Social determinants of health and hypertension in women compared with men in the United States: An analysis of the NHANES study

Li Wang · Hao Zhang · Hong Yao · Chunlin Gong · Jiaoyue Zhong · Dongxue Liu +1 more

19 citations0/0 files storedClinical Cardiology

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Health disparities and outcomes Blood Pressure and Hypertension Studies Public Health and Social Inequalities

Abstract

BACKGROUND: Social determinants of health (SDH) reflecting social deprivation have been developed for population health management. There is a paucity of data on the prevalence of SDH and its associations with prevalent hypertension in women compared with men. METHODS: A total of 49 791 participants aged over 20 years from the 1999-2018 National Health and Nutrition Examination Surveys, were included. Information on the SDH, including race/ethnicity, education level, family income, housing, marriage status, employment, were collected. We calculated the prevalence ratio (PR) for each adverse SDH with prevalent hypertension and uncontrolled hypertension by using Cox regression with equal times of follow-up assigned to all individuals with adjustment for age, diabetes, taking lipid-lowering medication, and health behaviors. The population-attributable fractions (PAF) of the SDH were also assessed. RESULTS: A lower proportion of low education attainment was observed in women than men (women: 16.8% vs. men: 17.9%, p = .003), but women had higher proportions of low family income (15.3% vs. 12.5%, p < .001), unmarried state (47.3% vs. 40.9%, p < .001), and unemployment (22.7% vs. 10.7%, p < .001). All the SDH was significantly associated with hypertension in women. There were significant dose-response associations between the numbers of adverse SDH with hypertension. The total PAF of SDH for prevalent hypertension was greater in women (22.2%) than in men (13.9%). CONCLUSIONS: The widely influential SDH is associated with prevalent hypertension and uncontrolled hypertension. To improve hypertension management, health resources should prioritize socioeconomically disadvantaged groups considering gender differences.

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2016Loneliness and social isolation as risk factors for coronary heart disease and stroke: systematic review and meta-analysis of longitudinal observational studies 2021Associations of healthy lifestyle and socioeconomic status with mortality and incident cardiovascular disease: two prospective cohort studies 2014Inequalities in health care among patients with type 2 diabetes by individual socio-economic status (SES) and regional deprivation: a systematic literature review 2019Associations of marital status with diabetes, hypertension, cardiovascular disease and all-cause mortality: A long term follow-up study 2020Number of Social Determinants of Health and Fatal and Nonfatal Incident Coronary Heart Disease in the REGARDS Study 2022Association between socioeconomic status and health behaviour change before and after non-communicable disease diagnoses: a multicohort study

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