Socioeconomic disparities in prevalence, awareness, treatment, and control of hypertension over the life course in China

Abstract

Background: The socioeconomically disadvantaged populations are more likely to suffer from hypertension, and few have effectively treated and controlled their hypertension. Research on socioeconomic disparities in prevalence, awareness, treatment, and control of hypertension is warranted to inform the development of new strategies for reducing such health inequities. Methods: The China Health and Nutrition Survey (CHNS) followed up 20,174 individuals over a 20-year period. We added seven key socioeconomic indicators with age and age-squared into the mixed-effects models to explicitly assess the effect of socioeconomic determinants on hypertension throughout the adult life course. Results: Prevalence of hypertension was at a higher level in the younger birth cohorts than that in the older generations. Age-related increases in prevalence, awareness, treatment, and control of hypertension were observed over the adult life course. Males, insured and ethnic Han were more likely to suffer from hypertension than their counterparts [coefficient (95% confidence intervals): 0.07(0.04, 0.09), 0.02(0.01, 0.03) and 0.05(0.03, 0.07), respectively]. Hypertension was more prevalent among individuals with higher income who lived in urbanized communities, and less among those with higher education attainment [coefficient (95% confidence intervals): -0.07(-0.12, -0.016)] across adulthood. High-level urbanization and education increased the probabilities of awareness, treatment, and control of hypertension, while household income decreased them [coefficient (95% confidence intervals): 0.28(0.17, 0.39), 0.27(0.17, 0.37) and 0.14(0.08, 0.21), respectively] over the adult life course. Conclusions: Community urbanicity brought the raise in awareness, treatment, and control of hypertension, but also led to an increase in prevalence of hypertension. People with fewer educational years or higher income may be the disadvantaged population of hypertension over the adult life course in China.