Hypertension and Socioeconomic Status in South Central Uganda: A Population-Based Cohort Study
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Date
2022
Journal Title
Journal ISSN
Volume Title
Publisher
Global Heart
Abstract
Limited studies exploring the impact of socioeconomic status (SES)
on hypertension in Africa suggest a positive association between higher SES and
hypertension. The economic development in sub-Saharan African countries has led to
changes in SES and associated changes in lifestyle, diet, and physical activity, which
may affect the relationship between hypertension and SES differently compared
with higher income countries. This cross-sectional study from a large populationbased
cohort, the Rakai Community Cohort Study (RCCS), examines SES, hypertension
prevalence, and associated risk factors in the rural Rakai Region in south-central
Uganda.
Methods: Adults aged 30–49 years residing in 41 RCCS fishing, trading, and agrarian
communities, were surveyed with biometric data obtained between 2016 and 2018.
The primary outcome was hypertension (systolic blood pressure (BP) ≥ 130 mmHg or
diastolic BP ≥ 80 mmHg). Modified Poisson regression assessed the adjusted prevalence
ratios (PR) of hypertension associated with SES; body mass index (BMI) was explored
as a potential mediator.
Results: Among 9,654 adults, 20.8% had hypertension (males 21.2%; females 20.4
%). Participants with hypertension were older (39.0 ± 6.0 vs. 37.8 ± 5.0; p < 0.001).
Higher SES was associated with overweight or obese BMI categories (p < 0.001). In the
multivariable model, hypertension was associated with the highest SES category (aPR
1.23; confidence interval 1.09–1.38; p = 0.001), older age, male sex, alcohol use, and
living in fishing communities and inversely associated with smoking and positive HIV
serostatus. When BMI was included in the model, there was no association between
SES and hypertension (aPR 1.02; CI 0.90–1.15, p = 0.76).
Conclusion: Hypertension is common in rural Uganda among individuals with higher
SES and appears to be mediated by BMI. Targeted interventions could focus on lifestyle
modification among highest-risk groups to optimize public health impact.
Description
Keywords
Hypertension, Socioeconomic status, Global cardiovascular disease, Cardiovascular disease, Rakai
Citation
Mustapha A, Ssekasanvu J, Chen I, Grabowski MK, Ssekubugu R, Kigozi G, Reynolds SJ, Gray RH, Wawer MJ, Kagaayi J, Chang LW, Post WS. Hypertension and Socioeconomic Status in South Central Uganda: A Population- Based Cohort Study. Global Heart. 2022; 17(1): 3. DOI: https://doi.org/10.5334/gh.1088