背景:社会经济地位(SES)在血压(BP)控制中起着至关重要的作用。SES可能通过肥胖指数影响血压控制,如体重指数(BMI)和腰围(WC)。本研究旨在了解老年高血压人群SES与血压控制的关系。并确定BMI和WC是否介导SES和BP控制之间的关系。
方法:本研究在贾县进行,河南省,中国,2023年7月1日至8月31日。对纳入国家基本公共卫生服务计划的18,963名65岁以上高血压人群进行调查。这项研究利用问卷调查来收集参与者的人口统计学特征数据,病史,生活方式行为,抗高血压药物,和测量的高度,体重,还有血压.SES按参与者自我报告的教育水平进行索引,家庭收入,和职业,并分类为低,中等,和高群体通过使用潜在类别分析(LCA)。采用Logistic回归模型分析SES与BP控制的相关性。肥胖指标,以BMI和WC为代表,纳入中介模型以检查BMI/WC对SES和BP控制之间关联的间接影响。
结果:17,234名参与者的平均年龄为73.4岁,其中9888名(57.4%)为女性。LCA结果表明低SES的参与者数量,中间SES,高SES组分别为7760、8347和1127。与低SES组相比,BP控制与中SES和高SES关联的比值比(ORs)和95%置信区间(CIs)为1.101(1.031,1.175),和1.492(1.312,1.696)。在随后的亚组分析中类似地发现了这种关联(p<0.05)。与低SES相比,我们的研究结果进一步表明,BMI(间接效应:95%CIs:-0.004--0.001;p<0.001)和WC(间接效应:95%CIs:-0.003--0.001;p=0.020)在高SES与BP控制之间的关联中起抑制作用.
结论:我们的研究表明,具有高SES的老年高血压人群可能具有更好的血压控制效果。然而,我们发现BMI/WC在这种关联中起抑制作用.这表明,尽管在高SES的老年高血压人群中观察到更好的血压控制,BMI和WC可能会破坏这种有益的关系。因此,实施肥胖预防策略是维持高SES与BP控制之间有益关联的有效方法.
BACKGROUND: Socioeconomic status (SES) plays a crucial role in blood pressure (BP) control. SES may influence BP control through obesity indices, such as body mass index (BMI) and waist circumference (WC). This study aimed to understand the relationships between SES and BP control in the elderly hypertensive population, and to determine whether BMI and WC mediate the relationship between SES and BP control.
METHODS: The study was conducted in Jia County, Henan Province,
China, from 1 July to 31 August 2023. The 18,963 hypertensive people over 65 years old who were included in the National Basic Public Health Service Program were investigated. The study utilized questionnaire surveys to collect data on participants\' demographic characteristics, disease history, lifestyle behaviors, antihypertensive medication, and measured height, weight, and blood pressure. SES was indexed by participants\' self-reported educational level, family income, and occupation, and categorized into low, medium, and high groups by using latent category analysis (LCA). Logistic regression models were used to analyze the associations between SES and BP control. Obesity indicators, represented by BMI and WC, were included in mediation models to examine the indirect effects of BMI/WC on the association between SES and BP control.
RESULTS: The mean age of 17,234 participants was 73.4 years and 9888 (57.4%) of the participants were female. The LCA results indicated the number of participants in low SES, middle SES, and high SES groups were 7760, 8347, and 1127, respectively. Compared with the low SES group, the odds ratios (ORs) and 95% confidence intervals (CIs) for the association of BP control with middle SES and high SES were 1.101 (1.031, 1.175), and 1.492 (1.312, 1.696). This association was similarly found in the subsequent subgroup analyses (p < 0.05). Compared with low SES, our findings further suggested that BMI (indirect effects: 95% CIs: -0.004--0.001; p < 0.001) and WC (indirect effects: 95% CIs: -0.003--0.001; p = 0.020) play a suppressing role in the association between high SES and BP control.
CONCLUSIONS: Our study indicated that the elderly hypertensive population with high SES may have a better result for BP control. However, we found that BMI/WC plays a suppressing role in this association. This indicated that despite the better BP control observed in elderly hypertensive populations with high SES, BMI and WC might undermine this beneficial relationship. Therefore, implementing strategies for obesity prevention is an efficient way to maintain this beneficial association between high SES and BP control.