Chhabra Pragti, Behera Shyambhavee, Sharma Rahul, Malhotra Rajeev Kumar, Mehta Kedar, Upadhyay Kritika, Goel Sonu
Department of Community Medicine, University College of Medical Sciences, New Delhi, India.
Delhi Cancer Registry, Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India.
Front Cardiovasc Med. 2022 Dec 14;9:999567. doi: 10.3389/fcvm.2022.999567. eCollection 2022.
The association of conventional (modifiable and non-modifiable) risk factors for hypertension has already been established in the literature. However, there are other putative risk factors specific to women (early menarche, age at first childbirth, women empowerment, number of children born, hysterectomy, etc.) in the development of hypertension. This study is the first study to highlight the potential association of gender-specific factors along with other conventional risk factors and hypertension, using a nationwide sample.
The study is a secondary analysis of the data collected from the National Family Health Survey-4 (NFHS-4), a nationally representative sample of 699,686 women of reproductive age in India. The interview schedule included data on general background characteristics, marriage, reproductive history, hysterectomy, knowledge, and utilization of family planning services, maternal and child care, women empowerment, non-communicable diseases, and domestic violence. The blood pressure was measured by direct observation by the study investigators using a digital blood pressure monitor. To account for disproportionate sampling and non-response, a weighted statistical analysis was performed. Logistic regression analysis was done to study the strength of the association between the risk factors and hypertension (computation of unadjusted and adjusted odds ratio).
The prevalence of hypertension was 11.8% among women. Among the conventional factors, older age, higher body mass index (BMI), tobacco use, and alcohol use had higher odds for hypertension, while higher education, higher socio-economic position, and living in urban areas had lower odds. Among the gender-specific factors, younger age at first childbirth, early menarche, oral contraceptive pill use [adjusted OR: 1.23; (1.18-1.28)], and hysterectomy [adjusted OR: 1.10; (1.05-1.69)] were found to be risk factors for hypertension. Domestic violence was significantly associated with hypertension [unadjusted OR: 1.11; (1.02-1.20)]. Empowered women had lower odds of hypertension [adjusted OR: 0.93; (0.95-1.03)].
Significant association of these gender-specific factors among women necessitates the need for taking into account these factors while screening for hypertension among women and thus, designing a tailored model better suited to them for risk assessment.
高血压的传统（可改变和不可改变）危险因素之间的关联已在文献中得到证实。然而，在高血压的发生发展中，还存在其他特定于女性的假定危险因素（初潮早、首次生育年龄、女性赋权、生育子女数、子宫切除术等）。本研究是第一项使用全国性样本，强调特定性别因素与其他传统危险因素及高血压之间潜在关联的研究。
该研究是对从第四次全国家庭健康调查（NFHS - 4）收集的数据进行的二次分析，NFHS - 4是印度699,686名育龄妇女的全国代表性样本。访谈问卷包括一般背景特征、婚姻、生育史、子宫切除术、计划生育服务的知识和利用情况、母婴保健、女性赋权、非传染性疾病以及家庭暴力等方面的数据。血压由研究调查人员使用数字血压监测仪直接观察测量。为了考虑不均衡抽样和无应答情况，进行了加权统计分析。采用逻辑回归分析来研究危险因素与高血压之间关联的强度（计算未调整和调整后的比值比）。
女性高血压患病率为11.8%。在传统因素中，年龄较大、体重指数（BMI）较高、吸烟和饮酒患高血压的几率较高，而受教育程度较高、社会经济地位较高以及居住在城市地区的几率较低。在特定性别因素中，首次生育年龄较小、初潮早、使用口服避孕药[调整后的比值比：1.23；（1.18 - 1.28）]和子宫切除术[调整后的比值比：1.10；（1.05 - 1.69）]被发现是高血压的危险因素。家庭暴力与高血压显著相关[未调整的比值比：1.11；（1.02 - 1.20）]。赋权女性患高血压的几率较低[调整后的比值比：0.93；（0.95 - 1.03）]。
这些特定于女性的因素之间存在显著关联，因此在对女性进行高血压筛查时需要考虑这些因素，从而设计出更适合她们的风险评估定制模型。
