Diseases of the Rich? The Social Patterning of Hypertension in Six Low- and Middle-Income Countries

Lloyd‐Sherlock, Peter; Minicuci, Nadia; Corso, Barbara; Beard, John; Chatterji, Somnath; Ebrahim, Shah

doi:10.1057/s41287-016-0063-2

Cited by 8 publications

(18 citation statements)

References 34 publications

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“…Consistent with our findings, other regional meta-analyses in Africa did not find significant sex differences [6, 10] while others reported higher male prevalence [5, 7]. In individual studies in older persons in Africa in which multivariable analyses were performed, female sex predicted a higher prevalence of hypertension [41, 43, 76, 77, 87] while in others sex was not independently associated with hypertension [49, 57, 67].…”

Section: Discussionsupporting

confidence: 90%

“…The increase in the prevalence of hypertension with age was rarely monotonic [65] and tended to peak in the middle or penultimate age group [49, 68, 72, 75]. In all the studies in which the relationship between age and hypertension was investigated through multivariate analysis, older age group was independently associated with hypertension [43, 57, 68, 76, 77].…”

Section: Resultsmentioning

confidence: 99%

“…The relationship between body mass index (BMI) and hypertension was reported by 13 studies. In multivariate analyses, older adults who were overweight or obese were up to 3.5 times as likely as those with normal BMI to have hypertension [72, 76, 77]. A dose-response relationship was observed in several studies [49, 78, 79].…”

Section: Resultsmentioning

confidence: 99%

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Hypertension in older adults in Africa: A systematic review and meta-analysis

et al. 2019

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Background Hypertension is the leading driver of cardiovascular disease deaths in Africa. Its prevalence is highest in older populations. Yet, this group has received little attention in many African countries. We conducted a systematic review and meta-analysis (PROSPERO registration: CRD42017056474) to estimate the prevalence of hypertension in older adults living in Africa. Methods We searched grey literature and major electronic databases including PubMed and Embase for population-based studies and published between 1 January 1980 to 28 May 2018 reporting the prevalence of hypertension for adults aged ≥50 years living in Africa. We employed a random effects model to estimate the pooled prevalence across included studies. Findings We screened 10,719 articles and retrieved 103 full-text articles to evaluate for inclusion in the review. Thirty-four unique studies providing 37 data points on 43,025 individuals in 15 African countries were analyzed. The prevalence of hypertension ranged from 22.3% to 90.0% from the individual studies while the overall pooled prevalence was 57.0% (95% CI 52%-61%). The prevalence was not statistically significantly different by sex, residence, or African sub-region. In individual studies, older age and overweight/obesity were independently associated with hypertension. Twenty-nine (78%) data points were deemed to be of low- or moderate-risk of bias. Eliminating high-risk bias studies made little difference to the pooled estimate of hypertension. Sensitivity analyses, omitting one study at a time, identified three studies with significant but relatively small impact on the pooled estimate. We observed substantial heterogeneity (I 2 = 98.9%) across the studies which was further explored by meta-regression analyses. Overall, the GRADE assessment suggested moderate quality evidence in the results. Conclusion The persistent high prevalence of hypertension among older adults in Africa, even in rural populations warrants more attention to the cardiovascular health of this group by public health authorities.

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Section: Discussionsupporting

confidence: 90%

Section: Resultsmentioning

confidence: 99%

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Hypertension in older adults in Africa: A systematic review and meta-analysis

et al. 2019

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“…The studies were conducted between 2007 and 2016 and published between 2010 and 2017. The number of covariates evaluated for their association with the binomial outcome of hypertension in the models ranged from five [19, 30] to thirteen [20]. One study provided separate estimates for the prevalence of hypertension in two countries, Central African Republic (CAR) and the Congo [36].…”

Section: Resultsmentioning

confidence: 99%

Determinants of systemic hypertension in older adults in Africa: a systematic review

Bosu

Aheto

Zucchelli

et al. 2019

BMC Cardiovasc Disord

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Background An estimated 55% of older adults in Africa have systemic hypertension, a major risk factor for stroke, heart failure and dementia in the region. The risk factors associated with hypertension in this population group in Africa have not been systematically evaluated. We, therefore, undertook a systematic review to identify these risk factors. Methods We searched for population-based studies of adults aged ≥50 years living in Africa and reporting an estimate of hypertension and associated risk factors. We included articles published in any language between January 1980 and May 2018 using a comprehensive search strategy. We extracted data including the sample characteristics, prevalence of hypertension and risk factors with their effect sizes. Results From an initial 10,719 records, we retained 63 eligible full text articles for review out of which we analyzed 23 studies made up of 19 primary and four multiple publications which had data on risk factors from bivariate or multivariable analysis. The primary studies, published from 2010 to 2018, involved a total of 30,500 participants in 12 different countries with mean ages ranging from 62.7 ± 9 years to 76.9 ± 8.4 years. Through narrative synthesis, we found consistent determinants of hypertension (overweight/obesity and history of stroke), less consistent but frequent determinants (including older age group, female sex and urban residence), inconsistent determinants (including education, wealth index, alcohol intake and physical activity) and nonsignificant covariates (marital status and having health insurance). Overall, the highest adjusted odds ratios were those associated with obesity and history of stroke. Conclusion The key determinants of systemic hypertension in older adults in Africa are older age group, overweight/obesity, history of stroke and female sex. Health programmes should promote weight reduction throughout the life course, including during the middle and older age of African adults. Electronic supplementary material The online version of this article (10.1186/s12872-019-1147-7) contains supplementary material, which is available to authorized users.

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“…In high income countries, evidence shows that NCDs are prevalent among those with low SES. Such vulnerabilities may be associated to poor access to healthcare, psychosocial stress, lack of awareness and control of NCDs (Lloyd-Sherlock et al 2017). However, despite these concurrent findings, a cross country study in six countries found that hypertension was more prevalent among rich elderly Ghanaians (Stringhini et al 2016).…”

Section: Discussionmentioning

confidence: 99%

Economic Analysis of Health Inequality Among the Elderly in Ghana

Fonta¹,

Nonvignon

Aikins

et al. 2019

Population Ageing

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In Ghana, the ageing population is growing at a fast pace amidst challenging socioeconomic environment. As such, the health of elderly persons in Ghana is of emerging concern and of high priority to the Government. In this study, we seek to measure health inequality among elderly persons in Ghana to determine its existence and explore the factors driving it. Data for the study were drawn from the World Health Organization (WHO)'s Study on Global Ageing and Adult Health (SAGE Wave 1) and analyzed using STATA and a Distributive Analysis Stata Package (DASP) installed in STATA. Health inequality was measured using concentration curves and concentration index (CI). Furthermore, a regression-based approach was used to determine factors associated with health inequality and their estimated contributions to health inequality. The CI for poor SRH was −0.059 indicating greatest poor health among the poor. The highest contributors to health inequality were presence of at least a chronic condition (63.4%), followed by the age group 70 years and above (26.6%), being single (13.9%), poor (3.9%) and uneducated (0.3%). The probability of reporting poor health was higher with increasing age (Coeff = 0.27, p < 0.05), having at least a chronic condition (Coeff = 0.34, p < 0.05), being single (Coeff = 0.14, p < 0.05) and being poor (Coeff = 0.17, p < 0.05). The results show that health inequality exists among the elderly in Ghana and that poor health was greatest among the poor. Socioeconomic, demographic and health related factors are associated with health inequality.

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Diseases of the Rich? The Social Patterning of Hypertension in Six Low- and Middle-Income Countries

Cited by 8 publications

References 34 publications

Hypertension in older adults in Africa: A systematic review and meta-analysis

Hypertension in older adults in Africa: A systematic review and meta-analysis

Determinants of systemic hypertension in older adults in Africa: a systematic review

Economic Analysis of Health Inequality Among the Elderly in Ghana

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