Analysing the socioeconomic determinants of hypertension in South Africa: a structural equation modelling approach

Abstract

BackgroundEpidemiological research has long observed a varying prevalence of hypertension across socioeconomic strata. However, patterns of association and underlying causal mechanisms are poorly understood in sub-Saharan Africa. Using education and income as indicators, we investigated the extent to which socioeconomic status is linked to blood pressure in the first wave of the National Income Dynamics Study — a South African longitudinal study of more than 15000 adults – and whether bio-behavioural risk factors mediate the association.MethodsIn a cross-sectional analysis, structural equation modelling was employed to estimate the effect of socioeconomic status on systolic and diastolic blood pressure and to assess the role of a set of bio-behavioural risk factors in explaining the observed relationships.ResultsAfter adjustment for age, race and antihypertensive treatment, higher education and income were independently associated with higher diastolic blood pressure in men. In women higher education predicted lower values of both diastolic and systolic blood pressure while higher income predicted lower systolic blood pressure. In both genders, body mass index was a strong mediator of an adverse indirect effect of socioeconomic status on blood pressure. Together with physical exercise, alcohol use, smoking and resting heart rate, body mass index therefore contributed substantially to mediation of the observed relationships in men. By contrast, in women unmeasured factors played a greater role.ConclusionIn countries undergoing epidemiological transition, effects of socioeconomic status on blood pressure may vary by gender. In women, factors other than those listed above may have substantial role in mediating the association and merit investigation.

Adolescent Childbirth Is Associated With Greater Framingham Risk Scores for Cardiovascular Disease Among Participants of the IMIAS (International Mobility in Aging Study)

“…Figure depicts our conceptual framework with relevant citations supporting each arrow in the model . Directed acyclic graphs were used to establish the minimum confounders required for the multivariate analyses.…”

The Current Situation of Hypertension among Rural Minimal Assurance Family Participants in Liaoning (China): A Cross-Sectional Study

“…Similarly, higher income was positively associated with hypertension in South Asia and teachers and bankers of Ethiopia [25] whereas no association was detected in East Asia and Africa [23]. However, several other studies conducted in developing countries also found out that education and income are inversely associated with the odds of developing hypertension [26,27], so the association of SES with hypertension differs according to geographical region. Previously, researchers proposed this association might be influenced by the phenomenon of epidemiological transition [28] and the society in China is experiencing comprehensive and profound social changes, so the association of SES with hypertension has no consistent trend at present and needs further research.…”

Socioeconomic and modifiable predictors of blood pressure control for hypertension in primary care attenders in the Western Cape, South Africa

“…[8] In SA, a higher level of education has been found to predict lower values of both diastolic and systolic blood pressure in women, while higher income predicted lower systolic blood pressure. [9] Interestingly, this did not hold true for men. Our study, which comprised predominantly women, adds new evidence for an association between low levels of education and poorer hypertension control and treatment intensification in SA.…”

“…[4][5][6] The burden of ill-health and of chronic diseases such as hypertension is strongly influenced by socioeconomic status. [7][8][9] Few publications have considered the impact of socioeconomic status on control of blood pressure and potentially modifiable factors associated with better blood pressure control in SA.…”