The Level of Smartphone Addiction and Its Relationship to High Blood Pressure Among Middle-Aged and Elderly People in Rural Areas of China

Objective: There is a lack of research on the association between smartphone addiction and hypertension (HTN) in middle-aged and elderly populations, and their associations with employment status and sleep quality are still unclear. Methods: This study was conducted in 85 villages in southeastern China. A total of 975 middle-aged and elderly participants (mean age: 60.70 years; 483 males and 492 females) were included. Demographic data were collected. Smartphone addiction was assessed using the Smartphone Addiction Scale–Short Version (SAS-SV), and sleep quality was measured using the Brief version of the Pittsburgh Sleep Quality Index (B-PSQI). Multiple regression and moderated mediation analyses were used to explore the potential moderating role of employment status (employed vs. unemployed/retired) and the mediating role of sleep quality in the association between smartphone addiction and HTN. Results: A total of 415 (42.56%) individuals were suffering from HTN. Smartphone addiction was significantly and positively associated with sleep quality ( p < 0.001). And sleep quality was also significantly positively associated with HTN ( p < 0.05). Distinct patterns were observed across employment status groups, with a significant association between smartphone addiction and HTN in unemployed/retired participants (1.511, 95% CI: 1.140– 2.002, p = 0.004), whereas this association was mediated by sleep quality among employed participants. The direct association was 0.940 (95% CI: 0.787– 1.122) and the indirect association was 1.034 (95% CI: 1.002– 1.071). Conclusion: Smartphone addiction is associated with HTN among middle-aged and elderly individuals in rural China. Among unemployed or retired individuals, smartphone addiction may be directly associated with HTN, whereas among employed individuals, this association may be mediated by sleep quality. Reducing excessive smartphone use in rural middle-aged and elderly residents and improving sleep quality (especially in employed individuals) may help mitigate HTN risk. Future studies are warranted to explore underlying mechanisms using longitudinal designs.