Article Impact Level: HIGH Data Quality: STRONG Summary of Clinical Cardiology, 46(8), 958–966. https://doi.org/10.1002/clc.24079 Dr. Li Wang et al.
Points
- This research paper examines the prevalence of social determinants of health (SDH) and their associations with hypertension in women compared to men.
- Data from the 1999-2018 National Health and Nutrition Examination Surveys, including information on SDH factors such as education, income, and employment, was analyzed.
- Women had a lower proportion of low education attainment but higher proportions of low family income, unmarried status, and unemployment compared to men.
- All SDH factors were significantly associated with hypertension in women, and there were dose-response associations between the number of adverse SDH factors and hypertension.
- The total population-attributable fraction (PAF) of SDH for prevalent hypertension was more significant in women than in men, highlighting the need to prioritize socioeconomically disadvantaged groups in hypertension management.
Summary
Social determinants of health (SDH) reflecting social deprivation have been developed for population health management. However, there is a paucity of data on the prevalence of SDH and its associations with prevalent hypertension in women compared with men.
49,791 participants aged over 20 years from the 1999–2018 National Health and Nutrition Examination Surveys were included in this study. Information on various SDH factors was collected, including race/ethnicity, education level, family income, housing, marriage status, and employment. The prevalence ratio (PR) for each adverse SDH with prevalent and uncontrolled hypertension was calculated using Cox regression, with adjustments made for age, diabetes, lipid-lowering medication use, and health behaviors. The population-attributable fractions (PAF) of the SDH were also assessed.
The study found that women had a lower proportion of low education attainment than men (16.8% vs. men: 17.9%, p = .003). However, women had higher proportions of low family income (15.3% vs. 12.5%, p < .001), unmarried status (47.3% vs. 40.9%, p < .001), and unemployment (22.7% vs. 10.7%, p < .001). All the SDH factors were significantly associated with hypertension in women. Significant dose–response associations existed between the numbers of adverse SDH factors and hypertension. The total PAF of SDH for prevalent hypertension was greater in women (22.2%) than in men (13.9%).
The study concludes that the widely influential SDH is associated with prevalent hypertension and uncontrolled hypertension. Women, in particular, experience higher proportions of adverse SDH factors, which contribute to the higher prevalence of hypertension. To improve hypertension management, health resources should prioritize socioeconomically disadvantaged groups, taking into consideration gender differences. These findings highlight the need for targeted interventions and support for individuals facing social deprivation to address the impact of SDH on hypertension outcomes.
Link to the article: https://onlinelibrary.wiley.com/doi/10.1002/clc.24079
References Wang, L., Zhang, H., Yao, H., Gong, C., Zhong, J., Liu, D., & Liang, Z. (2023). Social determinants of health and hypertension in women compared with men in the United States: An analysis of the NHANES study. Clinical Cardiology, 46(8), 958–966. https://doi.org/10.1002/clc.24079
