Key result
High socioeconomic status is linked to ~52% lower hypertension awareness but better control in younger adults.
Why the study?
The role of individual socioeconomic status in the awareness, treatment, and control of blood pressure had not been well studied in Taiwan despite comprehensive National Health Insurance coverage.
Does individual socioeconomic status affect the awareness, treatment, and control of hypertension in adults in Taiwan?
Cross-Sectional (n=4,599)
Yes
Does individual socioeconomic status affect the awareness, treatment, and control of hypertension in adults in Taiwan?
Effect estimate: OR 0.48 (95% CI 0.37-0.64)
p-value: p=<0.0001
In Taiwan, younger adults with higher socioeconomic status have lower awareness and treatment rates for hypertension, despite having better blood pressure control when treated.
Higher-SES younger adults warrant broader hypertension screening despite better control when treated; leaves open causal mechanisms in Taiwan.
OBJECTIVE: Implementation of National Health Insurance in 1995 improved the control of hypertension due to comprehensive coverage of medical costs for all residents in Taiwan. However, the role of individual socioeconomic status (iSES), namely, education and personal income, in awareness, treatmen, and control of blood pressure, has not been well studied in Taiwan. DESIGN: A nationwide cross-sectional survey was executed in this study. SETTING: A systematic, multistage sampling scheme from a nationwide cohort in Taiwan was adopted to select adult participants. Hypertension was defined as blood pressure ≥ 140/90 mm Hg or the use of antihypertensive medications. PARTICIPANTS: A total of 4599 subjects completed door-to-door household interviews and physical examinations. PRIMARY AND SECONDARY OUTCOME MEASURES: A summing z score of iSES was constructed by two domains of the iSES, namely, income and education, through which participants were classified into three SES levels. Logistic regression models were used to assess associations of awareness, treatment, and control in younger (<65 years) and older (≥65 years) participants with hypertension. RESULTS: Younger people in the highest tertile of iSES were less likely to be aware of their hypertension (OR: 0.48, 95% CI: 0.37 to 0.64, p<0.0001) or to have it treated (OR: 0.49, 95% CI 0.37 to 0.64, p<0.0001) but more likely to have their hypertension controlled (OR: 1.52, 95% CI 1.19 to 1.94, p=0.0009). We did not detect an association in people aged >65 years. CONCLUSION: Health education to improve awareness and treatment of hypertension should focus on younger people with higher iSES in Taiwan.
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Lin et al. (2022) conducted a cross-sectional in Hypertension (n=4,599). High individual socioeconomic status (highest tertile) vs. Lower socioeconomic status was evaluated on Awareness of hypertension in younger participants (<65 years) (OR 0.48, 95% CI 0.37-0.64, p=<0.0001). Younger adults (<65 years) in the highest socioeconomic tertile were less likely to be aware of their hypertension (OR 0.48; 95% CI 0.37-0.64; p<0.0001) but more likely to have it controlled.
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