Influence of contextual socioeconomic position on hypertension risk in low- and middle-income countries: disentangling context from composition

BMC Public Health

Shukri F. Mohamed¹  Mustapha S. Abba²  Chidozie U. Nduka²  Seun Anjorin²  Emmanuel Agogo³  Olalekan A. Uthman⁴ 

[1] Academic Unit of Primary Care (AUPC) and the NIHR Global Health Research Unit on Improving Health in Slums, University of Warwick, Coventry, UK;Health and Systems for Health Unit, African Population and Health Research Center (APHRC), Nairobi, Kenya;Lown Scholars Program, Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA;Division of Health Sciences, Warwick Medical School, The University of Warwick, CV4 7AL, Coventry, UK;Resolve to Save Lives, Country Office Nigeria, Abuja, Nigeria;Warwick Centre for Global Health Research, The University of Warwick, CV4 7AL, Coventry, UK;Division of Epidemiology and Biostatistics, Department of Global Health, Stellenbosch University, Stellenbosch, South Africa;Department of Public Health (IHCAR), Karolinska Institutet, Stockholm, Sweden;Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden;

关键词: Hypertension;    Blood pressure;    Socioeconomic status;    Multi-level analysis;    Low- and middle-income countries (LMICs);    Demographic health survey (DHS);   

DOI  :  10.1186/s12889-021-12238-x

来源: Springer

【 摘 要 】

BackgroundHypertension has emerged as the single most significant modifiable risk factor for cardiovascular disease and death worldwide. Resource-limited settings are currently experiencing the epidemiological transition from infectious diseases to chronic non-communicable diseases, primarily due to modifications in diet and lifestyle behaviour. The objective of this study was to examine the influence of individual-, community- and country-level factors associated with hypertension in low- and middle-income countries (LMICs).MethodsMultivariable multi-level logistic regression analysis was applied using 12 Demographic and Health Survey (DHS) datasets collected between 2011 and 2018 in LMICs. We included 888,925 respondents (Level 1) nested within 33,883 neighbourhoods (Level 2) from 12 LMICs (Level 3).ResultsThe prevalence of hypertension ranged from 10.3% in the Kyrgyz Republic to 52.2% in Haiti. After adjusting for the individual-, neighbourhood- and country-level factors, we found respondents living in the least deprived areas were 14% more likely to have hypertension than those from the most deprived areas (OR = 1.14, 95% CI 1.10 to 1.17). We observed a significant variation in the odds of hypertension across the countries and the neighbourhoods. Approximately 26.3 and 47.6% of the variance in the odds of hypertension could be attributed to country- and neighbourhood-level factors, respectively. We also observed that respondents moving to a different neighbourhood or country with a higher risk of hypertension had an increased chance of developing hypertension, the median increase in their odds of hypertension was 2.83-fold (95% CI 2.62 to 3.07) and 4.04- fold (95% CI 3.98 to 4.08), respectively.ConclusionsThis study revealed that individual compositional and contextual measures of socioeconomic status were independently associated with the risk of developing hypertension. Therefore, prevention strategies should be implemented at the individual level and the socioeconomic and contextual levels to reduce the burden of hypertension.

【 授权许可】

CC BY