Sex Difference and Socioeconomic Inequity in Chinese People With Hypertension: National Cross-Sectional Survey Study

Abstract

Background: Sex differences in blood pressure (BP) levels and hypertension are important and the role of socioeconomic status (SES) in sex differences in hypertension remains unclear.

Objective: This study aimed to evaluate the impact of SES on sex differences of hypertension in a nationally representative survey study.

Methods: A total of 98,658 participants aged ≥18 years who have lived in their current residence for ≥6 months were recruited from 162 study sites across mainland China. Sex was self-reported. Individual-level SES included the highest level of education and annual household income. Area-level SES included economic development status, urban/rural residency, and north/south location. Outcomes included levels of systolic and diastolic BP, and hypertension. Linear and Cox regression models were used to examine the associations between sex (women vs men) and BP characteristics stratified by individual or combined SES indicators.

Results: Systolic and diastolic BP levels and the prevalence of hypertension were higher in men than in women. This sex difference was found across categories of SES with widened sex disparities in participants having more favorable SES. Significant multiplicative interaction effects of SES on the association of sex with BP characteristics were found. Women with improving SES were associated with lower BP and hypertension prevalence compared to men. For combined SES, a 9% (prevalence ratio 0.91, 95% CI 0.83-0.98) and a 30% lower probability (prevalence ratio 0.70, 95% CI 0.63-0.78) of having hypertension were found in women with an overall intermediate SES and high SES, respectively, compared to those with low SES, while no significant reduction was found in men.

Conclusions: There are significant sex differences in BP characteristics and SES has a potent impact on the disparities. Sex-specific public health policies to alleviate socioeconomic inequalities, especially in women are important for the prevention of hypertension.

Keywords: blood pressure; cross-sectional survey; hypertension; sex difference; socioeconomic inequity.

Figure 1.. Distribution of BP characteristics in subcategories of education duration and economic development status stratified by age groups in men and women (hypertension was defined as a self-report of using antihypertensive medications within the previous 2 weeks, or a systolic BP ≥140 mm Hg, or a diastolic BP ≥90 mm Hg). Data are weighted means or percentages. The changing green color depicts different levels of BP and hypertension prevalence with darker green indicating higher levels. The changing blue and red colors depict differences between women and men with darker blue indicating lower levels in women versus men and darker red indicating higher levels in women versus men. BP: blood pressure.

Figure 2.. Associations between the overall SES and prevalent hypertension defined by BP ≥140/90 mm Hg in Chinese men and women in unadjusted (A) and multivariable-adjusted (B) models (hypertension was defined as a self-report of using antihypertensive medications within the previous 2 weeks, or a systolic BP ≥140 mm Hg, or a diastolic BP ≥90 mm Hg). The low-SES group was the reference group. Data are shown as PR (95% CIs). The multivariable model included age, smoking status, drinking status, physical activity, diet score, and obesity. BP: blood pressure; PR: prevalence ratio; SES: socioeconomic status.