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Social Determinants Status and Hypertension: Results from the China Hypertension Survey

21 Pages Posted: 19 Feb 2020

See all articles by Congyi Zheng

Congyi Zheng

Chinese Academy of Medical Sciences & Peking Union Medical College (CAMS & PUMC) - Division of Prevention and Community Health

Zengwu Wang

Chinese Academy of Medical Sciences & Peking Union Medical College (CAMS & PUMC) - Division of Prevention and Community Health

Xin Wang

Chinese Academy of Medical Sciences & Peking Union Medical College (CAMS & PUMC) - Division of Prevention and Community Health

Zuo Chen

Chinese Academy of Medical Sciences & Peking Union Medical College (CAMS & PUMC) - Division of Prevention and Community Health

Linfeng Zhang

University of Illinois Department of Mathematics

Yuting Kang

Chinese Academy of Medical Sciences & Peking Union Medical College (CAMS & PUMC) - Division of Prevention and Community Health

Ying Yang

Chinese Academy of Medical Sciences & Peking Union Medical College (CAMS & PUMC) - Division of Prevention and Community Health

Linlin Jiang

Chinese Academy of Medical Sciences & Peking Union Medical College (CAMS & PUMC) - Division of Prevention and Community Health

Runlin Gao

Chinese Academy of Medical Sciences

China Hypertension Survey Investigators Group

More...

Abstract

Background: The prevalence of hypertension (HTN) continues to increase in developing countries including China. Several reviews assessed the effects of social determinants status on the HTN epidemic, however, it is unclear throughout China. We explored the association between unbalanced social determinants status and HTN in China.

Methods: Of the China Hypertension Survey (CHS) study participants, those (n=299,220) who were aged ≥18 years from 181 districts and 31 provinces were eligible for the finally analysis. Data on demographic and other factors was recorded by a standardized questionnaire. Social determinants status were measured with: (1) district-level:Per capita GDP (Per_GDP), the number of hospital beds per 1000 residents (Per1000_bed) and tertiary industry added value (TIA); (2) individual-level: education and employment conditions.

Findings: Overall, HTN prevalence(r=0.16), awareness (r=0.29) and treatment(r=0.19) rates were correlated positively with the Per_GDP of district, all P<0.05. In the multivariable analysis, compared with the poorest level of Per_GDP, the middle and richest group had higher risk of HTN [OR, 95%CI: 1.12(1.09-1.14) and 0.99(0.96-1.02)] and higher possibility of HTN awareness, treatment and control. Higher risk of HTN and lower possibility of awareness, treatment and control were associated with elevated Per1000_bed (Ptrend <0.05). Higher possibility of HTN control was associated with the higher TIA (Ptrend <0.001). Compared to participants with primary education, those with middle (OR, 95%CI: 0.86, 0.84-0.88) and senior (OR, 95%CI: 0.72, 0.69-0.76) education had a decreased risk of HTN and higher HTN control possibility. And those in retirement or unemployment conditions had a higher risk of HTN and higher possibility of HTN awareness, treatment and control compared with the job-holders.

Interpretation: People with a higher economic area living, lower level of education and retirement/ unemployment conditions have a higher incidence of HTN, especially for male or rural residents. However, individuals have a higher possibility of HTN awareness, treatment, and control if they are living in a better environment of economic development and medical treatment.

Funding Statement: The Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences (grant 2017-I2M-1-004) and the Chinese National Science & Technology Pillar Program during the Twelfth Five-year Plan Period (No.: 2011BAI11B01).

Declaration of Interests: The authors stated: "None."

Ethics Approval Statement: All participant provided informed written consent. The protocol and operational procedures of the CHS study were approved by the Fuwai Hospital (Beijing, China) Ethics Committee.

Keywords: Social Determinants; Hypertension; Prevalence; Awareness; Treatment; Control; the China Hypertension Survey (CHS)

Suggested Citation

Zheng, Congyi and Wang, Zengwu and Wang, Xin and Chen, Zuo and Zhang, Linfeng and Kang, Yuting and Yang, Ying and Jiang, Linlin and Gao, Runlin and Group, China Hypertension Survey Investigators, Social Determinants Status and Hypertension: Results from the China Hypertension Survey (February 7, 2020). Available at SSRN: https://ssrn.com/abstract=3534202 or http://dx.doi.org/10.2139/ssrn.3534202

Congyi Zheng

Chinese Academy of Medical Sciences & Peking Union Medical College (CAMS & PUMC) - Division of Prevention and Community Health ( email )

Beijing, 102308
China

Zengwu Wang (Contact Author)

Chinese Academy of Medical Sciences & Peking Union Medical College (CAMS & PUMC) - Division of Prevention and Community Health

Beijing, 102308
China

Xin Wang

Chinese Academy of Medical Sciences & Peking Union Medical College (CAMS & PUMC) - Division of Prevention and Community Health

Beijing, 102308
China

Zuo Chen

Chinese Academy of Medical Sciences & Peking Union Medical College (CAMS & PUMC) - Division of Prevention and Community Health

Beijing, 102308
China

Linfeng Zhang

University of Illinois Department of Mathematics ( email )

Champaign, IL 61820
United States

Yuting Kang

Chinese Academy of Medical Sciences & Peking Union Medical College (CAMS & PUMC) - Division of Prevention and Community Health

Beijing, 102308
China

Ying Yang

Chinese Academy of Medical Sciences & Peking Union Medical College (CAMS & PUMC) - Division of Prevention and Community Health

Beijing, 102308
China

Linlin Jiang

Chinese Academy of Medical Sciences & Peking Union Medical College (CAMS & PUMC) - Division of Prevention and Community Health

Beijing, 102308
China

Runlin Gao

Chinese Academy of Medical Sciences

NO. 9, Dongdan Santiao
Beijing, Dongcheng District
China

No contact information is available for China Hypertension Survey Investigators Group

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