Socioeconomic Status Impact Hypertensive Risk and Treatment among Older Adults in China

Abstract

Background: Hypertension has become one of the significant health problems among the elderly. The disparities in the prevalence, awareness, and treatment of hypertension have been associated with socioeconomic status but lack of consistency especially in developing countries where is undergoing epidemiological transition. Methods: Data used in this study was drawn from the 2013 wave of the China Health and Retirement Longitudinal Study (CHARLS), which was designed with a multi-stage clustering population-based sampling. The dependent variables were hypertension as well as self-awareness and treatment of hypertension, both of which were measured as binary outcomes.The independent variables included the community and individual socioeconomic conditions mainly measured by education, income and occupations. A hierarchical logistic regression model was used for statistical analysis to considering the clustering at community level. Results: Individuals aged 45 years or older living in urban areas (Beta=0.144; p<0.1) and communities with higher mandarin fluency score (Beta=0.043; p<0.05) were positively associated with the risk of hypertension. Compared with agricultural workers, the retired (Beta=0.425; p<0.001), people working for government or institutions (Beta=0.519; p<0.001), working with a large company (Beta=0.362; p<0.05), farmer or working with a small private firm (Beta=0.302; p<0.05) were more likely to be hypertensive. We also found that urban living (Beta=0.194; p<0.1) and communities with a higher mandarin fluency score (Beta=0.061; p<0.05) were associated with a higher awareness of hypertension. There was a noted regional variation in both the awareness and treatment of hypertension; people living in the western China were less likely to be aware of (Beta=-0.186; p<0.1) and to manage their hypertension (Beta=-0.297; p<0.05) compared to those in the more developed eastern China. The inequality in treatment was also observed among occupations; the retired (Beta=0.785; p<0.001), individuals working for government or institutions (Beta=0.437; p<0.1) or for a private firm (Beta=0.395; p<0.1) were more likely to receive treatment for hypertension. Conclusion: Occupation, urban dwelling, and living in the more developed eastern China were associated with more likelihood of developing hypertension and being aware of and treated for hypertension. However, income and levels of education, two classical measures of socioeconomic status, were not associated with either of the three outcomeshypertensive risk, awareness and treatment in China.