The relationship between socioeconomic status and hypertension in South African adolescents
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Date
2021
Authors
Mahlati, Zisiwe
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Abstract
Background: Hypertension is a non-communicable condition marked by consistently elevated
systolic and diastolic blood pressures. Hypertension is associated with adverse outcomes
including various manifestations of morbidity e.g., cardiovascular disease, and disability, and
mortality. Literature suggests that hypertension may be associated with socioeconomic status
(SES), in addition to a range of other explanatory variables. Yet, pathways of this relationship
in adolescence are not clear due to a paucity of data on hypertension and its correlates in this
population, particularly in low- and middle-income countries (LMIC). Therefore, this study
aimed to examine the relationship between SES and hypertension and identify the possible
pathways between SES as exposure and the onset of hypertension among adolescents in South
Africa.
Methods: The primary data accessed for this study were from the South African Demographic
and Health Survey of 2016. A secondary analysis of the data entailed a crude estimation of the
prevalence of hypertension and a survey-weighted investigation of correlates of hypertension
among adolescents. For this secondary analysis, SES was categorized into five quintiles
namely; poorest, poorer, middle, richer, and richest. Hypertension was defined as BP greater
than the 95th percentile for sex, height and age in adolescents aged 17 years and younger.
Among those aged 18 and 19 years, hypertension was defined as SBP above 140 mmHg and/or
DBP above 90mmHg. Logistic regression models and generalized structural equation
modelling (SEM) were then employed to examine the relationship between SES and
hypertension in adolescence.
Results: The overall prevalence of hypertension in the study was 26% and was higher in males
(28.3%) compared to females (24.6%). The relationship between SES and hypertension was
not statistically significant. After adjusting for potential confounders age, sex, BMI, and level
of education, the relationship between SES and hypertension remained one of no statistical
significance. However, the results still suggested an increased risk of hypertension by 17% and
18% among the lowest two SES quintiles while the highest SES quintile suggested a 32%
decreased risk of hypertension. From the GSEM results it was observed that age and BMI were
the only factors that influenced hypertension with OR = 0.72 (95% CI: 0.63 - 0.82) and OR =
1.06 (95% CI:1.02 - 1.11) respectively.
Conclusion: This study reported a high prevalence of hypertension among adolescents in
South Africa. Surprisingly, there was no association between SES and hypertension. This
study emphasizes a need for further social epidemiology research on hypertension in this age
group, preferably with other proxies of socioeconomic status besides the wealth index. There
is a need for such data to then influence health policies to address the high burden of
hypertension in adolescents.
Description
A research report submitted in partial fulfilment of the requirements for the degree of Master of Science in Epidemiology (Epidemiology and Biostatistics) to the Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, 2021