Journal of Preventive Medicine and Public Health

The Korean Society for Preventive Medicine (대한예방의학회)
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Effects of Marital Status and Income on Hypertension: The Korean Genome and Epidemiology Study (KoGES)

  • Mia, Son (Department of Preventive Medicine, Kangwon National University School of Medicine) ;
  • Yeon Jeong, Heo (Department of Nursing, Kangwon National University) ;
  • Hye-Jin, Hyun (Department of Nursing, Kangwon National University) ;
  • Ho Jong, Kwak (Department of Nursing, Kangwon National University)
  • Received : 2022.06.09
  • Accepted : 2022.09.02
  • Published : 2022.11.30
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Abstract

Objectives: This study aimed to analyze the associations of income, marital status, and health behaviors with hypertension in male and female over 40 years of age in the Korea. Methods: The data were derived from the Korean Genome and Epidemiology Study (KoGES; 4851-302) which included 211 576 participants. To analyze the relationships of income, marital status, and health behaviors with hypertension in male and female over 40 years of age, multiple logistic regression was conducted with adjustments for these variables. Results: The prevalence of hypertension increased linearly as income decreased. The odds ratio for developing hypertension in people with an income of <0.5 million Korean won (KRW) compared to ≥6.0 million KRW was 1.55 (95% confidence interval [CI], 1.25 to 1.93) in the total population, 1.58 (95% CI, 1.27 to 1.98) in male, and 1.07 (95% CI, 0.35 to 3.28) in female. The combined effect of income level and marital status on hypertension was significant. According to income level and marital status, in male, low income and divorce were most associated with hypertension (1.76 times; 95% CI, 1.01 to 3.08). However, in female, the low-income, married group was most associated with hypertension (1.83 times; 95% CI, 1.71 to 1.97). Conclusions: The results of this study show that it is necessary to approach male and female marital status separately according to income in health policies to address inequalities in the prevalence of hypertension.

Keywords

Acknowledgement

We thank the Department of Genome Dynamics of the Centers for Disease Control and Prevention for providing raw data.

References

  1. World Health Organization. Noncommunicable diseases; 2021 [cited 2022 Jan 30]. Available from: https://www.who.int/news-room/fact-sheets/detail/noncommunicable-diseases.
  2. Statistics Korea. 2018 National Health and Nutrition Survey; 2022 [cited 2022 Feb 17]. Available from: https://www.index.go.kr/potal/main/EachDtlPageDetail.do?idx_cd=1438 (Korean).
  3. Korean Academy of Medical Sciences. Evidence-based guideline for hypertension in primary care; 2019 [cited 2022 Feb 17]. Available from: https://www.guideline.or.kr/chronic/view.php?number=88%EF%BF%BD%C3%87 (Korean).
  4. Marmot MG, Shipley MJ, Rose G. Inequalities in death--specific explanations of a general pattern? Lancet 1984;1(8384):1003-1006. https://doi.org/10.1016/S0140-6736(84)92337-7
  5. Defianna SR, Santosa A, Probandari A, Dewi FS. Gender differences in prevalence and risk factors for hypertension among adult populations: a cross-sectional study in Indonesia. Int J Environ Res Public Health 2021;18(12):6259.
  6. Ramezankhani A, Azizi F, Hadaegh F. Associations of marital status with diabetes, hypertension, cardiovascular disease and all-cause mortality: a long term follow-up study. PLoS One 2019;14(4):e0215593.
  7. Li K, Ma X, Yuan L, Ma J. Age differences in the association between marital status and hypertension: a population-based study. J Hum Hypertens 2022;36(7):670-680. https://doi.org/10.1038/s41371-021-00558-9
  8. Segawa HK, Uematsu H, Dorji N, Wangdi U, Dorjee C, Yangchen P, et al. Gender with marital status, cultural differences, and vulnerability to hypertension: findings from the national survey for noncommunicable disease risk factors and mental health using WHO STEPS in Bhutan. PLoS One 2021;16(8):e0256811.
  9. Manfredini R, De Giorgi A, Tiseo R, Boari B, Cappadona R, Salmi R, et al. Marital status, cardiovascular diseases, and cardiovascular risk factors: a review of the evidence. J Womens Health (Larchmt) 2017;26(6):624-632. https://doi.org/10.1089/jwh.2016.6103
  10. Lim AR. Analysis of the relationship between socioeconomic status and hypertension control in Korea [dissertation]. Seoul: Yonsei University; 2010 (Korean).
  11. He J, Muntner P, Chen J, Roccella EJ, Streiffer RH, Whelton PK. Factors associated with hypertension control in the general population of the United States. Arch Intern Med 2002;162(9):1051-1058. https://doi.org/10.1001/archinte.162.9.1051
  12. Shah S, Cook DG. Inequalities in the treatment and control of hypertension: age, social isolation and lifestyle are more important than economic circumstances. J Hypertens 2001;19(7):1333-1340. https://doi.org/10.1097/00004872-200107000-00020
  13. Shin JH, Jung MH, Kwon CH, Lee CJ, Kim DH, Kim HL, et al. Disparities in mortality and cardiovascular events by income and blood pressure levels among patients with hypertension in South Korea. J Am Heart Assoc 2021;10(7):e018446.
  14. Kang S, Kim HC. Effects of income level on the association between hypertension and depression: 2010-2017 Korea National Health and Nutrition Examination Survey. J Prev Med Public Health 2020;53(6):439-446. https://doi.org/10.3961/jpmph.20.337
  15. Kim OS, Jeon HO, Kim DH, Kim BH, Kim HJ. Risk factors of prehypertension in Korean adults: the Korean National Health and Nutrition Examination Survey 2005. Korean J Adult Nurs 2009;21(3):281-292 (Korean).
  16. Lee EK. Factors associated with hypertension control in Korean adults: the fifth Korea National Health and Nutrition Examination Survey (KNHANES V-2). J Korean Data Anal Soc 2013;15(6):3203-3217 (Korean).
  17. Byeon JH, Lee HJ, Chong HU, Choi JH, Choi YE, Cho KH. The analysis between the socioeconomic factor and the atherosclerotic cardiovascular disease risk: the 7th Korea National Health and Nutrition Examination Survey (1st Year), 2016. Korean J Fam Pract 2019;9(2):224-229 (Korean). https://doi.org/10.21215/kjfp.2019.9.2.224
  18. Grotto I, Huerta M, Sharabi Y. Hypertension and socioeconomic status. Curr Opin Cardiol 2008;23(4):335-339. https://doi.org/10.1097/HCO.0b013e3283021c70
  19. Antignac M, Diop IB, Macquart de Terline D, Kramoh KE, Balde DM, Dzudie A, et al. Socioeconomic status and hypertension control in sub-Saharan Africa: the Multination EIGHT Study (Evaluation of Hypertension in Sub-Saharan Africa). Hypertension 2018;71(4):577-584. https://doi.org/10.1161/hypertensionaha.117.10512
  20. O' Donnell M, Hankey GJ, Rangarajan S, Chin SL, Rao-Melacini P, Ferguson J, et al. Variations in knowledge, awareness andtreatment of hypertension and stroke risk by country income level. Heart 2021;107:282-289. https://doi.org/10.1136/heartjnl-2019-316515
  21. Korean Diabetes Association. Treatment guidelines for diabetes 7th edition; 2021 [cited 2022 Jul 22]. Available from: https://www.diabetes.or.kr/bbs/?code=guide&mode=view&number=853&page=1&code=guide (Korean).
  22. World Health Organization. More than 700 million people with untreated hypertension; 2021 [cited 2022 Jul 22]. Available from: https://www.who.int/news/item/25-08-2021-more-than700-million-people-with-untreated-hypertension.
  23. Lee H, Park JH, Floyd JS, Park S, Kim HC. Combined effect of income and medication adherence on mortality in newly treated hypertension: nationwide study of 16 million person-years. J Am Heart Assoc 2019;8(16):e013148.
  24. Singh S, Shankar R, Singh GP. Prevalence and associated risk factors of hypertension: a cross-sectional study in urban Varanasi. Int J Hypertens 2017;2017:5491838.
  25. Hemingway H, Shipley M, Brunner E, Britton A, Malik M, Marmot M. Does autonomic function link social position to coronary risk? The Whitehall II study. Circulation 2005;111(23):3071-3077. https://doi.org/10.1161/CIRCULATIONAHA.104.497347
  26. Trivedi AN, Zaslavsky AM, Schneider EC, Ayanian JZ. Relationship between quality of care and racial disparities in Medicare health plans. JAMA 2006;296(16):1998-2004. https://doi.org/10.1001/jama.296.16.1998
  27. Husain MJ, Datta BK, Kostova D, Joseph KT, Asma S, Richter P, et al. Access to cardiovascular disease and hypertension medicines in developing countries: an analysis of essential medicine lists, price, availability, and affordability. J Am Heart Assoc 2020;9(9):e015302.
  28. Sorato MM, Davari M, Kebriaeezadeh A, Sarrafzadegan N, Shibru T, Fatemi B. Reasons for poor blood pressure control in eastern sub-Saharan Africa: looking into 4P's (primary care, professional, patient, and public health policy) for improving blood pressure control: a scoping review. BMC Cardiovasc Disord 2021;21(1):123.
  29. Cozier YC, Palmer JR, Horton NJ, Fredman L, Wise LA, Rosenberg L. Relation between neighborhood median housing value and hypertension risk among black women in the United States. Am J Public Health 2007;97(4):718-724. https://doi.org/10.2105/AJPH.2005.074740
  30. Ganguli MC, Grimm RH Jr, Svendsen KH, Flack JM, Grandits GA, Elmer PJ. Higher education and income are related to a better Na:K ratio in blacks: baseline results of the Treatment of Mild Hypertension Study (TOMHS) data. Am J Hypertens 1997;10(9 Pt 1):979-984. https://doi.org/10.1016/S0895-7061(97)00162-3
  31. James WP, Nelson M, Ralph A, Leather S. Socioeconomic determinants of health. The contribution of nutrition to inequalities in health. BMJ 1997;314(7093):1545-1549. https://doi.org/10.1136/bmj.314.7093.1545
  32. Ganguli MC, Grimm RH Jr, Svendsen KH, Flack JM, Grandits GA, Elmer PJ. Urinary sodium and potassium profile of blacks and whites in relation to education in two different geographic urban areas. TOMHS Research Group. Treatment of Mild Hypertension Study. Am J Hypertens 1999;12(1 Pt 1):69-72. https://doi.org/10.1016/S0895-7061(98)00218-0
  33. Satoh A, Arima H, Ohkubo T, Nishi N, Okuda N, Ae R, et al. Associations of socioeconomic status with prevalence, awareness, treatment, and control of hypertension in a general Japanese population: NIPPON DATA2010. J Hypertens 2017;35(2):401-408. https://doi.org/10.1097/HJH.0000000000001169
  34. NCD Risk Factor Collaboration (NCD-RisC). Worldwide trends in hypertension prevalence and progress in treatment and control from 1990 to 2019: a pooled analysis of 1201 population-representative studies with 104 million participants. Lancet 2021;398(10304):957-980. https://doi.org/10.1016/S0140-6736(21)01330-1
  35. Bhadoria AS, Kasar PK, Toppo NA, Bhadoria P, Pradhan S, Kabirpanthi V. Prevalence of hypertension and associated cardiovascular risk factors in Central India. J Family Community Med 2014;21(1):29-38.
  36. Dhungana RR, Pandey AR, Bista B, Joshi S, Devkota S. Prevalence and associated factors of hypertension: a communitybased cross-sectional study in municipalities of Kathmandu, Nepal. Int J Hypertens 2016;2016:1656938.
  37. Khanal MK, Dhungana RR, Bhandari P, Gurung Y, Paudel KN. Prevalence, associated factors, awareness, treatment, and control of hypertension: findings from a cross sectional study conducted as a part of a community based intervention trial in Surkhet, Mid-western region of Nepal. PLoS One 2017;12(10):e0185806.
  38. Dastan I, Erem A, Cetinkaya V. Awareness, treatment, control of hypertension, and associated factors: results from a Turkish national study. Clin Exp Hypertens 2018;40(1):90-98. https://doi.org/10.1080/10641963.2017.1334797
  39. Sison O, Castillo-Carandang N, Ann Ladia M, Sy R, Eduardo Punzalan F, Jasper Llanes E, et al. Prevalence of metabolic syndrome and cardiovascular risk factors among community health workers in selected villages in the Philippines. J ASEAN Fed Endocr Soc 2019;34(2):171-179. https://doi.org/10.15605/jafes.034.02.08
  40. Baum A, Garofalo JP, Yali AM. Socioeconomic status and chronic stress. Does stress account for SES effects on health? Ann N Y Acad Sci 1999;896:131-144. https://doi.org/10.1111/j.1749-6632.1999.tb08111.x