Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK.
J Epidemiol Community Health. 2009 Aug;63(8):646-50. doi: 10.1136/jech.2008.081828. Epub 2009 Apr 29.
The association of socioeconomic position and cardiovascular disease risk factors in low- and middle-income countries has not been as consistent as that reported from high-income countries.
A cross-sectional study of 1015 participants from seven civil service departments in Accra, Ghana, was conducted in 2006. Hypertension was diagnosed when the mean of a second and third blood pressure reading on each of two visits 3 weeks apart was > or =140/90 mmHg or where participants were already diagnosed and on antihypertensive drugs. Socioeconomic measures considered were education, early life and adult wealth and civil service employment grade.
The age-adjusted prevalence of hypertension was lowest in participants of lower socioeconomic position (OR 21.9%; 95% CI 16.3 to 27.5) and highest in those of highest socioeconomic position (OR 31.8%; 95% CI 23.4 to 40.2) with inconsistent patterns among participants in the intermediate socioeconomic groups. Participants in the highest employment grade category were more likely to have hypertension than those in the lowest category (OR 1.91; 95% CI 1.14 to 3.20). There was a positive graded association between adult wealth and hypertension, with more assets associated with a greater risk (p trend 0.008). This trend was partly explained by body mass index differences. Blood pressure control among those with diagnosed hypertension was generally poor across the socioeconomic strata.
In low-income countries such as Ghana, there is a need to promote primary prevention of hypertension across the socioeconomic strata, with a focus on weight control among civil servants of higher socioeconomic position, and better hypertension control in those with hypertension.
在中低收入国家，社会经济地位与心血管疾病危险因素之间的关联并不像高收入国家报告的那样一致。
2006 年在加纳阿克拉的七个公务员部门中进行了一项针对 1015 名参与者的横断面研究。当两次访问中每一次的第二次和第三次血压读数的平均值间隔 3 周> =140/90mmHg 或参与者已经被诊断并服用抗高血压药物时，诊断为高血压。考虑的社会经济措施包括教育、早年和成年财富以及公务员就业等级。
社会经济地位较低的参与者中，高血压的年龄调整患病率最低（OR 21.9%；95%CI 16.3 至 27.5），社会经济地位最高的参与者中最高（OR 31.8%；95%CI 23.4 至 40.2），而处于中间社会经济群体的参与者则呈现不一致的模式。处于最高就业等级类别的参与者比处于最低等级类别的参与者更容易患高血压（OR 1.91；95%CI 1.14 至 3.20）。成年财富与高血压之间存在正分级关联，拥有更多资产与更高风险相关（p 趋势 0.008）。这种趋势部分解释了体重指数的差异。在所有社会经济阶层中，被诊断为高血压的患者的血压控制普遍较差。
在像加纳这样的低收入国家，需要在整个社会经济阶层中促进高血压的一级预防，重点关注社会经济地位较高的公务员的体重控制，以及对高血压患者的更好血压控制。
