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Visniauskas B, Kilanowski-Doroh I, Ogola BO, Mcnally AB, Horton AC, Imulinde Sugi A, Lindsey SH. Estrogen-mediated mechanisms in hypertension and other cardiovascular diseases. J Hum Hypertens 2023; 37:609-618. [PMID: 36319856 PMCID: PMC10919324 DOI: 10.1038/s41371-022-00771-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 10/06/2022] [Accepted: 10/18/2022] [Indexed: 06/08/2023]
Abstract
Cardiovascular disease (CVD) is the leading cause of death globally for men and women. Premenopausal women have a lower incidence of hypertension and other cardiovascular events than men of the same age, but diminished sex differences after menopause implicates 17-beta-estradiol (E2) as a protective agent. The cardioprotective effects of E2 are mediated by nuclear estrogen receptors (ERα and ERβ) and a G protein-coupled estrogen receptor (GPER). This review summarizes both established as well as emerging estrogen-mediated mechanisms that underlie sex differences in the vasculature during hypertension and CVD. In addition, remaining knowledge gaps inherent in the association of sex differences and E2 are identified, which may guide future clinical trials and experimental studies in this field.
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Affiliation(s)
- Bruna Visniauskas
- Department of Pharmacology, Tulane University School of Medicine, New Orleans, LA, USA
| | | | - Benard O Ogola
- Department of Pharmacology, Tulane University School of Medicine, New Orleans, LA, USA
| | - Alexandra B Mcnally
- Department of Pharmacology, Tulane University School of Medicine, New Orleans, LA, USA
| | - Alec C Horton
- Department of Pharmacology, Tulane University School of Medicine, New Orleans, LA, USA
| | - Ariane Imulinde Sugi
- Department of Pharmacology, Tulane University School of Medicine, New Orleans, LA, USA
| | - Sarah H Lindsey
- Department of Pharmacology, Tulane University School of Medicine, New Orleans, LA, USA.
- Tulane Center of Excellence in Sex-Based Biology and Medicine, New Orleans, LA, USA.
- Tulane Brain Institute, New Orleans, LA, USA.
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Klompmaker JO, Laden F, James P, Sabath MB, Wu X, Schwartz J, Dominici F, Zanobetti A, Hart JE. Effects of long-term average temperature on cardiovascular disease hospitalizations in an American elderly population. ENVIRONMENTAL RESEARCH 2023; 216:114684. [PMID: 36334826 PMCID: PMC10236856 DOI: 10.1016/j.envres.2022.114684] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 10/05/2022] [Accepted: 10/25/2022] [Indexed: 05/05/2023]
Abstract
BACKGROUND Short-term exposure to high or low temperatures is associated with increased mortality and morbidity. Less is known about effects of long-term exposure to high or low temperatures. Prolonged exposure to high or low temperatures might contribute to pathophysiological mechanisms, thereby influencing the development of diseases. Our aim was to evaluate associations of long-term temperature exposure with cardiovascular disease (CVD) hospitalizations. METHODS We constructed an open cohort consisting of all fee-for-service Medicare beneficiaries, aged ≥65, living in the contiguous US from 2000 through 2016 (∼61.6 million individuals). We used data from the 4 km Gridded Surface Meteorological dataset to assess the summer (June-August) and winter (December-February) average daily maximum temperature for each year for each zip code. Cox-equivalent Poisson models were used to estimate associations with first CVD hospitalization, after adjustment for potential confounders. We performed stratified analyses to assess potential effect modification by sex, age, race, Medicaid eligibility and relative humidity. RESULTS Higher summer average and lower winter average temperatures were associated with an increased risk of CVD hospitalization. We found a HR of 1.068 (95% CI: 1.063, 1.074) per IQR increase (5.2 °C) for summer average temperature and a HR of 1.022 (95% CI: 1.017, 1.028) per IQR decrease (11.7 °C) for winter average temperature. Positive associations of higher summer average temperatures were strongest for individuals aged <75 years, Medicaid eligible, and White individuals. Positive associations of lower winter average temperatures were strongest for individuals aged <75 years and Black individuals, and individuals living in low relative humidity areas. CONCLUSIONS Living in areas with high summer average temperatures or low winter average temperatures could increase the risk of CVD hospitalizations. The magnitude of the associations of summer and winter average temperatures differs by demographics and relative humidity levels.
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Affiliation(s)
- Jochem O Klompmaker
- Department of Environmental Health, Harvard T. H. Chan School of Public Health, Massachusetts 02115, USA; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA 02115, USA.
| | - Francine Laden
- Department of Environmental Health, Harvard T. H. Chan School of Public Health, Massachusetts 02115, USA; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA 02115, USA; Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA 02115, USA
| | - Peter James
- Department of Environmental Health, Harvard T. H. Chan School of Public Health, Massachusetts 02115, USA; Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA 02215, USA
| | - M Benjamin Sabath
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
| | - Xiao Wu
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
| | - Joel Schwartz
- Department of Environmental Health, Harvard T. H. Chan School of Public Health, Massachusetts 02115, USA; Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA 02115, USA
| | - Francesca Dominici
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
| | - Antonella Zanobetti
- Department of Environmental Health, Harvard T. H. Chan School of Public Health, Massachusetts 02115, USA
| | - Jaime E Hart
- Department of Environmental Health, Harvard T. H. Chan School of Public Health, Massachusetts 02115, USA; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA 02115, USA
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Peng M, Shi X, Zhu L, Wang Z. Follow-up management service and health outcomes of hypertensive patients in China: A cross-sectional analysis from the national health service survey in Jiangsu province. Front Public Health 2022; 10:956711. [PMID: 35958831 PMCID: PMC9360537 DOI: 10.3389/fpubh.2022.956711] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 07/06/2022] [Indexed: 11/15/2022] Open
Abstract
Background Hypertension is a major cause of early mortality worldwide. Health follow-up management services can encourage patients with hypertension to improve their health behavior and outcomes. However, a lack of studies on the relationship between specific factors of follow-up management and both subjective and objective health outcome among hypertensive patients exists. The current study investigated the relationship between service content, frequency, mode, and institutions of follow-up management and health outcomes among Chinese hypertensives. Methods Data were obtained from the sixth National Health Service Survey (NHSS) of Jiangsu Province, which was conducted in 2018. Descriptive statistics were used to analyze the sample characteristics and the utilization of follow-up management services. Both multiple linear regression and logistic regression were used to estimate the association of follow-up management service and other factors with hypertensives' subjective and objective health outcomes. Result Some respondents (19.30%) reported hypertension, and 75.36% of these patients obtained follow-up management services. Hypertensive patients' subjective health outcome self-reported health status and objective health outcome blood pressure (BP) control were found to be significantly associated with follow-up management services. The outcomes were both significantly improved by a high frequency of management services, a high level of follow-up providers, the mode of visiting healthcare facilities and/or calling, and receiving instructions on medication use. However, inquiring about patients' symptoms was negatively associated with self-reported health status and BP control. In addition, BP measurement was significantly and positively associated with hypertensive patients' self-reported health status; the patients receiving lifestyle guidance were more likely to have their BP levels under control. Conclusions Hypertension management strategies should further focus on the frequency of healthcare follow-up management via categorization of the follow-up services and appropriate adjustment of service delivery modes to optimize health follow-up management for hypertensives further improve their outcomes. Meanwhile, complementary policies are also needed to address other socioeconomic factors that can promote good health conditions for hypertension patients.
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Affiliation(s)
- Mingyao Peng
- School of Health Policy Management, Nanjing Medical University, Nanjing, China
| | - Xinyi Shi
- School of Health Policy Management, Nanjing Medical University, Nanjing, China
| | - Lin Zhu
- School of Health Policy Management, Nanjing Medical University, Nanjing, China
| | - Zhonghua Wang
- School of Health Policy Management, Nanjing Medical University, Nanjing, China
- The Public Health Policy and Management Innovation Research Team, Nanjing Medical University, Nanjing, China
- Center for Global Health, Nanjing Medical University, Nanjing, China
- *Correspondence: Zhonghua Wang
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Prevalence and Associated Factors of Hypertension among Women in Southern Ghana: Evidence from 2014 GDHS. Int J Hypertens 2022; 2022:9700160. [PMID: 35769765 PMCID: PMC9236813 DOI: 10.1155/2022/9700160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 05/23/2022] [Accepted: 06/01/2022] [Indexed: 12/05/2022] Open
Abstract
Background Hypertension, coupled with prehypertension and other hazards such as high blood pressure, is responsible for 8·5 million deaths from stroke, ischaemic heart disease, other vascular diseases, and renal disease worldwide. Hypertension is the fifth commonest cause of outpatient morbidity in Ghana. Some evidence have illustrated geographical variation in hypertension and it seems to have a heavy toll on women in southern Ghana compared to the north. This study seeks to determine the prevalence and associatedfactors of hypertension among women in southern Ghana using the most recent demographic and health survey (DHS) data set. Materials and Methods This study used data of 5,662 women from the current DHS data from Ghana that was conducted in 2014. Data were extracted from the women's file of the 2014 Ghana DHS. The outcome variable of this current study was hypertension and it was measured by blood pressure, according to guidelines of the Joint National Committee Seven (JNC7). Multivariable binary logistic regression analyses were performed to establish the factors associated with hypertension at the individual and community levels. Results Prevalence of hypertension among women in southern Ghana was 16%. Women aged 40–44 years (aOR = 8.04, CI = 4.88–13.25) and 45–49 years (aOR = 13.20, CI = 7.96–21.89] had the highest odds of hypertension relative to women aged 15–19 years. Women with two births (aOR = 1.45, CI = 1.01–2.07) and those with three births (aOR = 1.47, CI = 1.01–2.15) had a higher likelihood of being hypertensive. Greater Accra women had higher odds (aOR = 1.35, CI = 1.02–1.79) of being hypertensive relative to the reference category, women from the Western region. Women of Guan ethnicity had a lesser likelihood (aOR = 0.54, CI = 0.29–0.98) of being hypertensive. Women who engaged in agriculture had the least likelihood (aOR = 0.72, CI = 0.52–0.99) of being classified hypertensive compared to unemployed women. Conclusion This study has revealed the prevalence of hypertension among women in southern Ghana. The associated factors include age, parity, region, and occupation. As a result, existing interventions need to be appraised in the light of these factors. Of essence is the need for Ghana Health Service to implement wide-embracing health promotion initiatives that accommodate the nutritional, exercise, and lifestyle needs of women in southern Ghana. Having more children is associated with higher propensity of hypertension and consequently, women need to limit childbearing to reduce their chances of being hypertensive. It will also be advisable for women in the Greater Accra region to have frequent hypertension screening, as women in the region exhibited higher hypertension prospects.
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Almahmoud OH, Arabiat DH, Saleh MY. Systematic review and meta-analysis: Prevalence of hypertension among adolescents in the Arab countries. J Pediatr Nurs 2022; 65:e72-e79. [PMID: 35305878 DOI: 10.1016/j.pedn.2022.03.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Revised: 02/25/2022] [Accepted: 03/07/2022] [Indexed: 10/18/2022]
Abstract
PROBLEM Hypertension (HTN) is one of the non-communicable diseases which prevalence is rising in both developed and developing countries. There is a scarcity of data on the prevalence of HTN in Arab countries. This review outlines what is currently known about prevalence and risk factors of HTN in adolescence in Arab world. ELIGIBILITY CRITERIA A systematic review and meta-analysis were conducted using PubMed, Cochrane Library, Scopus, CINAHL, Science Direct, and Google Scholar databases from 2011 to 2021. SAMPLE Fourteen studies from 9 Arab countries met inclusion criteria. Studies included a total of 777 adolescents with HTN and 2147 adolescents with pre-HTN. RESULTS The overall prevalence of HTN among adolescents in the Arab World was estimated at 12.6% (95CI 0.083-0.176), while pre-HTN was 13.9% (95CI 0.084-0205). Overweight and obesity resemble the higher risk of developing hypertension. Family history, high consumption of salt, smoking and low physical activity also increase the risk of HTN. The development of adolescent HTN can be predicted through anthropometric measurements such as Body Mass Index (BMI), wrist circumferences, and high waist circumference. CONCLUSION The prevalence of HTN among adolescents in the Arab world was significant, ranging from 4 to 26%. The heterogeneity between studies was high. IMPLICATION Local governments and policymakers must consider strengthening regulations to address environmental risk factors and improve public awareness about risk factors to HTN. A combined use of nurse- and patient targeted educational interventions could also help in reducing the burden of HTN in this population.
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Affiliation(s)
- Omar H Almahmoud
- Nursing Department, Pharmacy, Nursing and Health Professions College, Birzeit University, Palestine.
| | - Diana H Arabiat
- School of Nursing and Midwifery, Edith Cowan University, Joondalup, WA, Australia; The Centre for Evidence Informed Nursing, Midwifery and Healthcare Practice, Joondalup, WA, Australia; Maternal and Child Nursing Department, Faculty of Nursing, The University of Jordan, Amman, Jordan
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Amponsem-Boateng C, Oppong TB, Zhang W, Boakye-Yiadom J, Wang L, Acheampong K, Opolot G. Screening of hypertension, risks, knowledge/awareness in second-cycle schools in Ghana. A national cross-sectional study among students aged 12-22. J Hum Hypertens 2022; 36:405-415. [PMID: 33790406 DOI: 10.1038/s41371-021-00502-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
In Ghana, the management of hypertension in primary health care is a cost-effective way of addressing premature deaths from vascular disorders that include hypertension. There is little or no evidence of large-scale studies on the prevalence, risk, and knowledge/awareness of hypertension in students aged 12-22 years in Ghana. In a cross-sectional study, blood pressure, anthropometric indices, and knowledge/awareness assessment of students at second-cycle schools were recorded from 2018 to 2020 in three regions of Ghana. Multistage cluster sampling was used in selecting regions and the schools. Prevalence of prehypertension and hypertension was categorized by the Joint National Committee 7, where appropriate, chi-square, scatter plots, and correlations were used in showing associations. A total of 3165 students comprising 1776 (56.1%) females and 1389 (43.9%) males participated in this study within three regions of Ghana. The minimum age was 12 years and the maximum age was 22 years. The mean age was 17.21 with standard deviation (SD: 1.59) years. A 95% confidence interval was set for estimations and a P value < 0.05 was set as significant. The prevalence rate of overall hypertension was 19.91% and elevated (prehypertension) was 26.07%. Risk indicators such as weight, BMI, waist circumference, physical activity, and form of the diet were positively correlated with hypertension. Among Ghanaian students currently in second-cycle educational institutions, 19.91% were hypertensive and 26.07% were prehypertensive. This may indicate a probable high prevalence of hypertension in the future adult population if measures are not taken to curb the associated risks.
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Affiliation(s)
- Cecilia Amponsem-Boateng
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, PR China
| | - Timothy Bonney Oppong
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, PR China
| | - Weidong Zhang
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, PR China.
| | | | - Lianke Wang
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, PR China
| | - Kwabena Acheampong
- Department of Epidemiology and Health Statistics, Central South University, Changsha, PR China
| | - Godfrey Opolot
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, PR China
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Delabays B, Cavassini M, Damas J, Beuret H, Calmy A, Hasse B, Bucher HC, Frischknecht M, Müller O, Méan M, Vollenweider P, Marques-Vidal P, Vaucher J. Cardiovascular risk assessment in people living with HIV compared to the general population. Eur J Prev Cardiol 2021; 29:689-699. [PMID: 34893801 DOI: 10.1093/eurjpc/zwab201] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 11/02/2021] [Accepted: 11/12/2021] [Indexed: 12/16/2022]
Abstract
AIMS We prospectively assessed and compared the accuracy of cardiovascular risk scores in people living with HIV (PLWH) and individuals from the general population. METHODS AND RESULTS The Systematic Coronary Risk Evaluation Score 2 (SCORE2), the Pooled Cohort Equations (PCE), and the HIV-specific Data Collection on Adverse events of Anti-HIV Drugs (D:A:D) score were calculated in participants free from atherosclerotic cardiovascular disease (ASCVD) between 2003 and 2009. In total, 6373 [mean age, 40.6 years (SD, 9.9)] PLWH from the Swiss HIV Cohort Study (SHCS) and 5403 [52.8 years (SD, 10.7)] individuals from the CoLaus|PsyCoLaus study were eligible for analysis. We tested discrimination and calibration, and the value of adding HIV-specific factors to scores using the net reclassification improvement (NRI). During mean follow-ups of 13.5 (SD, 4.1) in SHCS and 9.9 (SD, 2.3) years in CoLaus|PsyCoLaus study, 533 (8.4%) and 374 (6.9%) people developed an incident ASCVD, respectively. This translated into age-adjusted incidence rates of 12.9 and 7.5 per 1000 person-year, respectively. In SHCS, SCORE2, PCE, and D:A:D presented comparable discriminative capacities [area under the receiver operating characteristic curve of 0.745 (95% confidence interval, CI, 0.723-0.767), 0.757 (95% CI, 0.736-0.777), and 0.763 (95% CI, 0.743-0.783)]. Adding HIV-specific variables (CD4 nadir and abacavir exposure) to SCORE2 and PCE resulted in an NRI of -0.1% (95% CI, -1.24 to 1, P = 0.83) and of 2.7% (95% CI, 0.3-5.1, P = 0.03), respectively. CONCLUSIONS PLWH present a two-fold higher rate of incident ASCVD compared to individuals from the general population. SCORE2 and PCE, which are clinically easier to use (reduced set of variables without adding HIV-specific factors), are valid to predict ASCVD in PLWH.
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Affiliation(s)
- Benoît Delabays
- Division of Internal Medicine, Department of Medicine, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 46, 1011 Lausanne, Switzerland
| | - Matthias Cavassini
- Division of Infectious Diseases, Department of Medicine, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 46, 1011 Lausanne, Switzerland
| | - Jose Damas
- Division of Infectious Diseases, Department of Medicine, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 46, 1011 Lausanne, Switzerland
| | - Hadrien Beuret
- Division of Internal Medicine, Department of Medicine, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 46, 1011 Lausanne, Switzerland
| | - Alexandra Calmy
- Division of Infectious Diseases, Department of Medicine, Geneva University Hospital, Rue Gabrielle-Perret-Gentil 4, 1205 Geneva, Switzerland
| | - Barbara Hasse
- Department of Infectious Diseases and Hospital Epidemiology, Zürich University Hospital, Rämistrasse 100, 8091 Zürich, Switzerland
| | - Heiner C Bucher
- Basel Institute for Clinical Epidemiology & Biostatistics, Basel University Hospital, Spitalstrasse 12, 4031 Basel, Switzerland
| | - Manuel Frischknecht
- Division of Infectious Diseases and Hospital Epidemiology, Department of Internal Medicine, Cantonal Hospital St. Gallen, Rorschacher Strasse 95, 9007 St. Gallen, Switzerland
| | - Olivier Müller
- Division of Cardiology, Heart and Vessel Department, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 46, 1011 Lausanne, Switzerland
| | - Marie Méan
- Division of Internal Medicine, Department of Medicine, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 46, 1011 Lausanne, Switzerland
| | - Peter Vollenweider
- Division of Internal Medicine, Department of Medicine, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 46, 1011 Lausanne, Switzerland
| | - Pedro Marques-Vidal
- Division of Internal Medicine, Department of Medicine, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 46, 1011 Lausanne, Switzerland
| | - Julien Vaucher
- Division of Internal Medicine, Department of Medicine, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 46, 1011 Lausanne, Switzerland
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Niederseer D, Schmied C. Socioeconomic status matters: How can we individualize cardiac rehabilitation according to different socioeconomic needs? Eur J Prev Cardiol 2021; 28:510-512. [PMID: 32484046 DOI: 10.1177/2047487320931309] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- David Niederseer
- Department of Cardiology, University Heart Center Zurich, University of Zurich, University Hospital Zurich, Switzerland
| | - Christian Schmied
- Department of Cardiology, University Heart Center Zurich, University of Zurich, University Hospital Zurich, Switzerland
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Neufcourt L, Grimaud O. Response to invited editorial ‘What can be learnt from an atypical population?’. Eur J Prev Cardiol 2020; 27:999-1000. [DOI: 10.1177/2047487319864189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Lola Neufcourt
- Univ Rennes, EHESP, REPERES (Recherche en pharmaco-épidémiologie et recours aux soins), France
| | - Olivier Grimaud
- Univ Rennes, EHESP, REPERES (Recherche en pharmaco-épidémiologie et recours aux soins), France
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Gender differences in the association between socioeconomic status and hypertension in France: A cross-sectional analysis of the CONSTANCES cohort. PLoS One 2020; 15:e0231878. [PMID: 32311000 PMCID: PMC7170232 DOI: 10.1371/journal.pone.0231878] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 04/02/2020] [Indexed: 12/12/2022] Open
Abstract
Background Hypertension prevalence increases when socioeconomic status decreases but gender differences in the relationship between socioeconomic status and hypertension have been less studied. This work aimed to explore the pattern of associations between three indicators of socioeconomic status at individual, household, and municipal levels with hypertension across genders in a large sample of French adults from the CONSTANCES cohort. Methods Using data at inclusion from 59 805 participants (52% women) aged 25–69 years and recruited between 2012 and 2015, multilevel log-Poisson regressions with robust variance estimates were used to assess the associations of Relative Index of Inequality in education, monthly income per consumption unit and residential deprivation with hypertension. Modifying effects of gender and age in those associations were tested. Results Hypertension prevalence was higher in men than in women. Steep socioeconomic gradients of hypertension were observed for the three socioeconomic indicators in both genders and from the youngest to the oldest age class. Socioeconomic inequalities, especially educational inequalities, were larger among women than men: Relative Index of Inequality for highest versus lowest education among the 25–34 years were 0.43 [95%-confidence interval = 0.28–0.67] in women and 0.70 [95%-confidence interval = 0.53–0.92] in men. With increasing age, socioeconomic gradients of hypertension eased in men and even more in women so that gender differences decreased. Conclusions In this cross-sectional analysis of a large sample of adults, prevalence of hypertension was higher in men than in women. Moreover, socioeconomic status and especially education displayed a stronger association with hypertension prevalence in women compared to men. Reducing inequalities in hypertension may require gender-specific approaches.
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