Aging and hypertension among the global poor—Panel data evidence from Malawi

Abstract

Hypertension is a rapidly growing disease burden among older persons in low-income countries (LICs) that is often inadequately diagnosed and treated. Yet, most LIC research on hypertension is based on cross-sectional data that does not allow inferences about the onset or persistence of hypertension, its correlates, and changes in hypertension as individuals become older. The Mature Adults Cohort of the Malawi Longitudinal Study of Families and Health (MLSFH-MAC) is used to provide among the first panel analyses of hypertension for older individuals in a sub-Saharan LIC using blood pressure measurements obtained in 2013 and 2017. We find that high blood pressure is very common among mature adults aged 45+, and hypertension is more prevalent among older as compared to middle-aged respondents. Yet, in panel analyses for 2013–17, we find no increase in the prevalence of hypertension as individuals become older. Hypertension often persists over time, and the onset of hypertension is predicted by factors such as being overweight/obese, or being in poor physical health. Otherwise, however, hypertension has few socioeconomic predictors. There is also no gender differences in the level, onset or persistence in hypertension. While hypertension is associated with several negative health or socioeconomic consequences in longitudinal analyses, cascade-of-care analyses document significant gaps in the diagnosis and treatment of hypertension. Overall, our findings indicate that hypertension and related high cardiovascular risks are widespread, persistent, and often not diagnosed or treated in this rural sub-Saharan population of older individuals. Prevalence, onset and persistence of hypertension are common across all subgroups—including, importantly, both women and men. While age is an important predictor of hypertension risk, even in middle ages 45–55 years, hypertension is already widespread. Hypertension among adults aged 45+ in Malawi is thus more similar to a “generalized epidemic” than in high-income countries where cardiovascular risk has strong socioeconomic gradients.

Joint modelling of systolic and diastolic blood pressure and its associated factors among women in Ghana: Multivariate response multilevel modelling methods

“…Also, having unimproved toilet type in households was associated with increased SBP while using primitive fuel for cooking in households was associated with decreased DBP. Our finding that older ages was associated with increased SBP and DBP is not surprising because generally the older the age, the higher the chance of one developing hypertension and this is consistent with previous studies that found that high blood pressure increase with an increasing age [12,13,18,[29][30][31]. Consistent with previous studies that reported increase in hypertension prevalence among those who are obese [12,13,30,31], being obese was associated with increased SBP and DBP PLOS GLOBAL PUBLIC HEALTH in this study.…”

“…Our finding that older ages was associated with increased SBP and DBP is not surprising because generally the older the age, the higher the chance of one developing hypertension and this is consistent with previous studies that found that high blood pressure increase with an increasing age [12,13,18,[29][30][31]. Consistent with previous studies that reported increase in hypertension prevalence among those who are obese [12,13,30,31], being obese was associated with increased SBP and DBP PLOS GLOBAL PUBLIC HEALTH in this study. Obesity and age were reported to be the most powerful factors associated with hypertension in previous studies [12,18,29,30].…”

“…Hypertension is induced through a conglomeration of effects within a complex network of predisposing, enabling, and reinforcing factors. Many studies have found that predisposing factors contributing to hypertension include genetics, sex, race, age, marital status, type and place of residence, weight, pregnancy, health insurance, employment, educational attainment, and lack of understanding of hypertension [ 1 – 3 , 5 , 7 , 8 , 11 – 13 ]. Enabling factors include alcohol consumption, sedentary lifestyle, tobacco usage, diet, and socioeconomic status [ 1 – 3 , 5 , 7 , 8 , 11 ].…”

Resilience, Accelerated Aging, and Persistently Poor Health: Diverse Trajectories of Health in Malawi

“…However, studying global poor populations is important because the world's aging populations are increasingly concentrated in such contexts and the different socioeconomic contexts may have implications for health across the lifecourse. For example, in our study population, high blood pressure is common among older individuals despite the lack of conventional risk factors such as obesity or access to Western-type diets (Kohler et al 2020(Kohler et al , 2022b; NCD Risk Factor Collaboration (NCD-RisC) 2021). Declines in physical and mental health occur on average in this cohort at younger ages as compared to individuals in HICs (Kohler et al 2022a(Kohler et al , 2023, and similar patterns of early health declines have been documented in other populations exposed to significant lifecourse adversities (Geronimus et al 2006;Phelan and Link 2015;Simons et al 2021).…”

“…Currently, remaining life expectancy at age 45 is ≈28 years (UN Population Division 2019) and healthy life expectancy is ≈22 years (GBD 2019 Disease Collaboration 2020). Older adults aged 45+ years can expect to live a large proportion of their remaining life expectancy subject to physical and mental health limitations impacting their daily activities and overall wellbeing (Kohler et al 2017(Kohler et al , 2022a(Kohler et al , 2022b(Kohler et al , 2023Payne, Mkandawire, and Kohler 2013). HIV/AIDS remains widespread, with a prevalence of about 7.4 percent among rural adults 15-49 years old (Malawi DHS 2017).…”