Social Stressors and Excess Mortality from Hypertensive Diseases

Abstract

The relation of the social environment to excess mortality from diseases involving hypertension was investigated by correlating demographic, social and economic data with age-sex standardized mortality ratios for these diseases in the 39 mental health catchment areas of Massachusetts. Seventy-nine of the 130 social indicators had significant rank correlations with excess mortality from hypertensive diseases. A broader category of all hypertensive-related deaths correlated with 35 of the social indicators. Death rates were excessive in areas with low occupational status, low median education, widespread poverty, broken families, and substandard housing. This profile of community risk factors parallels closely those for ischemic heart disease, homicide, and deaths due to fire and flames. Quite different social indices are associated with excess mortality due to respiratory diseases and stroke, thus arguing for some specificity of association rather than a general force for all causes of mortality. Partial correlation procedures indicate that low education and low occupational status may be the most potent statistically of all the community predictors of excess hypertensive mortality. These findings suggest specific directions for research into the social mechanisms leading to aggravation of this common condition. They also provide a means for identifying areas having highest needs for community programs of hypertension control.

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