Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America.
Rakai Health Sciences Program, Kalisizo, Uganda.
Glob Heart. 2022 Jan 13;17(1):3. doi: 10.5334/gh.1088. eCollection 2022.
Limited studies exploring the impact of socioeconomic status (SES) on hypertension in Africa suggest a positive association between higher SES and hypertension. The economic development in sub-Saharan African countries has led to changes in SES and associated changes in lifestyle, diet, and physical activity, which may affect the relationship between hypertension and SES differently compared with higher income countries. This cross-sectional study from a large population-based cohort, the Rakai Community Cohort Study (RCCS), examines SES, hypertension prevalence, and associated risk factors in the rural Rakai Region in south-central Uganda.
Adults aged 30-49 years residing in 41 RCCS fishing, trading, and agrarian communities, were surveyed with biometric data obtained between 2016 and 2018. The primary outcome was hypertension (systolic blood pressure (BP) ≥ 130 mmHg or diastolic BP ≥ 80 mmHg). Modified Poisson regression assessed the adjusted prevalence ratios (PR) of hypertension associated with SES; body mass index (BMI) was explored as a potential mediator.
Among 9,654 adults, 20.8% had hypertension (males 21.2%; females 20.4 %). Participants with hypertension were older (39.0 ± 6.0 vs. 37.8 ± 5.0; p < 0.001). Higher SES was associated with overweight or obese BMI categories (p < 0.001). In the multivariable model, hypertension was associated with the highest SES category (aPR 1.23; confidence interval 1.09-1.38; p = 0.001), older age, male sex, alcohol use, and living in fishing communities and inversely associated with smoking and positive HIV serostatus. When BMI was included in the model, there was no association between SES and hypertension (aPR 1.02; CI 0.90-1.15, p = 0.76).
Hypertension is common in rural Uganda among individuals with higher SES and appears to be mediated by BMI. Targeted interventions could focus on lifestyle modification among highest-risk groups to optimize public health impact.
Hypertension is an important modifiable risk factor for cardiovascular disease.There are few large epidemiological studies that investigate the relationship between hypertension and socioeconomic status in low-income countries. Hypertension is common among adults in rural South-Central Uganda, particularly among those with higher socioeconomic status.BMI is a mediator of the relationship between hypertension and socioeconomic status. These findings suggest that public health interventions and community efforts to prevent chronic cardiovascular disease and hypertension should focus on lifestyle modification by elucidating obesity risk perception and health risk awareness, particularly among those of higher socioeconomic status.
有限的研究探索了社会经济地位（SES）对非洲高血压的影响，这些研究表明 SES 较高与高血压之间存在正相关关系。撒哈拉以南非洲国家的经济发展导致 SES 发生变化，以及生活方式、饮食和身体活动的相关变化，这可能会影响高血压与 SES 之间的关系，与高收入国家不同。这项来自大型基于人群的队列研究，即 Rakai 社区队列研究（RCCS）的横断面研究，检查了在乌干达中南部农村 Rakai 地区的 SES、高血压患病率和相关危险因素。
年龄在 30-49 岁之间、居住在 RCCS 渔业、贸易和农业社区的成年人，在 2016 年至 2018 年期间进行了生物特征数据调查。主要结果是高血压（收缩压（BP）≥130mmHg 或舒张压（BP）≥80mmHg）。修正泊松回归评估了 SES 与高血压相关的调整患病率比（PR）；体重指数（BMI）被探索为潜在的中介因素。
在 9654 名成年人中，20.8%患有高血压（男性 21.2%；女性 20.4%）。患有高血压的参与者年龄较大（39.0±6.0 岁 vs. 37.8±5.0 岁；p<0.001）。较高的 SES 与超重或肥胖的 BMI 类别相关（p<0.001）。在多变量模型中，高血压与最高 SES 类别相关（调整后的患病率比 1.23；95%置信区间 1.09-1.38；p=0.001），与年龄较大、男性、饮酒以及居住在渔业社区相关，与吸烟和 HIV 阳性呈负相关。当 BMI 纳入模型时，SES 与高血压之间没有关联（调整后的患病率比 1.02；95%置信区间 0.90-1.15，p=0.76）。
在乌干达农村，较高 SES 的个体中高血压很常见，并且似乎由 BMI 介导。有针对性的干预措施可以侧重于最高风险群体的生活方式改变，以优化公共卫生影响。
高血压是心血管疾病的一个重要可改变的危险因素。在低收入国家，很少有大型的流行病学研究调查高血压与社会经济地位之间的关系。在乌干达中南部农村，成年人中高血压很常见，特别是 SES 较高的成年人。BMI 是高血压与社会经济地位之间关系的中介。这些发现表明，预防慢性心血管疾病和高血压的公共卫生干预措施和社区努力应侧重于通过阐明肥胖风险认知和健康风险意识来进行生活方式改变，特别是在 SES 较高的人群中。
