Analysing the socioeconomic determinants of hypertension in South Africa: a structural equation modelling approach.
Analysing the socioeconomic determinants of hypertension in South Africa: a structural equation modelling approach.
复制标题
DOI：
10.1186/1471-2458-14-414
复制
发表时间：
2014-05-01
影响因子：
4.5
通讯作者：
Ehrlich R
中科院分区：
文献类型：
--
作者：
Cois A;Ehrlich R
流行病学研究长期以来观察到，不同社会经济阶层的高血压患病率各不相同。然而，在撒哈拉以南非洲，人们对关联模式和潜在的因果机制知之甚少。我们使用教育和收入作为指标，在国家收入动态研究的第一波中调查了社会经济地位与血压的联系程度——这是一项对超过15000名成年人的南非纵向研究——以及生物行为风险因素是否介导了这种联系。在横断面分析中，采用结构方程模型来估计社会经济地位对收缩压和舒张压的影响，并评估一组生物行为风险因素在解释观察到的关系中的作用。在调整了年龄、种族和抗高血压治疗后，高等教育和收入与男性舒张压升高独立相关。女性受教育程度越高，舒张压和收缩压越低，而收入越高，收缩压越低。在两性中，身体质量指数是社会经济地位对血压不利的间接影响的强有力中介。因此，身体质量指数与体育锻炼、饮酒、吸烟和静息心率一起，在男性中对观察到的关系起到了很大的中介作用。相比之下，在女性中，无法测量的因素发挥了更大的作用。在流行病学转型的国家，社会经济地位对血压的影响可能因性别而异。在女性中，上述因素之外的其他因素可能在中介关联和价值调查中发挥重要作用。
Epidemiological research has long observed a varying prevalence of hypertension across socioeconomic strata. However, patterns of association and underlying causal mechanisms are poorly understood in sub-Saharan Africa. Using education and income as indicators, we investigated the extent to which socioeconomic status is linked to blood pressure in the first wave of the National Income Dynamics Study — a South African longitudinal study of more than 15000 adults – and whether bio-behavioural risk factors mediate the association. In a cross-sectional analysis, structural equation modelling was employed to estimate the effect of socioeconomic status on systolic and diastolic blood pressure and to assess the role of a set of bio-behavioural risk factors in explaining the observed relationships. After adjustment for age, race and antihypertensive treatment, higher education and income were independently associated with higher diastolic blood pressure in men. In women higher education predicted lower values of both diastolic and systolic blood pressure while higher income predicted lower systolic blood pressure. In both genders, body mass index was a strong mediator of an adverse indirect effect of socioeconomic status on blood pressure. Together with physical exercise, alcohol use, smoking and resting heart rate, body mass index therefore contributed substantially to mediation of the observed relationships in men. By contrast, in women unmeasured factors played a greater role. In countries undergoing epidemiological transition, effects of socioeconomic status on blood pressure may vary by gender. In women, factors other than those listed above may have substantial role in mediating the association and merit investigation.
登录
查看更多内容
影响因子：
12.7
作者：
Fleischer, Nancy L.;Roux, Ana V. Diez;De Maio, Fernando
通讯作者：
De Maio, Fernando
影响因子：
2.1
作者：
Kayima, James;Wanyenze, Rhoda K.;Nuwaha, Fred
通讯作者：
Nuwaha, Fred
影响因子：
4.8
作者：
GREEN, MS;JUCHA, E;LUZ, Y
通讯作者：
LUZ, Y
影响因子：
6.3
作者：
Matheson, Flora I.;White, Heather L.;Glazier, Richard H.
通讯作者：
Glazier, Richard H.
影响因子：
5.4
作者：
Kaufman, JS;Cooper, RS;McGee, DL
通讯作者：
McGee, DL