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Sex difference and socioeconomic inequity in hypertension: a national survey study of 98,658 adults from 162 study sites
Xiaoyun Zhang;
Siyu Wang;
Qianqian Yang;
Ruizhi Zheng;
Long Wang;
Hong Lin;
Shuangyuan Wang;
Mian Li;
Tiange Wang;
Zhiyun Zhao;
Jieli Lu;
Min Xu;
Yuhong Chen;
Jie Zheng;
Meng Dai;
Di Zhang;
Weiqing Wang;
Guang Ning;
Yufang Bi;
Yu Xu
ABSTRACT
Background:
Sex differences in blood pressure (BP) levels and hypertension are important and the role of socioeconomic status (SES) in sex differences of hypertension remains unclear.
Objective:
We aimed to evaluate the impact of SES on sex differences of hypertension in a nationally representative survey study.
Methods:
A total of 98,658 participants aged ≥18 years who have lived in their current residence for ≥6 months were recruited from 162 study sites across mainland China. Sex was self-reported. Individual-level SES included the highest level of education and annual household income. Area-level SES included economic development status, urban/rural residency, and north/south location. Outcomes included levels of systolic and diastolic BP, and hypertension. Linear and Cox regression models were used to examine the associations between sex (women vs. men) and BP characteristics stratified by individual or combined SES indicators.
Results:
Systolic and diastolic BP levels and prevalence of hypertension were higher in men than women. This sex difference was found across categories of SES with widened sex disparities in participants having more favorable SES. Significant interaction effects of SES on the association of sex with BP characteristics were found. Women with improving SES were associated with lower BP and hypertension prevalence compared with men. For combined SES, a 9% (prevalence ratio (PR)=0.91, 95% confidence interval (CI)=0.85, 0.98) and a 22% lower probability (PR=0.78, 95% CI=0.71, 0.86) of having hypertension were found in women with an overall intermediate SES and high SES, respectively compare with low SES while no significant reduction was found in men.
Conclusions:
There are significant sex differences in BP characteristics and SES has a potent impact on the disparities. Sex-specific public health policies to alleviate socioeconomic inequalities, especially in women are important for the prevention of hypertension.
Citation
Please cite as:
Zhang X, Wang S, Yang Q, Zheng R, Wang L, Lin H, Wang S, Li M, Wang T, Zhao Z, Lu J, Xu M, Chen Y, Zheng J, Dai M, Zhang D, Wang W, Ning G, Bi Y, Xu Y
Sex Difference and Socioeconomic Inequity in Chinese People With Hypertension: National Cross-Sectional Survey Study