Association of household wealth and education with hypertension among adults in Lesotho: Evidence from a propensity score–based study

In Lesotho, rapid urbanization and lifestyle transitions have contributed to a rising burden of hypertension, yet the role of socioeconomic factors remains inadequately understood. This study examined the independent and joint associations of household wealth and educational attainment with hypertension among adults in Lesotho. We analyzed data from 5,457 adults aged 18–49 years from the 2023–2024 Lesotho Demographic and Health Survey. Hypertension was defined as systolic blood pressure ≥140 mmHg, diastolic blood pressure ≥90 mmHg, self-reported prior diagnosis by a health professional, or current use of antihypertensive medication. The main exposures were household wealth status (poor vs non poor) and educational attainment (below secondary vs secondary or higher). Propensity scores were estimated using a super learner algorithm and applied through one-to-one nearest neighbor matching (PS matched) and inverse probability weighting (IPW) to adjust for covariates. Weighted logistic regression models generated adjusted odds ratios (AORs) and 95% confidence intervals (CIs). Overall, 21.2% (weighted) of participants were hypertensive. Adults from non poor households had significantly higher odds of hypertension than those from poor households (PS matched AOR 1.56, 95% CI 1.13–2.14; IPW AOR 1.76, 95% CI 1.21–2.57). Educational attainment alone was not significantly associated with hypertension. The wealth related gradient persisted across education strata, with the highest odds observed among non poor adults with secondary or higher education (AOR 2.06, 95% CI 1.34–3.16). Household wealth, but not education, was independently associated with hypertension among adults in Lesotho.