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Islam H, Ladak Z, Patel A, Lo DF. Assessing cardiovascular benefits of beetroot juice and exercise in women planning to conceive. J Hypertens 2024; 42:1282. [PMID: 38818840 DOI: 10.1097/hjh.0000000000003660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2024]
Affiliation(s)
- Hamidul Islam
- Department of Medicine, Rowan University School of Osteopathic Medicine
| | - Zarif Ladak
- Department of Medicine, Rowan University School of Osteopathic Medicine
| | - Aarsh Patel
- Department of Medicine, Rowan University School of Osteopathic Medicine
| | - David F Lo
- Department of Medicine, Rowan University School of Osteopathic Medicine
- American Preventive Screening & Education Association (APSEA), Stratford
- Department of Biology, Rutgers, the State University of New Jersey
- Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
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Osman MMA, Mullins E, Lees C. Assessing cardiovascular benefits of beetroot juice and exercise in women planning to conceive: reply to correspondence. J Hypertens 2024; 42:1287. [PMID: 38818843 DOI: 10.1097/hjh.0000000000003734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2024]
Affiliation(s)
| | - Edward Mullins
- Department of Metabolism, Digestion and Reproduction, Imperial College London
- The George Institute for Global Health, London, UK
| | - Christoph Lees
- Department of Metabolism, Digestion and Reproduction, Imperial College London
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Vallée A. The impact of the COVID-19 pandemic on the socioeconomic gradient of hypertension. J Public Health Policy 2024:10.1057/s41271-024-00491-4. [PMID: 38831023 DOI: 10.1057/s41271-024-00491-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/22/2024] [Indexed: 06/05/2024]
Abstract
The COVID-19 pandemic has brought into sharp focus the impact of socioeconomic factors on hypertension outcomes. This review examines the implications of the pandemic on the socioeconomic gradient of hypertension and explores the physiological and pathophysiological processes underlying this relationship. Changes in socioeconomic factors have disproportionately affected individuals with lower socioeconomic status, leading to adverse hypertension outcomes. The pandemic-related stressors, coupled with social isolation and disrupted daily routines, have contributed to elevated stress levels among individuals, particularly those with lower socioeconomic status. Equitable access to healthcare, enhancing health literacy and patient empowerment, and addressing social determinants of health are essential components of hypertension management strategies. By recognizing the specific challenges faced by individuals with lower socioeconomic status and implementing targeted interventions, public health efforts can help reduce the socioeconomic gradient of hypertension.
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Affiliation(s)
- Alexandre Vallée
- Department of Epidemiology and Public Health, Foch Hospital, 92150, Suresnes, France.
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Caceres BA, Sharma Y, Levine A, Wall MM, Hughes TL. Investigating the Associations of Sexual Minority Stressors and Incident Hypertension in a Community Sample of Sexual Minority Adults. Ann Behav Med 2023; 57:1004-1013. [PMID: 37306778 PMCID: PMC10653588 DOI: 10.1093/abm/kaac073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023] Open
Abstract
BACKGROUND Sexual minority adults are at higher risk of hypertension than their heterosexual counterparts. Sexual minority stressors (i.e., unique stressors attributed to sexual minority identity) are associated with a variety of poor mental and physical health outcomes. Previous research has not tested associations between sexual minority stressors and incident hypertension among sexual minority adults. PURPOSE To examine the associations between sexual minority stressors and incident hypertension among sexual minority adults assigned female sex at birth. METHODS Using data from a longitudinal study, we examined associations between three sexual minority stressors and self-reported hypertension. We ran multiple logistic regression models to estimate the associations between sexual minority stressors and hypertension. We conducted exploratory analyses to determine whether these associations differed by race/ethnicity and sexual identity (e.g., lesbian/gay vs. bisexual). RESULTS The sample included 380 adults, mean age 38.4 (± 12.81) years. Approximately 54.5% were people of color and 93.9% were female-identified. Mean follow-up was 7.0 (± 0.6) years; during which 12.4% were diagnosed with hypertension. We found that a 1-standard deviation increase in internalized homophobia was associated with higher odds of developing hypertension (AOR 1.48, 95% Cl: 1.06-2.07). Stigma consciousness (AOR 0.85, 95% CI: 0.56-1.26) and experiences of discrimination (AOR 1.07, 95% CI: 0.72-1.52) were not associated with hypertension. The associations of sexual minority stressors with hypertension did not differ by race/ethnicity or sexual identity. CONCLUSIONS This is the first study to examine the associations between sexual minority stressors and incident hypertension in sexual minority adults. Implications for future studies are highlighted.
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Affiliation(s)
- Billy A Caceres
- Columbia University School of Nursing, 560 West 168th Street, Room 603, New York, NY 10032, USA
- Center for Sexual and Gender Minority Health Research, Columbia University School of Nursing, 560 West 168th Street, New York, NY 10032, USA
| | - Yashika Sharma
- Columbia University School of Nursing, 560 West 168th Street, Room 603, New York, NY 10032, USA
- Center for Sexual and Gender Minority Health Research, Columbia University School of Nursing, 560 West 168th Street, New York, NY 10032, USA
| | - Alina Levine
- Department of Biostatistics, Columbia Mailman School of Public Health, 722 West 168th Street, New York, NY 10032, USA
| | - Melanie M Wall
- Department of Biostatistics, Columbia Mailman School of Public Health, 722 West 168th Street, New York, NY 10032, USA
| | - Tonda L Hughes
- Columbia University School of Nursing, 560 West 168th Street, Room 603, New York, NY 10032, USA
- Center for Sexual and Gender Minority Health Research, Columbia University School of Nursing, 560 West 168th Street, New York, NY 10032, USA
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Wright L, Staatz CB, Silverwood RJ, Bann D. Trends in the ability of socioeconomic position to predict individual body mass index: an analysis of repeated cross-sectional data, 1991-2019. BMC Med 2023; 21:434. [PMID: 37957618 PMCID: PMC10644438 DOI: 10.1186/s12916-023-03103-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 10/04/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND The widening of group-level socioeconomic differences in body mass index (BMI) has received considerable research attention. However, the predictive power of socioeconomic position (SEP) indicators at the individual level remains uncertain, as does the potential temporal variation in their predictive value. Examining this is important given the increasing incorporation of SEP indicators into predictive algorithms and calls to reduce social inequality to tackle the obesity epidemic. We thus investigated SEP differences in BMI over three decades of the obesity epidemic in England, comparing population-wide (SEP group differences in mean BMI) and individual-level (out-of-sample prediction of individuals' BMI) approaches to understanding social inequalities. METHODS We used repeated cross-sectional data from the Health Survey for England, 1991-2019. BMI (kg/m2) was measured objectively, and SEP was measured via educational attainment, occupational class, and neighbourhood index of deprivation. We ran random forest models for each survey year and measure of SEP adjusting for age and sex. RESULTS The mean and variance of BMI increased within each SEP group over the study period. Mean differences in BMI by SEP group also increased: differences between lowest and highest education groups were 1.0 kg/m2 (0.4, 1.6) in 1991 and 1.3 kg/m2 (0.7, 1.8) in 2019. At the individual level, the predictive capacity of SEP was low, though increased in later years: including education in models improved predictive accuracy (mean absolute error) by 0.14% (- 0.9, 1.08) in 1991 and 1.05% (0.18, 1.82) in 2019. Similar patterns were obtained for occupational class and neighbourhood deprivation and when analysing obesity as an outcome. CONCLUSIONS SEP has become increasingly important at the population (group difference) and individual (prediction) levels. However, predictive ability remains low, suggesting limited utility of including SEP in prediction algorithms. Assuming links are causal, abolishing SEP differences in BMI could have a large effect on population health but would neither reverse the obesity epidemic nor reduce much of the variation in BMI.
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Affiliation(s)
- Liam Wright
- Centre for Longitudinal Studies, Social Research Institute, University College London, 55-59 Gordon Square, London, WC1H 0NT, UK.
| | - Charis Bridger Staatz
- Centre for Longitudinal Studies, Social Research Institute, University College London, 55-59 Gordon Square, London, WC1H 0NT, UK
| | - Richard J Silverwood
- Centre for Longitudinal Studies, Social Research Institute, University College London, 55-59 Gordon Square, London, WC1H 0NT, UK
| | - David Bann
- Centre for Longitudinal Studies, Social Research Institute, University College London, 55-59 Gordon Square, London, WC1H 0NT, UK
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Öhlin J, Liv P, Andersson M, Järvholm B, Slunga Järvholm L, Stjernbrandt A, Wahlström V. Occupational physical activity and resting blood pressure in male construction workers. Int Arch Occup Environ Health 2023; 96:1283-1289. [PMID: 37725195 PMCID: PMC10560137 DOI: 10.1007/s00420-023-02006-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 09/01/2023] [Indexed: 09/21/2023]
Abstract
OBJECTIVE This study investigated the association between occupational physical activity (OPA) and resting blood pressure in a cohort of Swedish construction workers. METHODS The final sample included 241,176 male construction workers. Occupations with low OPA were foremen and white-collar workers. The most frequent occupations in the medium OPA group were electricians, pipe workers, and machine operators, and in the high OPA group woodworkers, concrete workers, and painters. RESULTS Mixed effects models showed higher systolic and lower diastolic blood pressure with higher OPA, but the associations varied depending on the year of participation and participant age as shown by significant interaction terms (OPA*age, OPA*calendar year, age*calendar year). Age-stratified linear regression analyses showed a pattern of slightly higher systolic (1.49, 95% confidence interval: 1.08-1.90 mmHg) and lower diastolic (0.89, 95% confidence interval: 0.65-1.13 mmHg) blood pressure when comparing low with high OPA, but not among the oldest age groups. CONCLUSION Despite a rather large contrast in OPA, the differences in systolic and diastolic blood pressure according to OPA were small.
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Affiliation(s)
- Jerry Öhlin
- Section of Sustainable Health, Department of Public Health and Clinical Medicine, Umeå University, 901 87, Umeå, Sweden.
| | - Per Liv
- Section of Sustainable Health, Department of Public Health and Clinical Medicine, Umeå University, 901 87, Umeå, Sweden
| | - Martin Andersson
- Section of Sustainable Health, Department of Public Health and Clinical Medicine, Umeå University, 901 87, Umeå, Sweden
| | - Bengt Järvholm
- Section of Sustainable Health, Department of Public Health and Clinical Medicine, Umeå University, 901 87, Umeå, Sweden
| | - Lisbeth Slunga Järvholm
- Section of Sustainable Health, Department of Public Health and Clinical Medicine, Umeå University, 901 87, Umeå, Sweden
| | - Albin Stjernbrandt
- Section of Sustainable Health, Department of Public Health and Clinical Medicine, Umeå University, 901 87, Umeå, Sweden
| | - Viktoria Wahlström
- Section of Sustainable Health, Department of Public Health and Clinical Medicine, Umeå University, 901 87, Umeå, Sweden
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7
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Chan KY, Srivastava N, Wang Z, Xia X, Huang Z, Poon AN, Reidpath DD. A systematic review and meta-analysis of the effectiveness of hypertension interventions in faith-based organisation settings. J Glob Health 2023; 13:04075. [PMID: 37830137 PMCID: PMC10570758 DOI: 10.7189/jogh.13.04075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2023] Open
Abstract
Background Hypertension is the global, leading cause of mortality and is the main risk factor for cardiovascular disease. Community-based partnerships can provide cost-saving ways of delivering effective blood pressure (BP) interventions to people in resource-poor settings. Faith-based organisations (FBOs) prove important potential health partners, given their reach and community standing. This potential is especially strong in hard-to-reach, socio-economically marginalised communities. This systematic review explores the state of the evidence of FBO-based interventions on BP management, with a focus on randomised controlled trials (RCTs) and cluster RCTs (C-RCTs). Methods Seven academic databases (English = 5, Chinese = 2) and grey literature were searched for C-/RCTs of community-based interventions in FBO settings. Only studies with pre- and post-intervention BP measures were kept for analysis. Random effects models were developed using restricted maximum likelihood estimation (REML) to estimate the population average mean change and 95% confidence interval (CI) of both systolic and diastolic blood pressure (SBP and DBP). The overall heterogeneity was assessed by successively adding studies and recording changes in heterogeneity. Prediction intervals were generated to capture the spread of the pooled effect across study settings. Results Of the 19 055 titles identified, only 11 studies of fair to good quality were kept for meta-analysis. Non-significant, average mean differences between baseline and follow-up for the intervention and control groups were found for both SBP (0.78 mm of mercury (mmHg) (95% CI = 2.11-0.55)) and DBP (-0.20 mm Hg (95% CI = -1.16 to 0.75)). Subgroup analysis revealed a significant reduction in SBP of -6.23 mm Hg (95% CI = -11.21 to -1.25) for populations with mean baseline SBP of ≥140 mm Hg. Conclusions The results support the potential of FBO-based interventions in lowering SBP in clinically hypertensive populations. However, the limited evidence was concentrated primarily in Christian communities in the US More research is needed to understand the implications of such interventions in producing clinically meaningful long-term effects in a variety of settings. Further research can illuminate factors that affect success and potential expansion to sites outside the US as well as non-Christian FBOs. Current evidence is inadequate to evaluate the potential of FBO-based interventions in preventing hypertension in non-hypertensive populations. Intervention effects in non-hypertensive population might be better reflected through intermediate outcomes.
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Affiliation(s)
- Kit Yee Chan
- Centre for Global Health, Usher Institute, University of Edinburgh, Edinburgh, UK
- School of Social Sciences, Monash University, Clayton, Victoria, Australia
| | - Noori Srivastava
- Department of Medicine, School of Medicine & Health Sciences, George Washington University, Washington DC, USA
| | - Zhicheng Wang
- China Development Research Foundation, Beijing, China
| | - Xiaoqian Xia
- London School of Hygiene & Tropical Medicine, London, UK
| | - Zhangziyue Huang
- Milken Institute School of Public Health, George Washington University, Washington DC, USA
| | - Adrienne N Poon
- Department of Medicine, School of Medicine & Health Sciences, George Washington University, Washington DC, USA
| | - Daniel D Reidpath
- School of Social Sciences, Monash University, Clayton, Victoria, Australia
- Institute for Global Health and Development, Queen Margaret University, Edinburgh, UK
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Sharma SK, Joseph J, D HS, Nambiar D. Assessing inequalities in publicly funded health insurance scheme coverage and out-of-pocket expenditure for hospitalization: findings from a household survey in Kerala. Int J Equity Health 2023; 22:197. [PMID: 37759247 PMCID: PMC10537906 DOI: 10.1186/s12939-023-02005-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 09/05/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND Increasing financial risk protection is a key feature of Universal Health Coverage and the path towards health for all. Publicly Funded Health Insurance Schemes (PFHIS) have been considered as one of the pathways to safeguard against financial shocks and potentially reduce Out-of-Pocket Expenditure (OOPE). The south Indian state of Kerala has roughly a decade-long experience in implementing PFHIS. To date, there have been very few assessments of the coverage of these schemes and their impact on expenditure. Aiming to fill this gap, we explored the extent of and inequalities in insurance coverage, as well as choice of providers, and median cost of hospitalization in Kerala among insured and uninsured individuals. METHODS A cross-sectional household survey was conducted in four districts of Kerala as part of a larger health systems research study from July-October 2019. We employed multistage random sampling to collect data from 13,064 individuals covering 3234 households in the catchment area of eight primary health care facilities. We used descriptive statistics, bivariate and multivariate analysis. We evaluated socioeconomic disparities using an absolute measure of inequality-the Slope Index of Inequality (SII) and a relative measure-the Relative Concentration Index (RCI). RESULTS A substantial proportion of our study respondents reported that they were covered by PFHIS (45.8%). Respondents belonging to lowest and middle wealth quintiles of household had significantly greater odds of being covered by insurance than respondents belonging to the richest wealth quintile. The negative magnitude of RCI [-16.8% (95%CI: -25.3, -8.4)] and SII [-21.5% (95%CI: -36.1, -7.0)] suggest a higher concentration of PFHIS coverage among the poor. Median OOPE for hospitalisation at private health facilities was INR 9000 (approx. USD 108.70) among those covered by PFHIS, whereas it was INR 10500 (approx. USD 126.82) at private health facilities among those not covered by insurance. CONCLUSION While PFHIS seems to be appropriately targeting poorer populations, among the insured, OOPE for hospitalization persists. Among the uninsured, population subgroups with advantage are spending the greatest amount, raising questions about whether those facing relative disadvantage are forgoing care altogether or seeking care using cheaper, public avenues. Further policy action to more effectively reduce financial burden among left behind eligible populations under PFHIS will be essential to UHC progress in the state.
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Affiliation(s)
| | - Jaison Joseph
- The George Institute for Global Health, New Delhi, India.
| | - Hari Sankar D
- The George Institute for Global Health, New Delhi, India
| | - Devaki Nambiar
- The George Institute for Global Health, New Delhi, India
- Faculty of Medicine, University of New South Wales, Sydney, Australia
- Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India
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Sharma SK, Nambiar D, Joseph J. Hidden educational inequalities in high blood pressure and high blood glucose levels in Kerala: evidence from the National Family Health Survey (2019-2021). BMJ Open 2023; 13:e068553. [PMID: 37015784 PMCID: PMC10083770 DOI: 10.1136/bmjopen-2022-068553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/06/2023] Open
Abstract
OBJECTIVE This study assesses educational inequalities in measured as well as self-reported high blood pressure (BP) and high blood glucose (BG) in the southern Indian state of Kerala, which is known to have high chronic disease morbidity. DESIGN The present findings are drawn from a large-scale, nationally representative cross-sectional study. SETTINGS AND PARTICIPANTS India's Demographic and Health Survey (conducted in 2019-2021) had data on 36 526 individuals aged 15 years and above in the state of Kerala, India. PRIMARY AND SECONDARY OUTCOMES MEASURES Measured high BP and BG; self-reported high BP and BG; as well as self-reported BP and BG testing. Descriptive statistics, bivariate analysis, along with multivariate statistics, were used. Educational inequalities were assessed through absolute and relative complex measures of inequality, namely the Slope Index of Inequality (SII) and Relative Concentration Index (RCI), respectively, with 95% CIs. RESULTS The largest margin of inequality in Kerala, between the least and the most educated groups, was observed for measured high BP (57.7% and 17.6%). Measured high BP (SII -45.4% (95% CI -47.3% to -43.4%); RCI -26.6% (95% CI -27.9% to -25.3%)), self-reported high BP (SII -34.5% (95% CI -36.3% to -32.7%); RCI -19.0% (95% CI -20.1% to -17.9%)). High BG levels were concentrated among those with lower educational attainment (SII -26.6% (95% CI -28.6% to -24.7%); RCI -15.7% (95% CI -16.9% to -14.5%)), represented by negative SII and RCI values. CONCLUSIONS The study findings suggest that research and programme efforts need to be redoubled to determine what is driving greater vulnerability to non-communicable diseases among population with lower educational attainment on the one hand and the possible role that improving education access can be on health outcomes, on the other hand. Further research should explore relevant intersections with low education.
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Affiliation(s)
- Santosh Kumar Sharma
- Healthier Societies, The George Institute for Global Health India, New Delhi, Delhi, India
| | - Devaki Nambiar
- Healthier Societies, The George Institute for Global Health India, New Delhi, Delhi, India
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
- Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India
| | - Jaison Joseph
- Healthier Societies, The George Institute for Global Health India, New Delhi, Delhi, India
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Ma H, Liu F, Li J, Chen J, Cao J, Chen S, Liu X, Yang X, Huang K, Shen C, Yu L, Zhao Y, Wu X, Zhao L, Li Y, Hu D, Huang J, Lu X, Gu D. Sex Differences in Associations Between Socioeconomic Status and Incident Hypertension Among Chinese Adults. Hypertension 2023; 80:783-791. [PMID: 36695186 DOI: 10.1161/hypertensionaha.122.20061] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND With rapid socioeconomic development and transition, associations between socioeconomic status (SES) and hypertension remained uncertain in China. We aimed to examine the health effects of SES on hypertension incidence and explore the sex differences among Chinese adults. METHODS We included 53 891 participants without hypertension from the China-PAR (Prediction for Atherosclerotic Cardiovascular Disease Risk in China) project. SES was evaluated by education level, occupation prestige, and household monthly per capita income, and categorized into low, medium, and high groups. Hazard ratios and their 95% CIs were calculated using Cox proportional hazards regression models. RESULTS Compared with high SES, participants with medium SES (hazard ratio, 1.142 [95% CI, 1.068-1.220]) or low SES (hazard ratio, 1.166 [95% CI, 1.096-1.241]) had increased risks of incident hypertension in multivariate analyses. Interactions between SES and sex on hypertension were observed, with more pronounced adverse effects of lower SES among women. The corresponding hazard ratios (95% CIs) for low SES group were 1.270 (1.155-1.397) for women and 1.086 (0.999-1.181) for men. Effects of occupation prestige on hypertension were the strongest among SES factors. CONCLUSIONS Our study provided the compelling evidence from China that lower SES was associated with incident hypertension and women were more susceptible. These findings will have substantial implications on future hypertension prevention and management, especially among women. Sex-specific approaches are warranted to reduce socioeconomic disparities.
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Affiliation(s)
- Han Ma
- Department of Epidemiology, Key Laboratory of Cardiovascular Epidemiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China (H.M., F.L., J.L., J. Chen, J. Cao, S.C., K.H., L.Z., Y.L., J.H., X. Lu, D.G.)
| | - Fangchao Liu
- Department of Epidemiology, Key Laboratory of Cardiovascular Epidemiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China (H.M., F.L., J.L., J. Chen, J. Cao, S.C., K.H., L.Z., Y.L., J.H., X. Lu, D.G.)
| | - Jianxin Li
- Department of Epidemiology, Key Laboratory of Cardiovascular Epidemiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China (H.M., F.L., J.L., J. Chen, J. Cao, S.C., K.H., L.Z., Y.L., J.H., X. Lu, D.G.)
| | - Jichun Chen
- Department of Epidemiology, Key Laboratory of Cardiovascular Epidemiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China (H.M., F.L., J.L., J. Chen, J. Cao, S.C., K.H., L.Z., Y.L., J.H., X. Lu, D.G.)
| | - Jie Cao
- Department of Epidemiology, Key Laboratory of Cardiovascular Epidemiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China (H.M., F.L., J.L., J. Chen, J. Cao, S.C., K.H., L.Z., Y.L., J.H., X. Lu, D.G.)
| | - Shufeng Chen
- Department of Epidemiology, Key Laboratory of Cardiovascular Epidemiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China (H.M., F.L., J.L., J. Chen, J. Cao, S.C., K.H., L.Z., Y.L., J.H., X. Lu, D.G.)
| | - Xiaoqing Liu
- Division of Epidemiology, Guangdong Provincial People's Hospital and Cardiovascular Institute, Guangzhou, China (X. Liu)
| | - Xueli Yang
- Department of Occupational and Environmental Health, School of Public Health, Tianjin Medical University, Tianjin, China (X.Y.)
| | - Keyong Huang
- Department of Epidemiology, Key Laboratory of Cardiovascular Epidemiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China (H.M., F.L., J.L., J. Chen, J. Cao, S.C., K.H., L.Z., Y.L., J.H., X. Lu, D.G.)
| | - Chong Shen
- Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing, China (C.S.)
| | - Ling Yu
- Department of Cardiology, Fujian Provincial Hospital, Fuzhou, China (L.Y.)
| | - Yingxin Zhao
- Cardio-Cerebrovascular Control and Research Center, Institute of Basic Medicine, Shandong Academy of Medical Sciences, Jinan, China (Y.Z.)
| | - Xianping Wu
- Center for Chronic and Noncommunicable Disease Control and Prevention, Sichuan Center for Disease Control and Prevention, Chengdu, China (X.W.)
| | - Liancheng Zhao
- Department of Epidemiology, Key Laboratory of Cardiovascular Epidemiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China (H.M., F.L., J.L., J. Chen, J. Cao, S.C., K.H., L.Z., Y.L., J.H., X. Lu, D.G.)
| | - Ying Li
- Department of Epidemiology, Key Laboratory of Cardiovascular Epidemiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China (H.M., F.L., J.L., J. Chen, J. Cao, S.C., K.H., L.Z., Y.L., J.H., X. Lu, D.G.)
| | - Dongsheng Hu
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, China (D.H.).,Department of Biostatistics and Epidemiology, School of Public Health, Shenzhen University Health Science Center, Shenzhen, China (D.H.)
| | - Jianfeng Huang
- Department of Epidemiology, Key Laboratory of Cardiovascular Epidemiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China (H.M., F.L., J.L., J. Chen, J. Cao, S.C., K.H., L.Z., Y.L., J.H., X. Lu, D.G.)
| | - Xiangfeng Lu
- Department of Epidemiology, Key Laboratory of Cardiovascular Epidemiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China (H.M., F.L., J.L., J. Chen, J. Cao, S.C., K.H., L.Z., Y.L., J.H., X. Lu, D.G.)
| | - Dongfeng Gu
- Department of Epidemiology, Key Laboratory of Cardiovascular Epidemiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China (H.M., F.L., J.L., J. Chen, J. Cao, S.C., K.H., L.Z., Y.L., J.H., X. Lu, D.G.).,School of Public Health and Emergency Management, School of Medicine, Southern University of Science and Technology, Shenzhen, China (D.G.)
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Donfrancesco C, Di Lonardo A, Lo Noce C, Buttari B, Profumo E, Vespasiano F, Vannucchi S, Galletti F, Onder G, Gulizia MM, Galeone D, Bellisario P, Palmieri L. Trends of blood pressure, raised blood pressure, hypertension and its control among Italian adults: CUORE Project cross-sectional health examination surveys 1998/2008/2018. BMJ Open 2022; 12:e064270. [PMID: 36375969 PMCID: PMC9664280 DOI: 10.1136/bmjopen-2022-064270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES To assess in the Italian general adult population the trends of blood pressure (BP) and prevalence of raised BP (RBP), hypertension and its control in order to evaluate population health and care, and the achievement of an RBP 25% relative reduction as recommended by the WHO at population level. DESIGN Results comparison of health examination surveys, cross-sectional observational studies based on health examination of randomly selected age and sex stratified samples including residents aged 35-74 years. Data of the 2018/2019 survey were compared with the previous ones collected in 1998/2002 and 2008/2012. SETTING Health examination surveys conducted in Italy within the CUORE Project following standardised methodologies. PARTICIPANTS 2985 men and 2955 women examined in 1998/2002, 2218 men and 2204 women examined in 2008/2012 and 1031 men and 1066 women examined in 2018/2019. PRIMARY AND SECONDARY OUTCOME MEASURES Age-standardised mean of BP, prevalence of RBP (systolic BP and/or diastolic BP ≥140/90 mm Hg), hypertension (presenting or being treated for RBP) and its awareness and control, according to sex, age class and educational level. RESULTS In 2018/2019, a significant reduction was observed in systolic BP and diastolic BP in men (1998/2002: 136/86 mm Hg; 2008/2012: 132/84 mm Hg; and 2018/2019: 132/78 mm Hg) and women (132/82 mm Hg, 126/78 mm Hg and 122/73 mm Hg), and in the prevalence of RBP (50%, 40% and 30% in men and 39%, 25% and 16% in women) and of hypertension (54%, 49% and 44% in men and 45%, 35% and 32% in women). Trends were consistent by age and education attainment. In 2018/2019, hypertensive men and women with controlled BP were only 27% and 41%, but a significant favourable trend was observed. CONCLUSIONS Data from 2018/2019 underlined that RBP is still commonly observed in the Italian population aged 35-74 years, however, the WHO RBP target at that time may be considered met.
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Affiliation(s)
- Chiara Donfrancesco
- Department of Cardiovascular, Endocrine-Metabolic Diseases and Aging, Istituto Superiore di Sanita', Rome, Italy
| | - Anna Di Lonardo
- Department of Cardiovascular, Endocrine-Metabolic Diseases and Aging, Istituto Superiore di Sanita', Rome, Italy
| | - Cinzia Lo Noce
- Department of Cardiovascular, Endocrine-Metabolic Diseases and Aging, Istituto Superiore di Sanita', Rome, Italy
| | - Brigitta Buttari
- Department of Cardiovascular, Endocrine-Metabolic Diseases and Aging, Istituto Superiore di Sanita', Rome, Italy
| | - Elisabetta Profumo
- Department of Cardiovascular, Endocrine-Metabolic Diseases and Aging, Istituto Superiore di Sanita', Rome, Italy
| | | | - Serena Vannucchi
- Department of Cardiovascular, Endocrine-Metabolic Diseases and Aging, Istituto Superiore di Sanita', Rome, Italy
| | - Ferruccio Galletti
- Department of Clinical Medicine and Surgery, Federico II University, Napoli, Italy
| | - Graziano Onder
- Department of Cardiovascular, Endocrine-Metabolic Diseases and Aging, Istituto Superiore di Sanita', Rome, Italy
| | - Michele Massimo Gulizia
- National Enterprise of National Relevance and High Specialization 'Garibaldi-Nesima Hospital', Catania, Italy
- Heart Care Foundation, Florence, Italy
| | | | | | - Luigi Palmieri
- Department of Cardiovascular, Endocrine-Metabolic Diseases and Aging, Istituto Superiore di Sanita', Rome, Italy
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Liefke J, Steding-Ehrenborg K, Sjöberg P, Ryd D, Morsing E, Arheden H, Ley D, Hedström E. Higher blood pressure in adolescent boys after very preterm birth and fetal growth restriction. Pediatr Res 2022:10.1038/s41390-022-02367-3. [PMID: 36344695 DOI: 10.1038/s41390-022-02367-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 10/06/2022] [Accepted: 10/13/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND Although preterm birth predisposes for cardiovascular disease, recent studies in children indicate normal blood pressure and arterial stiffness. This prospective cohort study therefore assessed blood pressure and arterial stiffness in adolescents born very preterm due to verified fetal growth restriction (FGR). METHODS Adolescents (14 (13-17) years; 52% girls) born very preterm with FGR (preterm FGR; n = 24) and two control groups born with appropriate birth weight (AGA), one in similar gestation (preterm AGA; n = 27) and one at term (term AGA; n = 28) were included. 24-hour ambulatory blood pressure and aortic pulse wave velocity (PWV) and distensibility by magnetic resonance imaging were acquired. RESULTS There were no group differences in prevalence of hypertension or in arterial stiffness (all p ≥ 0.1). In boys, diastolic and mean arterial blood pressures increased from term AGA to preterm AGA to preterm FGR with higher daytime and 24-hour mean arterial blood pressures in the preterm FGR as compared to the term AGA group. In girls, no group differences were observed (all p ≥ 0.1). CONCLUSIONS Very preterm birth due to FGR is associated with higher, yet normal blood pressure in adolescent boys, suggesting an existing but limited impact of very preterm birth on cardiovascular risk in adolescence, enhanced by male sex and FGR. IMPACT Very preterm birth due to fetal growth restriction was associated with higher, yet normal blood pressure in adolescent boys. In adolescence, very preterm birth due to fetal growth restriction was not associated with increased thoracic aortic stiffness. In adolescence, very preterm birth in itself showed an existing but limited effect on blood pressure and thoracic aortic stiffness. Male sex and fetal growth restriction enhanced the effect of preterm birth on blood pressure in adolescence. Male sex and fetal growth restriction should be considered as additional risk factors to that of preterm birth in cardiovascular risk stratification.
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Affiliation(s)
- Jonas Liefke
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
| | - Katarina Steding-Ehrenborg
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
| | - Pia Sjöberg
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
| | - Daniel Ryd
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
| | - Eva Morsing
- Paediatrics, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
| | - Håkan Arheden
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
| | - David Ley
- Paediatrics, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
| | - Erik Hedström
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden. .,Diagnostic Radiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden.
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Social determinants of hypertension in high-income countries: A narrative literature review and future directions. Hypertens Res 2022; 45:1575-1581. [PMID: 35859023 PMCID: PMC9296364 DOI: 10.1038/s41440-022-00972-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 01/19/2022] [Accepted: 02/02/2022] [Indexed: 11/26/2022]
Abstract
Hypertension is a leading cause of cardiovascular disease and despite established strategies to lower blood pressure, the control of hypertension remains poor. This is true even in high-income countries with well-established welfare and medical systems. Among the social factors associated with hypertension (i.e., social determinants of hypertension, SDHT), individual socioeconomic status (SES), including education, income, and occupation, can be crucial for hypertension management (prevalence, awareness, treatment, and control). This article reviews the findings of recently published studies that examined the association between SES and hypertension management in high-income countries. It also discusses social prescribing, which targets social isolation and loneliness as modifiable SDHT to improve hypertension management. Conceptual framework of social determinants of hypertension![]()
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Investigating change across time in prevalence or association: the challenges of cross-study comparative research and possible solutions. DISCOVER SOCIAL SCIENCE AND HEALTH 2022; 2:18. [PMID: 36317190 PMCID: PMC9613735 DOI: 10.1007/s44155-022-00021-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 10/18/2022] [Indexed: 11/30/2022]
Abstract
UNLABELLED Cross-study research initiatives to understand change across time are an increasingly prominent component of social and health sciences, yet they present considerable practical, analytical and conceptual challenges. First, we discuss the key challenges to comparative research as a basis for detecting societal change, as well as possible solutions. We focus on studies which investigate changes across time in outcome occurrence or the magnitude and/or direction of associations. We discuss the use and importance of such research, study inclusion, sources of bias and mitigation, and interpretation. Second, we propose a structured framework (a checklist) that is intended to provide guidance for future authors and reviewers. Third, we outline a new open-access teaching resource that offers detailed instruction and reusable analytical syntax to guide newcomers on techniques for conducting comparative analysis and data visualisation (in both R and Stata formats). SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1007/s44155-022-00021-1.
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Bann D, Scholes S, Hardy R, O'Neill D. Changes in the body mass index and blood pressure association across time: Evidence from multiple cross-sectional and cohort studies. Prev Med 2021; 153:106825. [PMID: 34599929 PMCID: PMC8633761 DOI: 10.1016/j.ypmed.2021.106825] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 09/15/2021] [Accepted: 09/26/2021] [Indexed: 11/26/2022]
Abstract
Although body mass index (BMI) is considered a key determinant of high blood pressure, its importance may differ over time and by age group. We utilised separate data sources to investigate temporal changes in this association: 23 independent (newly sampled), repeated cross-sectional studies (Health Survey for England (HSE)) at ≥25 years (1994-2018; N = 126,742); and three British birth cohorts at 43-46 years (born 1946, 1958, and 1970; N = 18,657). In HSE, associations were weaker in more recent years, with this trend most pronounced amongst older adults. After adjustment for sex, anti-hypertensive treatment and education, the mean difference in systolic blood pressure (SBP) per 1 kg/m2 increase in BMI amongst adults ≥55 years was 0.75 mmHg (95%CI: 0.60-0.90) in 1994, 0.66 mmHg (0.46-0.85) in 2003, and 0.53 mmHg (0.35-0.71) in 2018. In the 1958 and 1970 cohorts, BMI and SBP associations were of similar magnitude yet weaker in the 1946 cohort, potentially due to differences in blood pressure measurement device. Quantile regression analyses suggested that associations between BMI and SBP were present both below and above the hypertension threshold. A weaker association between BMI and blood pressure may partly offset the public health impacts of increasing obesity prevalence. However, despite sizable increases in use of antihypertensive medication, BMI remains positively associated with SBP in all ages. Our findings highlight the need to tackle non-medical factors such as population diet which influence both BMI and blood pressure, and the utility of using multiple datasets to obtain robust inferences on trends in risk factor-outcome associations across time.
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Affiliation(s)
- David Bann
- Centre for Longitudinal Studies, Social Research Institute, University College London, London, UK.
| | - Shaun Scholes
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Rebecca Hardy
- CLOSER, Social Research Institute, University College London, London, UK
| | - Dara O'Neill
- CLOSER, Social Research Institute, University College London, London, UK
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