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 Damasceno; Pascal Bovet; Silver K Bahendeka; Krishna K Aryal; Glennis Andall-Brereton; Justine I.  Davies; Rifat Atun; Sebastian J. Vollmer; Till  Bärnighausen; Lindsay Jaacks; Pascal Geldsetzer

doi:10.1016/j.jacc.2022.05.044

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

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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 language	English
Pages (from-to)	804-817
Journal	Journal of the American College of Cardiology
Volume	80
Issue number	8
Early online date	23 Aug 2022
DOIs	https://doi.org/10.1016/j.jacc.2022.05.044
Publication status	Published - 23 Aug 2022

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Hypertension.SES_ManuscriptAccepted author manuscript, 895 KBLicence: Creative Commons: Attribution (CC-BY)

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Kirschbaum, T. K., Sudharsanan, N., Manne-Goehler, J., De Neve, J.-W., Lemp, J. M., Theilmann, M., Marcus, M.-E., Ebert, C., Chen, S., Yoosefi, M., Sibai, A. M., Rouhifard, M., Moghaddam, S. S., Mayige, M. T., Martins, J. S., Lunet, N., Jorgensen, J. M. A., Houehanou, C., Farzadfar, F., ... Geldsetzer, P. (2022). The Association of Socioeconomic Status With Hypertension in 76 Low Q1 and Middle-Income Countries. Journal of the American College of Cardiology, 80(8), 804-817. https://doi.org/10.1016/j.jacc.2022.05.044

@article{afdde98af4fb4e948fb65b2c2e643c83,

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

abstract = "BACKGROUND Effective equity-focused health policy for hypertension in low- and middle-income countries (LMICs)requires an in-depth understanding of the condition{\textquoteright}s current socioeconomic gradients and how these are likely to changein the future as countries continue to develop economically.OBJECTIVES This study aimed to determine how hypertension prevalence in LMICs varies by individuals{\textquoteright} education andhousehold wealth, and how these socioeconomic gradients in hypertension prevalence are associated with a country{\textquoteright}sgross domestic product (GDP) per capita.METHODS We pooled nationally representative individual-level data in 76 LMICs of 1.2 million adults across LMICs. Wedisaggregated hypertension prevalence by education and household wealth quintile, and used regression analyses toadjust for age and sex.RESULTS Pooling across the 76 study countries, hypertension prevalence tended to be similar between educationgroups and household wealth quintiles. The only world region with a clear positive association of hypertension withincreasing education or household wealth was Southeast Asia. Countries with a lower GDP per capita had, on average, amore positive association among hypertension and increasing education and household wealth quintile than countrieswith a higher GDP per capita, especially in rural regions and among men.CONCLUSIONS Differences in hypertension prevalence between socioeconomic groups were generally small, witheven the least educated and least wealthy groups having a substantial prevalence. Our cross-sectional interactionanalyses of GDP per capita with the socioeconomic gradients of hypertension suggest that hypertension may increasinglyaffect adults in the lowest socioeconomic groups as LMICs develop economically. (J Am Coll Cardiol 2022;-:-–-)",

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

note = "Funding Information: Drs De Neve and B{\"a}rnighausen were supported by the Alexander von Humboldt Foundation, funded by Germany{\textquoteright}s Federal Ministry of Education and Research. Dr Jaacks has received funding from the Harvard McLennan Family Fund. Dr Geldsetzer is a Chan Zuckerberg Biohub investigator. The content is solely the responsibility of the authors and does not necessarily represent the official views of the Harvard McLennan Family Fund, Chan Zuckerberg Biohub, or Alexander von Humboldt Foundation. The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; or decision to submit the manuscript for publication. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Publisher Copyright: {\textcopyright} 2022 American College of Cardiology Foundation",

year = "2022",

month = aug,

day = "23",

doi = "10.1016/j.jacc.2022.05.044",

language = "English",

volume = "80",

pages = "804--817",

journal = "Journal of the American College of Cardiology",

issn = "0735-1097",

publisher = "Elsevier Science",

number = "8",

}

Kirschbaum, TK, Sudharsanan, N, Manne-Goehler, J, De Neve, J-W, Lemp, JM, Theilmann, M, Marcus, M-E, Ebert, C, Chen, S, Yoosefi, M, Sibai, AM, Rouhifard, M, Moghaddam, SS, Mayige, MT, Martins, JS, Lunet, N, Jorgensen, JMA, Houehanou, C, Farzadfar, F, Damasceno, A, Bovet, P, Bahendeka, SK, Aryal, KK, Andall-Brereton, G, Davies, JI, Atun, R, Vollmer, SJ, Bärnighausen , T, Jaacks, L & Geldsetzer, P 2022, 'The Association of Socioeconomic Status With Hypertension in 76 Low Q1 and Middle-Income Countries', Journal of the American College of Cardiology, vol. 80, no. 8, pp. 804-817. https://doi.org/10.1016/j.jacc.2022.05.044

TY - JOUR

T1 - The Association of Socioeconomic Status With Hypertension in 76 Low Q1 and Middle-Income Countries

AU - Kirschbaum, Tabea K.

AU - Sudharsanan, Nikkil

AU - Manne-Goehler, Jennifer

AU - De Neve, Jan-Walter

AU - Lemp, Julia M.

AU - Theilmann, Michaela

AU - Marcus, Maja-Emilia

AU - Ebert, Cara

AU - Chen, Simiao

AU - Yoosefi, Moein

AU - Sibai, Abla Mehio

AU - Rouhifard, Mahtab

AU - Moghaddam, Sahar Saeedi

AU - Mayige, Mary T

AU - Martins, Joao S.

AU - Lunet, Nuno

AU - Jorgensen, Jutta M.A.

AU - Houehanou, Corine

AU - Farzadfar, Farshad

AU - Damasceno, Albertino

AU - Bovet, Pascal

AU - Bahendeka, Silver K

AU - Aryal, Krishna K

AU - Andall-Brereton, Glennis

AU - Davies, Justine I.

AU - Atun, Rifat

AU - Vollmer, Sebastian J.

AU - Bärnighausen , Till

AU - Jaacks, Lindsay

AU - Geldsetzer, Pascal

N1 - Funding Information: Drs De Neve and Bärnighausen were supported by the Alexander von Humboldt Foundation, funded by Germany’s Federal Ministry of Education and Research. Dr Jaacks has received funding from the Harvard McLennan Family Fund. Dr Geldsetzer is a Chan Zuckerberg Biohub investigator. The content is solely the responsibility of the authors and does not necessarily represent the official views of the Harvard McLennan Family Fund, Chan Zuckerberg Biohub, or Alexander von Humboldt Foundation. The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; or decision to submit the manuscript for publication. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Publisher Copyright: © 2022 American College of Cardiology Foundation

PY - 2022/8/23

Y1 - 2022/8/23

N2 - 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 changein the future as countries continue to develop economically.OBJECTIVES This study aimed to determine how hypertension prevalence in LMICs varies by individuals’ education andhousehold wealth, and how these socioeconomic gradients in hypertension prevalence are associated with a country’sgross domestic product (GDP) per capita.METHODS We pooled nationally representative individual-level data in 76 LMICs of 1.2 million adults across LMICs. Wedisaggregated hypertension prevalence by education and household wealth quintile, and used regression analyses toadjust for age and sex.RESULTS Pooling across the 76 study countries, hypertension prevalence tended to be similar between educationgroups and household wealth quintiles. The only world region with a clear positive association of hypertension withincreasing education or household wealth was Southeast Asia. Countries with a lower GDP per capita had, on average, amore positive association among hypertension and increasing education and household wealth quintile than countrieswith a higher GDP per capita, especially in rural regions and among men.CONCLUSIONS Differences in hypertension prevalence between socioeconomic groups were generally small, witheven the least educated and least wealthy groups having a substantial prevalence. Our cross-sectional interactionanalyses of GDP per capita with the socioeconomic gradients of hypertension suggest that hypertension may increasinglyaffect adults in the lowest socioeconomic groups as LMICs develop economically. (J Am Coll Cardiol 2022;-:-–-)

AB - 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 changein the future as countries continue to develop economically.OBJECTIVES This study aimed to determine how hypertension prevalence in LMICs varies by individuals’ education andhousehold wealth, and how these socioeconomic gradients in hypertension prevalence are associated with a country’sgross domestic product (GDP) per capita.METHODS We pooled nationally representative individual-level data in 76 LMICs of 1.2 million adults across LMICs. Wedisaggregated hypertension prevalence by education and household wealth quintile, and used regression analyses toadjust for age and sex.RESULTS Pooling across the 76 study countries, hypertension prevalence tended to be similar between educationgroups and household wealth quintiles. The only world region with a clear positive association of hypertension withincreasing education or household wealth was Southeast Asia. Countries with a lower GDP per capita had, on average, amore positive association among hypertension and increasing education and household wealth quintile than countrieswith a higher GDP per capita, especially in rural regions and among men.CONCLUSIONS Differences in hypertension prevalence between socioeconomic groups were generally small, witheven the least educated and least wealthy groups having a substantial prevalence. Our cross-sectional interactionanalyses of GDP per capita with the socioeconomic gradients of hypertension suggest that hypertension may increasinglyaffect adults in the lowest socioeconomic groups as LMICs develop economically. (J Am Coll Cardiol 2022;-:-–-)

U2 - 10.1016/j.jacc.2022.05.044

DO - 10.1016/j.jacc.2022.05.044

M3 - Article

SN - 0735-1097

VL - 80

SP - 804

EP - 817

JO - Journal of the American College of Cardiology

JF - Journal of the American College of Cardiology

IS - 8

ER -

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

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