中国高血压患者的性别差异与社会经济不平等：全国横断面调查研究

Sex Difference and Socioeconomic Inequity in Chinese People With Hypertension: National Cross-Sectional Survey Study.

作者信息

Zhang Xiaoyun, Wang Siyu, Yang Qianqian, Zheng Ruizhi, Wang Long, Lin Hong, Wang Shuangyuan, Li Mian, Wang Tiange, Zhao Zhiyun, Lu Jieli, Xu Min, Chen Yuhong, Zheng Jie, Dai Meng, Zhang Di, Wang Weiqing, Ning Guang, Bi Yufang, Xu Yu

机构信息

Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.

National Clinical Research Center for Metabolic Diseases (Shanghai), Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.

出版信息

JMIR Public Health Surveill. 2024 Nov 20;10:e63144. doi: 10.2196/63144.

DOI:10.2196/63144

PMID:39621934

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11611794/

Abstract

BACKGROUND

Sex differences in blood pressure (BP) levels and hypertension are important and the role of socioeconomic status (SES) in sex differences in hypertension remains unclear.

OBJECTIVE

This study aimed to evaluate the impact of SES on sex differences of hypertension in a nationally representative survey study.

METHODS

A total of 98,658 participants aged ≥18 years who have lived in their current residence for ≥6 months were recruited from 162 study sites across mainland China. Sex was self-reported. Individual-level SES included the highest level of education and annual household income. Area-level SES included economic development status, urban/rural residency, and north/south location. Outcomes included levels of systolic and diastolic BP, and hypertension. Linear and Cox regression models were used to examine the associations between sex (women vs men) and BP characteristics stratified by individual or combined SES indicators.

RESULTS

Systolic and diastolic BP levels and the prevalence of hypertension were higher in men than in women. This sex difference was found across categories of SES with widened sex disparities in participants having more favorable SES. Significant multiplicative interaction effects of SES on the association of sex with BP characteristics were found. Women with improving SES were associated with lower BP and hypertension prevalence compared to men. For combined SES, a 9% (prevalence ratio 0.91, 95% CI 0.83-0.98) and a 30% lower probability (prevalence ratio 0.70, 95% CI 0.63-0.78) of having hypertension were found in women with an overall intermediate SES and high SES, respectively, compared to those with low SES, while no significant reduction was found in men.

CONCLUSIONS

There are significant sex differences in BP characteristics and SES has a potent impact on the disparities. Sex-specific public health policies to alleviate socioeconomic inequalities, especially in women are important for the prevention of hypertension.

摘要

背景

血压水平和高血压存在性别差异，社会经济地位（SES）在高血压性别差异中的作用尚不清楚。

目的

本研究旨在通过一项具有全国代表性的调查研究，评估社会经济地位对高血压性别差异的影响。

方法

从中国大陆162个研究地点招募了98658名年龄≥18岁且在现居住地居住≥6个月的参与者。性别由参与者自行报告。个体层面的社会经济地位包括最高教育水平和家庭年收入。地区层面的社会经济地位包括经济发展状况、城乡居住地以及南北地理位置。研究结果包括收缩压和舒张压水平以及高血压。采用线性回归模型和Cox回归模型，按个体或综合社会经济地位指标分层，研究性别（女性与男性）与血压特征之间的关联。

结果

男性的收缩压和舒张压水平以及高血压患病率均高于女性。在社会经济地位的各个类别中均发现了这种性别差异，且在社会经济地位更优的参与者中，性别差异有所扩大。发现社会经济地位对性别与血压特征之间的关联存在显著的相乘交互作用。与男性相比，社会经济地位改善的女性血压和高血压患病率较低。对于综合社会经济地位，总体处于中等社会经济地位和高社会经济地位的女性患高血压的概率分别比低社会经济地位的女性低9%（患病率比0.91，95%CI 0.83-0.98）和30%（患病率比0.70，95%CI 0.63-0.78），而男性未发现显著降低。