A Structural Equation Modeling Approach for the Impact of Socioeconomic Status on Blood Pressure among Older Adults in India and the Role of Mediators - Evidence from the Longitudinal Aging Study of India - Wave 1.

Raised blood pressure (BP) is an important risk factor for cardiovascular diseases. Research has shown a negative gradient of BP with socioeconomic status (SES) in developed countries. However, studies in India reveal conflicting results. To examine the association between SES and BP among older adults in India and to explore the mediating mechanisms. Structural Equation Modeling was employed to investigate the association of SES indicators (monthly per-capita expenditure and education) with systolic and diastolic BP using the cross-sectional data from Longitudinal Aging Study of India- Wave-1 (2017-2019). Separate models were fitted for rural men, rural women, urban men, and urban women to capture the residence- and gender-based variations. Mediating effects of bio-behavioral risk factors and antihypertensive medication use were explored. The sample size under analysis was 59,333. After adjusting for age, SES was positively associated with systolic and diastolic BP in both rural men and women. A clear pattern was not observed in urban men, while a negative association was observed in urban women. The hypothesized mediators exhibited a harmful mediating effect in all associations, with Body Mass Index being the strongest. There existed a significant protective effect of raising SES on BP in urban women which was not explained by the mediators. In a country like India undergoing rapid socioeconomic changes, BP complexly interacts with SES, varying between residence and genders. This underscores the need for further exploration to inform effective public health interventions.