Educational attainment modifies the association of wealth status with elevated blood pressure in the Ghanaian population

Abstract

The relationship between wealth and blood pressure (BP) in developing countries is unclear and it is important to understand how the socioeconomic environment influences BP in an African setting. Our objective was to determine the wealth differences in BP in the Ghanaian population and to clarify whether the relationship is modified by education level. Data from the 2014 Ghana Demographic and Health Survey was analyzed. A total of 9396 women and 4388 men were sampled nationwide and interviewed for the survey. Prevalence of hypertension in the population was low (10.4%). Systolic BP, diastolic BP, and odds of elevated BP increased with increasing wealth status. A linear trend was noted. Richest respondents recorded a 2.65 mmHg (95% CI: 1.09, 4.21) and 3.14 mmHg (95% CI: 1.97, 4.31) excess in systolic BP and diastolic BP, respectively and also, a 151% (AOR = 2.51, 95% CI: 1.80, 3.48) increased odds of elevated BP compared with the poorest. The wealth trend in BP was strongest among primary educated respondents (Interaction p = 0.0007). We found evidence of a consistent increase in elevated BP with increasing wealth status in this African population, a trend that is contrary to what is seen in high income countries.

Hypertension determinants among Ghanaians differ according to location of residence: RODAM study

“…The positive association between educational level and hypertension among females is in contrast to findings from high-income countries, where studies have found a higher level of education to be protective against hypertension [44,45]. Our finding, however, is supported by studies from Ghana and other low-income and middle-income countries, where higher socioeconomic status is associated with higher BP and hypertension prevalence [46,47]. In these settings, socioeconomic development is associated with the adoption of unhealthy lifestyles, such as less physical activity and a more sedentary lifestyle, resulting in more obesity and hypertension [48].…”

Barriers to healthcare access and healthcare seeking for childhood illnesses among childbearing women in sub-Saharan Africa: A multilevel modelling of Demographic and Health Surveys

“…The main strength of this study lies in the use of nationally representative data. The sampling strategy–multi-stage—employed by the DHS usually helps to minimize selection bias [ 39 ]. Also, the DHS employs standard data collection instruments and procedures.…”

Temporal variation in prevalence, awareness and control of hypertension in urban and rural areas in Northeast Brazil between 2006 and 2016

“…The relationship between socioeconomic status and hypertension has been well established 15 as either a cardiovascular risk factor or a means to predict lifestyle 35,36 . The socioeconomic statushypertension gradient appears to differ by development region with a positive gradient often seen in LMICs 17,29 and a negative in HICs 15 . The results of this study are contrary to those identified in LMICs, but this inverse association may indicate that the country reached an advanced development stage 19 , as it has been observed in China with exception of some rural areas 17 .…”

“…The educational level is reported as the best marker 35 and it can modify the effect of other socioeconomic determinants 29 once well educated people are more likely to be employed, have a better work and economic conditions, social and psychological resources, and to adhere a healthier lifestyle 38 . A low level of schooling is associated with the perception of stress and with high BMI and waist circumference, what contribute to the increase of blood pressure 16 .…”