Who is at higher risk of hypertension? Socioeconomic status differences in blood pressure among Polish adolescents: a population-based ADOPOLNOR study

Abstract

In Poland, there is no data on parental socioeconomic status (SES) as a potent risk factor in adolescent elevated blood pressure, although social differences in somatic growth and maturation of children and adolescents have been recorded since the 1980s. This study aimed to evaluate the association between parental SES and blood pressure levels of their adolescent offspring. A cross-sectional survey was carried out between 2009 and 2010 on a sample of 4941 students (2451 boys and 2490 girls) aged 10–18, participants in the ADOPOLNOR study. The depended outcome variable was the level of blood pressure (optimal, pre- and hypertension) and explanatory variables included place of residence and indicators of parental SES: family size, parental educational attainments and occupation status, income adequacy and family wealth. The final selected model of the multiple multinomial logistic regression analysis (MLRA) with backward elimination procedure revealed the multifactorial dependency of blood pressure levels on maternal educational attainment, paternal occupation and income adequacy interrelated to urbanization category of the place of residence after controlling for family history of hypertension, an adolescent’s sex, age and weight status. Consistent rural-to-urban and socioeconomic gradients were found in prevalence of elevated blood pressure, which increased with continuous lines from large cities through small- to medium-sized cities to villages and from high-SES to low-SES familial environments. The adjusted likelihood of developing systolic and diastolic hypertension decreased with each step increase in maternal educational attainment and increased urbanization category. The likelihood of developing prehypertension decreased with increased urbanization category, maternal education, paternal employment status and income adequacy. Weight status appeared to be the strongest confounder of adolescent blood pressure level and, at the same time, a mediator between their blood pressure and parental SES.Conclusion: The findings of the present study confirmed socioeconomic disparities in blood pressure levels among adolescents. This calls for regularly performed blood pressure assessment and monitoring in the adolescent population. It is recommended to focus on obesity prevention and socioeconomic health inequalities by further trying to improve living and working conditions in adverse rural environments. What is known: • Socioeconomic gradient exists in adolescent blood pressure levels. • Adolescents from lower SES families are at greater risk of hypertension. What is new: • Urbanization levels of residence area affect adolescent blood pressure by parental socioeconomic status. • Socioeconomic inequalities in adolescent hypertension may be modulated through effects of body weight.

Correlates of elevated blood pressure in healthy children: a systematic review

“…In all of these, higher adiposity was associated with higher BP or odds of hypertension. This association was observed in cross‐sectional studies ( n = 46) , and also in prospective studies ( n = 9) . Results were mostly consistent across study type (i.e.…”

“…In three cross‐sectional studies, age was dichotomized between pre‐pubertal/pubertal ages and post‐pubertal ages, and their effects were explored with hypertension ranges. For example, when compared against 10‐year‐olds, 18‐year‐olds had higher odds of pre‐hypertension and hypertension . Similarly, in Xu et al ., when older children were compared to 8‐year‐olds, higher risk for hypertension was observed .…”

The frequency of overweight and obesity occurrence among Polish children (age 6–7 years) in relation to the place of residence, the education level of parents and the number children in the family

“…This problem has intensified over time: the number of people who are overweight or obese has clearly increased over consecutive age groups (Krawczyński et al 2003, Dollman and Pilgrim 2005, Kozieł et al 2006, O'Neill et al 2007, Olds 2009Kaczmarek et al 2015). These problems affect younger children, adolescents and adults in developed and developing countries as well (Kalies et al 2002, WHO 2003, Branca et al 2007, Rodrigo 2013, Gomuła at.al.…”

Percentile distribution of blood pressure readings in relation to body mass index: a populationbased cross-sectional study ADOPOLNOR

“…Data from epidemiological studies provide evidence for the rising trend toward elevated blood pressure in children and adolescents (Krzyżaniak et al 2003, Ostrowska-Nawarycz and Nawarycz 2007, Kułaga et al 2009). Our recent study has demonstrated that the overall prevalence of elevated BP was 6.6% for prehypertension and 8.9% for hypertension for SBP and/or DBP combined (Kaczmarek et al 2015). These data indicate that the prevalence of systemic hypertension in the juvenile population in Poland has doubled over the last decade.…”