Socioeconomic differentials in trends in the prevalence of hypertension and pre-hypertension and hypertension awareness, treatment, and control in rural Southwestern China.

BACKGROUND: This study examines the socioeconomic differentials in trends in the prevalence of hypertension and pre-hypertension and hypertension awareness, treatment, and control in rural Southwestern China. METHODS: Two cross-sectional interviews and health examination surveys were administered in rural Yunnan Province, including 6,350 consenting participants in 2009 and 6,359 consenting participants in 2016 (aged ≥ 35 years). Participant demographics, socioeconomic status (SES), and ethnicity, along with information about hypertension awareness, treatment, and control, were collected using similar questionnaires in the two surveys. The participants' blood pressure levels were also measured. RESULTS: From 2009 to 2016, the prevalence of hypertension substantially increased from 28.4% to 39.5% (P < 0.01), and awareness and control rose from 42.2 and 25.8% to 53.1 (P < 0.01) and 30.6% (P < 0.05), respectively. Although people with a higher education level also had higher awareness and control rates than the lower education level ones, there were no conspicuous differences in the improvement of awareness and control between publics with different education levels over the 7 years studied. Increases were observed in both rates of awareness and control in people with a high level of income (P < 0.01). However, only the awareness rate increased in participants with a low level of income. Furthermore, the prevalence (P < 0.01) and treatment (P < 0.05) of hypertension were higher in the Han people than in ethnic minorities. CONCLUSIONS: Individual SES has clear associations with trends in the prevalence, awareness, and control of hypertension. Future interventions to improve hypertension prevention and control should be tailored to address individual SES.

Socioeconomic and lifestyle determinants of the prevalence of hypertension among elderly individuals in rural southwest China: a structural equation modelling approach.

BACKGROUND: This study examines the association between socioeconomic and lifestyle factors and the prevalence of hypertension among elderly individuals in rural Southwest China. METHODS: A cross-sectional survey of 4833 consenting adults aged ≥ 60 years in rural regions of Yunnan Province, China, was conducted in 2017. Data on individual socioeconomic status, sleep quality, physical activity level, and family history of hypertension were collected with a standardized questionnaire. Blood pressure, fasting blood glucose, height, weight, and waist circumference were also measured. An individual socioeconomic position (SEP) index was constructed using principal component analysis. Structural equation modelling (SEM) was applied to analyse the association between socioeconomic and lifestyle factors and the prevalence of hypertension. RESULTS: The overall prevalence of hypertension was 50.6% in the study population. Body fat distribution, including measures of obesity and central obesity, had the greatest total effect on hypertension (0.21), followed by family history of hypertension (0.14), biological sex (0.08), sleep quality (- 0.07), SEP (- 0.06), physical inactivity (0.06), and diabetes (0.06). Body fat distribution, SEP, and family history of hypertension had both direct and indirect effects on hypertension, whereas physical inactivity, diabetes, and sleep quality were directly associated with the prevalence of hypertension. Biological sex was indirectly associated with the prevalence of hypertension. CONCLUSIONS: SEP, body fat distribution, physical inactivity, diabetes, and sleep quality critically influence the prevalence of hypertension. Future interventions to prevent and control hypertension should give increased attention to individuals with low SEP and should focus on controlling diabetes and obesity, increasing physical activity levels, and improving quality of sleep among older adults aged ≥ 60 years in rural Southwest China.

Association of socioeconomic factors and prevalence of hypertension with sleep disorder among the elderly in rural southwest China.

OBJECTIVES: This study examines the distribution of sleep disorder prevalence across socioeconomic status (SES) and investigates the relationship between sleep disorders and hypertension among southwest China's rural older adult population. METHODS: A cross-sectional survey was conducted in rural Yunnan Province, China from 2017 to 2018, consisting of 4833 consenting participants aged ≥60 years. Each participant completed a structured interview and had their blood pressure measured. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI). Multivariate logistic regression was used to model variations in prevalence of sleep disorders and hypertension. RESULTS: In the study population, the prevalence rates of sleep disorders and hypertension were 46.5% and 50.3%, respectively. Women had higher prevalence of both chronic illnesses (53.4% vs. 38.7%, 53.1% vs. 47.6%, P < 0.01). After adjusting for age, sex, and residential status, older adults of minority ethnicity had a higher prevalence of sleep disorders than the Han ethnic majority (P < 0.01). Attainment of higher levels of education and lower annual household income were also associated with a greater risk of sleep disorders (P < 0.01). Further, logistic regression analysis indicated that older adults with sleep disorders had a greater risk of being hypertensive (P < 0.01). CONCLUSIONS: Sleep disorders are highly prevalent in rural southwest China. Future interventions to improve sleep quality would benefit from tailoring to address individual SES. Improving sleep quality profoundly reduces prevalence of hypertension.

Socioeconomic variations in chronic obstructive pulmonary disease prevalence, diagnosis, and treatment in rural Southwest China.

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is a major and growing cause of morbidity and mortality throughout the world. However, there remains a limited understanding of the association between individual socioeconomic status (SES) and COPD diagnosis and treatment worldwide, including in China. This study investigates socioeconomic variations in prevalence, diagnosis, and treatment of COPD in rural China. METHODS: The present study employed a cross-sectional survey design. The study population was composed of Han majority as well as Na Xi and Bai ethnic minority individuals 35 years of age and older living in Yunnan Province from 2017 to 2019. In total, 7534 individuals consented to participate in the study and complete a structured interview as well as a post-bronchodilator spirometry test. Multivariate logistic regression was used to analyze the association between individual socioeconomic status variables and the prevalence, diagnosis, and treatment of COPD. RESULTS: The age-standardized prevalence of COPD in the present study was 14.3%. Prevalence differed by gender: prevalence for men was 17.1%, versus 11.4% for women (P = 0.0001). Overall, levels of diagnosis and treatment of COPD for participants with COPD were 24.2 and 23.1%, respectively. Multivariate logistic regression indicated that higher educational levels and good access to medical services was associated with an overall lower risk of COPD (P = 0.032 vs. P = 0.018) as well as a higher probability of COPD diagnosis among those with COPD (P = 0.0001 vs. P = 0.002). Participants with COPD with higher educational levels (P = 0.0001) and higher annual household incomes (P = 0.0001) as well as good access to medical services (P = 0.016) were more likely to receive COPD medications and treatment than their counterparts. While Na Xi and Bai participants had a higher probability of having COPD (P = 0.0001), they had a lower probability of having received a diagnosis or treatment for COPD than Han participants (P = 0.0001 vs. P = 0.0012). CONCLUSIONS: Future interventions to further control COPD and improve diagnosis and treatment should focus on ethnic minority communities, and those with low education levels, low annual household incomes, and poor access to medical services.

Socioeconomic disparities in prevalence and behaviors of smoking in rural Southwest China.

BACKGROUND: This study examines how prevalence and behaviors of smoking differ by socioeconomic status among rural southwest Chinese adults. METHODS: A cross-sectional survey was conducted including 7743 adults aged ≥35 years in rural regions of Yunnan Province, China from 2016 to 2018. Information on individual socioeconomic status (SES), ethnicity, and self-reported smoking behaviors was collected utilizing a standardized questionnaire. The individual socioeconomic position (SEP) index was constructed using principal component analysis. Multivariate logistic regression models were used to analyze the association between individual SES variables and the prevalence and behaviors of smoking. RESULTS: In the study population, the overall prevalence rate of current smokers was 33.5%. Males had a markedly higher prevalence of current smokers than females (62.6% vs. 4.8%, P < 0.01). Of these smokers, 74.5% began smoking during adolescence, 88.8% had never attempted to quit smoking, and 81.1% reported smoking in public places. Ethnic minority participants and those with low levels of education and/or low SEP were more likely to use tobacco as well as more likely to start smoking, and regularly smoke, during adolescence (P < 0.01). Participants with poor access to medical services had a higher prevalence of current smoking than their counterparts (P < 0.01). Among current smokers, Han ethnicity, good access to medical services, and high SEP were positively associated with the probability of having attempted to quit smoking at least once, while a high level of education and high SEP were negatively associated with the probability of smoking in public places. CONCLUSIONS: Disparities in prevalence and behaviors of smoking exist across a diversity of indicators of individual SES in rural southwest China. Future tobacco cessation interventions should focus on men, ethnic minorities, and those with low education levels, poor access to medical services, and low SEP.