The Association of Socioeconomic Status With Hypertension in 76 Low Q1 and Middle-Income Countries

Tabea K. Kirschbaum, Nikkil Sudharsanan, Jennifer Manne-Goehler, Jan-Walter De Neve, Julia M. Lemp, Michaela Theilmann, Maja-Emilia Marcus, Cara Ebert, Simiao Chen, Moein Yoosefi, Abla Mehio Sibai, Mahtab Rouhifard, Sahar Saeedi Moghaddam, Mary T Mayige, Joao S. Martins, Nuno Lunet, Jutta M.A. Jorgensen, Corine Houehanou, Farshad Farzadfar, Albertino DamascenoPascal Bovet, Silver K Bahendeka, Krishna K Aryal, Glennis Andall-Brereton, Justine I. Davies, Rifat Atun, Sebastian J. Vollmer, Till Bärnighausen , Lindsay Jaacks, Pascal Geldsetzer

Research output: Contribution to journalArticlepeer-review

Abstract / Description of output

BACKGROUND Effective equity-focused health policy for hypertension in low- and middle-income countries (LMICs)
requires an in-depth understanding of the condition’s current socioeconomic gradients and how these are likely to change
in the future as countries continue to develop economically.
OBJECTIVES This study aimed to determine how hypertension prevalence in LMICs varies by individuals’ education and
household wealth, and how these socioeconomic gradients in hypertension prevalence are associated with a country’s
gross domestic product (GDP) per capita.
METHODS We pooled nationally representative individual-level data in 76 LMICs of 1.2 million adults across LMICs. We
disaggregated hypertension prevalence by education and household wealth quintile, and used regression analyses to
adjust for age and sex.
RESULTS Pooling across the 76 study countries, hypertension prevalence tended to be similar between education
groups and household wealth quintiles. The only world region with a clear positive association of hypertension with
increasing education or household wealth was Southeast Asia. Countries with a lower GDP per capita had, on average, a
more positive association among hypertension and increasing education and household wealth quintile than countries
with a higher GDP per capita, especially in rural regions and among men.
CONCLUSIONS Differences in hypertension prevalence between socioeconomic groups were generally small, with
even the least educated and least wealthy groups having a substantial prevalence. Our cross-sectional interaction
analyses of GDP per capita with the socioeconomic gradients of hypertension suggest that hypertension may increasingly
affect adults in the lowest socioeconomic groups as LMICs develop economically. (J Am Coll Cardiol 2022;-:-–-)
Original languageEnglish
Pages (from-to)804-817
JournalJournal of the American College of Cardiology
Issue number8
Early online date23 Aug 2022
Publication statusPublished - 23 Aug 2022


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