Socioeconomic Inequalities in Hypertension Prevalence and Care

Abstract

Abstract-To analyze the health disparities relative to the prevalence of arterial hypertension and its therapeutic control in the active French population, in relation to occupational categories (OC), a population of 17 359 men and 12 267 women was assessed from January 1997 to April 1998. The initial phase was a cross-sectional analysis of a cohort study designed to assess the incidence of arterial hypertension in a French working population. Information was collected by the worksite physician during the annual examination. Blood pressure (BP) was measured using a validated automatic device. Among subjects with a BP Ն140/90 mm Hg, patients not treated with antihypertensive drugs were invited to have an additional BP measurement, 1 month later. Overall prevalence was 16.1% for men and 9.4% for women. Both prevalence and therapeutic control of high BP were related to OCs in this study. Prevalence of hypertension was higher and maintenance of therapeutic control lower among lower OCs. In contrast, awareness of high BP and the proportion of hypertensive subjects under current treatment were not related to OCs. Educational level and low OC were significantly related to prevalence of high BP after adjustment for obesity, excessive alcohol consumption, and sedentary lifestyle in women only. A poor BP control under treatment was related to high alcohol intake and low OC in men. In women only, however, low educational level was related to high prevalence of hypertension and poor BP control under antihypertensive treatment. Inequalities in hypertension prevalence persist, with prevalence being higher among lower OCs. Social disparities were not observed, however, in awareness of their condition among hypertensive subjects and among patients for receiving versus not receiving any treatment for hypertension. In contrast, BP control under antihypertensive treatment was lower among lower OCs. Key Words: hypertension, arterial Ⅲ blood pressure Ⅲ population Ⅲ obesity Ⅲ socioeconomic factors Ⅲ body mass index Ⅲ alcohol Ⅲ epidemiology A rterial hypertension is one of the important determinants of health inequalities of cardiovascular diseases, which have been observed to persist or increase in developed countries in the previous 20 years. 1,2 Higher prevalence of hypertension and poorer therapeutic control of hypertension care have been noted in populations in the low social classes. [3][4][5] Information regarding the continued presence and type of disparity (prevalence or therapeutic control) could provide guidance for the most efficient treatment activities for reducing the disparity. For example, differences in prevalence would stress the importance of primary prevention. Differences in therapeutic blood pressure control would emphasize the need for reinforcing secondary prevention. These questions are all the more important because insufficient therapeutic control of hypertension at the population level has been shown to be persistent. 6 The causality chain between socioeconomic factors and blood pressure is complex. Hypert...

Association between perceived racial discrimination and hypertension: findings from the ELSA-Brasil study

“…In line with the literature 1,8,9,37 , the following covariables were considered: age (continuous, in years), sex, schooling (incomplete secondary education, complete secondary education, and higher education), family history of hypertension (yes/no), research center, and body mass index (BMI) (< 25kg/ m² and ≥ 25kg/m²). All covariables were collected by interview 32 , except BMI (weight measured in kg divided by the square of the height measured in meters) 38 .…”

“…Socioeconomic differences -lack of schooling is one of the main determinants of hypertension 8,9 -can partly explain differences in prevalence among blacks, "pardos" and whites 10,11 . However, psychosocial and contextual factors also seem to contribute to differences in the prevalence of hypertension among blacks, "pardos" and whites in Brazil, and among blacks and whites in the United States.…”

Health Inequalities in Diabetes Mellitus and Hypertension: A Parish Level Study in the Northern Region of Portugal

“…Several SE factors were selected accordingly to the literature 1,[4][5][6][7][8][9][10][11][12][13][14][15] and to its availability in these data sources. We included variables related to education (analphabetism and superior education), income (low income), employment (unemployment), professional activity (tertiary sector activity), living conditions (bad housing conditions), and health care access (absence of family doctor).…”

“…7 Regarding type 2 diabetes mellitus (T2DM) and high blood pressure (HBP), their SE patterning has been already shown elsewhere. [8][9][10][11][12] However, in Portugal, the evidence Revista Científica da Ordem dos Médicos www.actamedicaportuguesa.com Leão T, et al Health inequalities in diabetes mellitus and hypertension in the northern region of Portugal, Acta Med Port 2016 Oct;29 (10): [605][606][607][608][609][610][611][612] about inequalities is limited to cardiovascular disease, [13][14][15] while little is known about T2DM and HBP inequalities and its prevalence distribution at the local level. This lack of knowledge is particularly worrisome, given that DM HBP are two major risk factors for cerebrovascular and cardiovascular disease.…”

Reducing the burden of arterial hypertension: what can be expected from an improved access to health care? Results from a study in 2420 unemployed subjects in the Caribbean

“…These questions are all the more important because inadequate therapeutic control of hypertension at the population level has been shown to be persistent. 7,8 Guadeloupe is an island in the French West Indies, in the Caribbean. Its area is 1200 km 2 with a population of 420 000.…”