Educational attainment and arterial hypertension in 160,000 Mexican adults: a pooled subanalysis of three surveys endorsed by the Collaborative Group on Arterial Hypertension

Educational attainment is a key structural social determinant of health linked to arterial hypertension. However, evidence from Mexico, particularly regarding potentially modifiable mediators, is limited. Here, we evaluated the association between educational attainment and arterial hypertension and explored potential mediators. We pooled harmonized data from adults (≥ 20 years) screened in Mexico May Measurement Month surveys in 2021, 2022, and 2023. Arterial hypertension was defined as prior medical diagnosis, use of blood pressure (BP)–lowering medication, and/or systolic BP ≥ 140 mmHg or diastolic BP ≥ 90 mmHg. Educational attainment was categorized as 0–6, 7–12, and ≥ 13 years. Sex-stratified Poisson models with robust variance were used to estimate adjusted prevalence ratios. Exploratory mediation analyses were conducted. Among 166,251 participants (60% women; mean age, 47 ± 17 years; 37% with arterial hypertension), we found an inverse association between educational attainment and arterial hypertension. Compared with adults with ≥ 13 years of education, those with 0–6 and 7–12 years of education had 22% (95% CI: 1.19–1.24) and 10% (95% CI: 1.09–1.12) higher prevalence of hypertension, respectively. The association was stronger in women than in men. When diabetes, alcohol intake, and physical inactivity were considered jointly, they explained between 14 to 19% of the association between education and arterial hypertension. Lower educational attainment were positively associated with a higher prevalence of arterial hypertension, and modifiable factors explained approximately one-fifth of this association. These results suggest that educational attainment should be considered in BP screening and risk factor management.