Department of Family Medicine and Public Health Sciences, Wayne State University School of Medicine, Detroit, Michigan, USA.
Department of Internal Medicine, Wayne State University School of Medicine, Detroit, Michigan, USA.
Am J Hypertens. 2024 Feb 15;37(3):207-219. doi: 10.1093/ajh/hpad113.
Lower socioeconomic status (SES) has been associated with hypertension; however, the mediators and moderators of this association remain understudied. We examined the mediation effect of psychological distress on the link between lower SES and self-reported hypertension and the racial and sex moderation effects.
We analyzed the data collected from 2009 to 2019 among adults from the Panel Study of Income Dynamics (PSID). Lower SES was defined as one of 3 indicators: education ≤12 years, unemployed, or individual annual income <$27,800. Psychological distress was assessed using the Kessler K6 scale. Cox proportional hazard regression was conducted. Mediation analyses were performed using the PROCESS macro.
In the sample of heads of family who did not have self-reported hypertension in 2009 (N = 6,214), the mean age was 41 years, 30.6% were female, 32.9% were African American. The cumulative incidence of self-reported hypertension was 29.8% between 2009 and 2019. Cox proportional hazard regression analysis showed that after controlling for covariates, lower SES (score > 0 vs. score = 0) was associated with self-reported hypertension (hazard ratio = 1.27, 95% confidence interval = 1.14-1.42). SES had indirect effect on self-reported hypertension through psychological distress and the indirect effect (0.02 in females, 0.01 in males, P < 0.05) was moderated by sex but not by race.
The association of SES and self-reported hypertension was mediated by psychological distress and sex moderated the mediation effect. Interventions focused on reducing contributors to SES and psychological stress should be considered to reduce hypertension risk.
较低的社会经济地位（SES）与高血压有关；然而，这种关联的中介和调节因素仍有待研究。我们研究了心理困扰在较低 SES 与自我报告的高血压之间的联系中的中介作用，以及种族和性别调节作用。
我们分析了 2009 年至 2019 年期间来自收入动态面板研究（PSID）的成年人的数据。SES 较低定义为以下 3 个指标之一：教育程度≤12 年、失业或个人年收入<$27,800。使用 Kessler K6 量表评估心理困扰。使用 Cox 比例风险回归进行分析。使用 PROCESS 宏进行中介分析。
在 2009 年没有自我报告高血压的家庭负责人样本中（N=6214），平均年龄为 41 岁，30.6%为女性，32.9%为非裔美国人。2009 年至 2019 年期间，自我报告高血压的累积发病率为 29.8%。Cox 比例风险回归分析显示，在控制了混杂因素后，SES 较低（评分>0 与评分=0）与自我报告的高血压相关（风险比=1.27，95%置信区间=1.14-1.42）。SES 通过心理困扰对自我报告的高血压有间接影响，性别（女性为 0.02，男性为 0.01，P<0.05）调节了这种间接影响，但不受种族的影响。
SES 和自我报告的高血压之间的关联是通过心理困扰介导的，性别调节了这种中介效应。应考虑针对降低 SES 和心理压力因素的干预措施，以降低高血压风险。
