7 versus 3.6 for those with 12-15 years and 3.1 for those with < 12 years, p = 0.0112), and increased intake more after the intervention (+0.4 versus -0.1 and -0.1, p = 0.0142). The two methods of delivery - peer-led versus professional - had similar effects on all measures. CONCLUSIONS We conclude that educational interventions, whether delivered by peers or professionals, may improve chronic disease self-management among participants but do not confer greater benefits on participants with lower educational levels.
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Affiliation(s)
- Kun Zhang
- Department of Medicine, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Dan Eastwood
- Division of Biostatistics, Institute for Health and Society, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Kristyn Ertl
- Center for Patient Care Outcomes Research, Medical College of Wisconsin, Milwaukee, WI 53226, USA; Primary Care Research Division, Clement J. Zablocki VA Medical Center, Milwaukee, WI 53295, USA
| | - Jeff Whittle
- Center for Patient Care Outcomes Research, Medical College of Wisconsin, Milwaukee, WI 53226, USA; Primary Care Research Division, Clement J. Zablocki VA Medical Center, Milwaukee, WI 53295, USA
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Sanon MA, Mohammed SA, McCullagh MC. Definition and management of hypertension among Haitian immigrants: a qualitative study. J Health Care Poor Underserved 2016; 25:1067-78. [PMID: 25130225 DOI: 10.1353/hpu.2014.0147] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Hypertension is a major health concern among Haitian immigrants, one of the largest Caribbean immigrant groups in the United States. Yet, little is known about how Hatian immigrants define and manage hypertension. For this qualitative study, face-to-face semi-structured interviews were conducted with 31 Haitian immigrants in Miami Dade County, Florida. Results indicated that most Haitian immigrants used the Haitian Creole word tansyon to represent hypertension. Tansyon was considered as either a normal condition of the human body or a maladi (illness). Both traditional biomedical and alternative approaches were used to manage hypertension. The findings show that how Haitian immigrants defined hypertension shaped their beliefs about its occurrence and the resulting management strategies used. Those who believed tansyon was a normal body condition did not take any management measures. Awareness and understanding of Haitian immigrants' beliefs about and approaches to hypertension management can enhance culturally sensitive care and improve health outcomes.
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Howard G, Howard VJ. Stroke Disparities. Stroke 2016. [DOI: 10.1016/b978-0-323-29544-4.00014-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Rahman M, H SE, Islam MJ, Mostofa MG, Saadat KA. Association of socioeconomic status with diagnosis, treatment and control of hypertension in diabetic hypertensive individuals in Bangladesh: a population-based cross-sectional study. JRSM Open 2015; 6:2054270415608118. [PMID: 26688743 PMCID: PMC4601127 DOI: 10.1177/2054270415608118] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Objectives This study aimed to examine if socioeconomic status could affect the likelihood of diagnosis, treatment and control of hypertension in diabetic hypertensive individuals. Design Cross-sectional nationally representative study. Settings Bangladesh. Participants This paper used data from the 2011 Bangladesh Demographic Health Survey. The analyses were based on the responses of 339 diabetes hypertensive individuals. Main outcome measures Diagnosis, treatment and control of hypertension. Results The age-adjusted prevalence of hypertension in diabetes individuals was 38.4% in the study population. Among diabetic hypertensive subjects only 65.7% had been diagnosed, 58.4% were receiving treatment and 42% controlled their hypertension. Individuals from high socioeconomic status (AOR 2.60; 95% CI 1.16–5.83) had an increased likelihood of reporting diagnosis of hypertension. Individuals from medium (AOR 2.22; 95% CI 1.11–4.46) and high socioeconomic status (AOR 3.47; 95% CI 1.59–7.58) had increased chance of receiving treatment. In addition, individuals belonging to high socioeconomic status (AOR 2.53; 95% CI 1.14–5.63) were more likely to report of controlling hypertension. Conclusions This study indicated that hypertension is more prevalent among diabetic patients. Furthermore, diabetic hypertensive patients from the low socioeconomic status group are also less likely to be diagnosed and also less likely to receive treatment for hypertension. In addition, diabetic hypertensive patients from the low socioeconomic status were less likely to control hypertension compared with an individual belonging to the high socioeconomic status group. This reduced likelihood of receiving proper treatment will lead to a rapid increase in the prevalence of macrovascular and microvascular diseases among diabetic hypertensive patients.
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Affiliation(s)
- Mosiur Rahman
- Department of Population Science and Human Resource Development, University of Rajshahi, Rajshahi 6205, Bangladesh
| | - Syed Emdadul H
- UChicago Research Bangladesh, House 4, Road 2/B, Sector 4, Uttra-1230, Dhaka, Bangladesh
| | - Md Jahirul Islam
- Ministry of Health and Family Welfare, Bangladesh Secretariat, Dhaka 1000, Bangladesh
| | - Md Golam Mostofa
- Department of Population Science and Human Resource Development, University of Rajshahi, Rajshahi 6205, Bangladesh
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Brennan-Olsen SL, Williams LJ, Holloway KL, Hosking SM, Stuart AL, Dobbins AG, Pasco JA. Small area-level socioeconomic status and all-cause mortality within 10 years in a population-based cohort of women: Data from the Geelong Osteoporosis Study. Prev Med Rep 2015; 2:505-11. [PMID: 26844110 PMCID: PMC4721425 DOI: 10.1016/j.pmedr.2015.05.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
BACKGROUND The social gradient of health and mortality is well-documented. However, data are scarce regarding whether differences in mortality are observed across socio-economic status (SES) measured at the small area-level. We investigated associations between area-level SES and all-cause mortality in Australian women aged ≥ 20 years. METHODS We examined SES, obesity, hypertension, lifestyle behaviors and all-cause mortality within 10 years post-baseline (1994), for 1494 randomly-selected women. Participants' residential addresses were matched to Australian Bureau of Statistics Census data to identify area-level SES, and deaths were ascertained from the Australian National Deaths Index. Logistic regression models were adjusted for age, and subsequent adjustments made for measures of weight status and lifestyle behaviors. RESULTS We observed 243 (16.3%) deaths within 10 years post-baseline. Females in SES quintiles 2-4 (less disadvantaged) had lower odds of mortality (0.49-0.59) compared to SES quintile 1 (most disadvantaged) under the best model, after adjusting for age, smoking status and low mobility. CONCLUSIONS Compared to the lowest SES quintile (most disadvantaged), females in quintiles 2 to 5 (less disadvantaged) had significantly lower odds ratio of all-cause mortality within 10 years. Associations between extreme social disadvantage and mortality warrant further attention from research, public health and policy arenas.
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Affiliation(s)
- Sharon L Brennan-Olsen
- School of Medicine, Deakin University, Ryrie St., Geelong 3220, Australia; NorthWest Academic Centre, The University of Melbourne, Sunshine Hospital, 176 Furlong Road, St Albans, 3021, Australia; Australian Institute for Musculoskeletal Sciences, 176 Furlong Road, St Albans, 3021, Australia; Institute for Health and Ageing, Australian Catholic University, 215 Spring Street, Melbourne 3000, Australia
| | - Lana J Williams
- School of Medicine, Deakin University, Ryrie St., Geelong 3220, Australia
| | - Kara L Holloway
- School of Medicine, Deakin University, Ryrie St., Geelong 3220, Australia
| | - Sarah M Hosking
- School of Medicine, Deakin University, Ryrie St., Geelong 3220, Australia
| | - Amanda L Stuart
- School of Medicine, Deakin University, Ryrie St., Geelong 3220, Australia
| | - Amelia G Dobbins
- School of Medicine, Deakin University, Ryrie St., Geelong 3220, Australia
| | - Julie A Pasco
- School of Medicine, Deakin University, Ryrie St., Geelong 3220, Australia; NorthWest Academic Centre, The University of Melbourne, Sunshine Hospital, 176 Furlong Road, St Albans, 3021, Australia
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Bresan D, Bastos JL, Leite MS. Epidemiology of high blood pressure among the Kaingang people on the Xapecó Indigenous Land in Santa Catarina State, Brazil, 2013. CAD SAUDE PUBLICA 2015; 31:331-44. [DOI: 10.1590/0102-311x00058714] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Accepted: 07/28/2014] [Indexed: 11/21/2022] Open
Abstract
This cross-sectional study describes the prevalence of high blood pressure (HBP; measured at one setting, and suggestive of a clinical diagnosis of arterial hypertension) and mean systolic blood pressure (SBP) and diastolic blood pressure (DBP) and their associations with socio-demographic and anthropometric variables among 355 Kaingang adults (≥ 20 years) on the Xapecó Indigenous Land in Brazil. Weight, height, waist circumference (WC), SBP, and DBP were measured and socio-demographic data were collected. Prevalence of HBP was 53.2% (95%CI: 45.3; 61.1) in men and 40.7% (95%CI: 33.8; 47.6) in women. In women, age and WC were directly associated with HBP; age was associated with SBP and schooling with DBP. In men, HBP was statistically associated with high body mass index (BMI) and tile floor in the home (as a socioeconomic proxy); BMI and WC were associated with SBP; BMI and WC were associated with DBP. The study highlights the need for measures to control risk factors for HBP, especially due to its relevance for cardiovascular diseases and their consequences.
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Affiliation(s)
- Deise Bresan
- Universidade Federal de Mato Grosso do Sul, Brasil
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Plantinga LC. Socio-economic impact in CKD. Nephrol Ther 2013; 9:1-7. [PMID: 23318113 DOI: 10.1016/j.nephro.2012.07.361] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2012] [Revised: 05/27/2012] [Accepted: 07/29/2012] [Indexed: 12/22/2022]
Abstract
BACKGROUND Socio-economic status (SES) may be conceptualized as an individual's position in society, as determined by their income, occupation, education, wealth, and housing situation. This review summarizes the current literature regarding associations of these markers of SES with both chronic kidney disease (CKD) and associated poor outcomes. METHODS Literature searches were conducted in the US National Library of Medicine, National Institutes of Health, PubMed database using the search terms "chronic kidney disease" and "chronic renal insufficiency," combined with "socio-economic status," "income," "occupation," "employment," "education," "social class," "wealth," and "housing." Articles not in the English language, using non-human subjects, or primarily concerning subjects with ESRD or acute kidney injury were excluded. RESULTS Income is the most-studied aspect of SES in relation to CKD, but there is increasing literature involving occupation and education as well. Additionally, the associations of CKD and its outcomes with area-level and life course SES are both burgeoning areas of research. There are several research areas that remain mostly unexplored, including the roles of wealth and housing in defining SES-related risk in CKD. Additionally, none have explored the relative utility of composite versus individual indicators of SES in predicting risk of CKD and outcomes. CONCLUSION Given the overwhelming evidence that SES plays an important role in the development and progression of disease, the development and testing of more targeted interventions should be a top priority in CKD research. Continuing examination of these factors, with increased rigor and focus on potentially modifiable intermediate pathways, is needed.
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Affiliation(s)
- Laura C Plantinga
- Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Road NE 3rd Floor, Atlanta, GA 30023, United States of America.
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Ng N, Carlberg B, Weinehall L, Norberg M. Trends of blood pressure levels and management in Västerbotten County, Sweden, during 1990-2010. Glob Health Action 2012; 5:GHA-5-18195. [PMID: 22855645 PMCID: PMC3409341 DOI: 10.3402/gha.v5i0.18195] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2012] [Revised: 06/12/2012] [Accepted: 06/21/2012] [Indexed: 12/24/2022] Open
Abstract
Background Availability of longitudinal data on hypertension and blood pressure levels are important to assess changes over time at the population level. Moreover, detailed information in different population sub-groups is important to understand inequity and social determinants of blood pressure distribution in the population. Objectives The objectives of this study are to: (1) describe the trends of population blood pressure levels in men and women between different educational levels and geographic areas in Sweden during 1990–2010; (2) identify prevalences of hypertension, awareness, treatment, and control in the population; and (3) assess the 10-year risk of developing hypertension among individuals with normal and high normal blood pressures. Methods This study is based on data from the Västerbotten Intervention Program (VIP) in Västerbotten County, Sweden. The cross-sectional analysis includes 133,082 VIP health examinations among individuals aged 30, 40, 50, and 60 years from 1990 to 2010. The panel analysis includes 34,868 individuals who were re-examined 10 years after the baseline examination. Individuals completed a self-administered health questionnaire that covers demographic and socio-economic information, self-reported health, and lifestyle behaviours. Blood pressure measurement was obtained prior to the questionnaire. In the cross-sectional analysis, trends of blood pressure by sex, and between educational groups and geographic areas are presented. In the panel analysis, the 10-year risk of developing hypertension is estimated using the predicted probability from logistic regression analysis for each sex, controlling for age and educational level. Results The prevalence of hypertension decreased from 1990 to 2010; from 43.8 to 36.0% (p < 0.001) among men, and 37.6 to 27.5% among women (p < 0.001). Individuals with basic education had a significantly higher prevalence of hypertension compared to those with medium or high education. Although the decreases were observed in all geographic areas, individuals in rural inland areas had a much higher prevalence compared to those who lived in Umeå City. The proportion of hypertensive women who were aware of their hypertension (61.7%) was significantly higher than men (51.6%). About 34% of men and 42% of women with hypertension reported taking blood pressure medication. Over time, awareness and control of hypertension improved (from 46.5% in 1990 to 69% in 2010 and from 30 to 65%, respectively). The gaps between educational groups diminished. This study shows a significantly higher risk of developing hypertension for men and women with high normal blood pressure compared to those with normal blood pressure at baseline in all age cohorts and educational groups. The average risks of developing hypertension among men with high normal blood pressure were 21.5, 45.8, and 56.3% in the 30, 40, and 50-year cohorts, respectively. Corresponding numbers for women were 22.6, 47.4, and 57.9%. Conclusions Levels of blood pressure and hypertension decreased significantly among the Västerbotten population in the last 21 years. Hypertension management has improved and there is increased awareness, treatment, and control of blood pressure. Despite these achievements, the persisting social gaps in blood pressure levels and management demand further investigation and action from policy makers. Future research should attempt to identify and address the root causes of these health inequities to ensure better and equal health for the whole population.
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Affiliation(s)
- Nawi Ng
- Department of Public Health and Clinical Medicine, Division of Epidemiology and Global Health, Umeå University, Umeå, Sweden.
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Wee LE, Koh GCH. Individual and neighborhood social factors of hypertension management in a low-socioeconomic status population: a community-based case-control study in Singapore. Hypertens Res 2011; 35:295-303. [PMID: 22089533 DOI: 10.1038/hr.2011.187] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The aim of this study was to determine hypertension awareness, treatment and control, as well as to carry out regular blood pressure (BP) screening and monitoring, in a multi-ethnic urban low-socioeconomic status (SES) Asian community; and to compare these estimates with those of a higher-SES community in the same geographic location. We studied a neighborhood of three blocks of rented public flats (lower-SES community) and three adjacent blocks of owner-occupied public flats (higher-SES community) in Taman Jurong, Singapore. BP was measured, and demographic details and reasons for irregular BP screening, monitoring and treatment were collected from 2009 to 2010. Logistic regression was used to determine predictors of hypertension management. Participation was 90.0% (359/400) for the rental flat community and 70.2% (351/500) for the owner-occupied flats. Prevalence, awareness, treatment and control in the low-SES community (rental flats) were 63.9% (228/357), 61.8% (141/228), 69.5% (98/141) and 43.9% (43/98), respectively, whereas in the neighboring community these were 65.0% (228/351), 83.3% (190/228), 85.3% (162/190) and 66.0% (107/162), respectively. Adjusting for other sociodemographic variables, awareness, treatment and control were poorer in the low-SES community. In the low-SES community, awareness was higher among diabetics, dyslipidemics, those ≥60 years and those with regular access to doctors. Treatment was more likely among those ≥60 years, but less likely among those needing financial aid. Control was less likely in the employed. High cost of screening and treatment, if diagnosed, was the most frequently cited barrier among the low-SES group. Hypertension management in those of lower SES is poorer than in those of higher SES. For the lower-SES population, financial barriers need to be addressed.
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Affiliation(s)
- Liang En Wee
- Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore.
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