Department of Health Management, College of Public Health, Zhengzhou University, 100 Kexue Road, Gaoxin District, Zhengzhou 450001, China.
Department of Science and Laboratory Technology, Dar es Salaam Institute of Technology, Dar es Salaam P.O. Box 2958, Tanzania.
Nutrients. 2024 Jul 24;16(15):2401. doi: 10.3390/nu16152401.
Socioeconomic status (SES) plays a crucial role in blood pressure (BP) control. SES may influence BP control through obesity indices, such as body mass index (BMI) and waist circumference (WC). This study aimed to understand the relationships between SES and BP control in the elderly hypertensive population, and to determine whether BMI and WC mediate the relationship between SES and BP control.
The study was conducted in Jia County, Henan Province, China, from 1 July to 31 August 2023. The 18,963 hypertensive people over 65 years old who were included in the National Basic Public Health Service Program were investigated. The study utilized questionnaire surveys to collect data on participants' demographic characteristics, disease history, lifestyle behaviors, antihypertensive medication, and measured height, weight, and blood pressure. SES was indexed by participants' self-reported educational level, family income, and occupation, and categorized into low, medium, and high groups by using latent category analysis (LCA). Logistic regression models were used to analyze the associations between SES and BP control. Obesity indicators, represented by BMI and WC, were included in mediation models to examine the indirect effects of BMI/WC on the association between SES and BP control.
The mean age of 17,234 participants was 73.4 years and 9888 (57.4%) of the participants were female. The LCA results indicated the number of participants in low SES, middle SES, and high SES groups were 7760, 8347, and 1127, respectively. Compared with the low SES group, the odds ratios (ORs) and 95% confidence intervals (CIs) for the association of BP control with middle SES and high SES were 1.101 (1.031, 1.175), and 1.492 (1.312, 1.696). This association was similarly found in the subsequent subgroup analyses ( < 0.05). Compared with low SES, our findings further suggested that BMI (indirect effects: 95% CIs: -0.004--0.001; < 0.001) and WC (indirect effects: 95% CIs: -0.003--0.001; = 0.020) play a suppressing role in the association between high SES and BP control.
Our study indicated that the elderly hypertensive population with high SES may have a better result for BP control. However, we found that BMI/WC plays a suppressing role in this association. This indicated that despite the better BP control observed in elderly hypertensive populations with high SES, BMI and WC might undermine this beneficial relationship. Therefore, implementing strategies for obesity prevention is an efficient way to maintain this beneficial association between high SES and BP control.
社会经济地位（SES）在血压（BP）控制中起着至关重要的作用。SES 可能通过肥胖指数（如体重指数（BMI）和腰围（WC））影响 BP 控制。本研究旨在了解 SES 与老年高血压人群血压控制之间的关系，并确定 BMI 和 WC 是否介导 SES 与 BP 控制之间的关系。
该研究于 2023 年 7 月 1 日至 8 月 31 日在河南省甲县进行。本研究纳入了 18963 名年龄在 65 岁以上、参加国家基本公共卫生服务项目的高血压患者。采用问卷调查收集参与者的人口统计学特征、疾病史、生活方式行为、降压药物使用以及身高、体重和血压等数据。SES 由参与者自我报告的教育水平、家庭收入和职业来衡量，并采用潜在类别分析（LCA）将 SES 分为低、中、高三个组别。采用逻辑回归模型分析 SES 与 BP 控制之间的关联。将 BMI 和 WC 等肥胖指标纳入中介模型，以检验 BMI/WC 对 SES 与 BP 控制之间关联的间接影响。
在 17234 名参与者中，平均年龄为 73.4 岁，其中 9888 名（57.4%）为女性。LCA 结果显示，低 SES、中 SES 和高 SES 组的参与者人数分别为 7760、8347 和 1127 人。与低 SES 组相比，中 SES 和高 SES 组 BP 控制与 SES 之间的关联的比值比（OR）和 95%置信区间（CI）分别为 1.101（1.031，1.175）和 1.492（1.312，1.696）。在后续的亚组分析中也发现了类似的关联（<0.05）。与低 SES 组相比，我们的研究结果进一步表明 BMI（间接效应：95%CI：-0.004--0.001；<0.001）和 WC（间接效应：95%CI：-0.003--0.001；=0.020）在 SES 与 BP 控制之间的关联中发挥抑制作用。
本研究表明，社会经济地位较高的老年高血压人群可能在 BP 控制方面表现更好。然而，我们发现 BMI/WC 在这种关联中发挥抑制作用。这表明，尽管 SES 较高的老年高血压人群的 BP 控制情况更好，但 BMI 和 WC 可能会破坏这种有益的关系。因此，实施肥胖预防策略是维持 SES 与 BP 控制之间这种有益关联的有效方法。
