Department of Epidemiology and Population Health, Stanford University, Stanford, California, United States of America.
Public Health Sciences Program, Santa Clara University, Santa Clara, California, United States of America.
PLoS One. 2022 Apr 28;17(4):e0266729. doi: 10.1371/journal.pone.0266729. eCollection 2022.
Geographic and contextual socioeconomic risk factors in adolescence may be more strongly associated with young adult hypertension than individual-level risk factors. This study examines the association between individual, neighborhood, and school-level influences during adolescence on young adult blood pressure.
Data were analyzed from the National Longitudinal Study of Adolescent to Adult Health (1994-1995 aged 11-18 and 2007-2008 aged 24-32). We categorized hypertension as systolic blood pressure ≥140 mm Hg and/or diastolic blood pressure ≥90 mm Hg. Secondary outcomes included continuous systolic and diastolic blood pressure. We fit a series of cross-classified multilevel models to estimate the associations between young adulthood hypertension with individual-level, school-level, and neighborhood-level factors during adolescence (i.e., fixed effects) and variance attributable to each level (i.e., random effects). Models were fit using Bayesian estimation procedures. For linear models, intra-class correlations (ICC) are reported for random effects.
The final sample included 13,911 participants in 128 schools and 1,917 neighborhoods. Approximately 51% (7,111) young adults were hypertensive. Individual-level characteristics-particularly older ages, Non-Hispanic Black race, Asian race, male sex, BMI, and current smoking-were associated with increased hypertension. Non-Hispanic Black (OR = 1.21; 95% CI: 1.03-1.42) and Asian (OR = 1.28; 95% CI: 1.02-1.62) students had higher odds of hypertension compared to non-Hispanic White students. At the school level, hypertension was associated with the percentage of non-Hispanic White students (OR for 10% higher = 1.06; 95% CI: 1.01-1.09). Adjusting for individual, school, and neighborhood predictors attenuated the ICC for both the school (from 1.4 null to 0.9 fully-adjusted) and neighborhood (from 0.4 to 0.3).
We find that adolescents' schools and individual-level factors influence young adult hypertension, more than neighborhoods. Unequal conditions in school environments for adolescents may increase the risk of hypertension later in life. Our findings merit further research to better understand the mechanisms through which adolescents' school environments contribute to adult hypertension and disparities in hypertension outcomes later in life.
青少年时期的地理和背景社会经济风险因素与青年成年人高血压的相关性可能强于个体层面的风险因素。本研究旨在探讨青少年时期个体、社区和学校层面的影响因素与青年成年人血压之间的关系。
本研究数据来自国家青少年健康纵向研究（1994-1995 年年龄为 11-18 岁，2007-2008 年年龄为 24-32 岁）。我们将高血压定义为收缩压≥140mmHg 和/或舒张压≥90mmHg。次要结局包括连续的收缩压和舒张压。我们拟合了一系列交叉分类多水平模型，以估计青少年时期个体水平、学校水平和社区水平因素与青年成年人高血压（即固定效应）之间的关联，以及每个水平的方差归因（即随机效应）。模型采用贝叶斯估计程序进行拟合。对于线性模型，报告了随机效应的组内相关系数（ICC）。
最终样本包括 128 所学校和 1917 个社区的 13911 名参与者。大约 51%（7111 名）的青年成年人患有高血压。个体水平的特征，特别是年龄较大、非西班牙裔黑人种族、亚洲种族、男性性别、BMI 和当前吸烟，与高血压的发生风险增加相关。与非西班牙裔白人学生相比，非西班牙裔黑人（比值比[OR]=1.21；95%置信区间[CI]：1.03-1.42）和亚洲学生（OR=1.28；95%CI：1.02-1.62）发生高血压的可能性更高。在学校层面，高血压与非西班牙裔白人学生的比例相关（每增加 10%，OR=1.06；95%CI：1.01-1.09）。调整个体、学校和社区预测因素后，学校（从 1.4 完全调整到 0.9）和社区（从 0.4 完全调整到 0.3）的 ICC 均减弱。
我们发现青少年的学校和个体层面的因素比社区更能影响青年成年人的高血压。青少年在学校环境中面临的不平等条件可能会增加他们日后患高血压的风险。我们的研究结果值得进一步研究，以更好地理解青少年学校环境对成年人高血压和日后高血压结局差异的影响机制。
