Table 3.
Adjusted associations between social determinants and hypertension, stage 2 hypertension, and blood pressure control among US adults, stratified by sex, in the 2011–2018 National Health and Nutrition Examination Surveys
| Men | Women | |||||
|---|---|---|---|---|---|---|
| Hypertension | Stage 2 hypertension | Controlled blood pressure | Hypertension | Stage 2 hypertension | Controlled blood pressure | |
| Prevalence ratio (95% CI) | Prevalence ratio (95% CI) | |||||
| Social determinants | ||||||
| Race and Hispanic status | ||||||
| Non-Hispanic White | 1.0 | 1.0 | 1.0 | 1.0 | 1.0 | 1.0 |
| Hispanic | 0.93 (0.85–1.01) | 0.92 (0.71–1.18) | 0.83 (0.62–1.10) | 0.97 (0.90–1.05) | 1.24 (1.04–1.48) | 0.92 (0.75–1.14) |
| Non-Hispanic Black | 1.19 (1.11–1.27) | 1.50 (1.29–1.75) | 0.78 (0.66–0.93) | 1.28 (1.22–1.34) | 1.79 (1.56–2.05) | 0.80 (0.67–0.94) |
| Non-Hispanic Asian | 1.17 (1.05–1.30) | 1.48 (1.15–1.92) | 0.79 (0.54–1.13) | 1.33 (1.16–1.54) | 1.40 (1.08–1.82) | 0.91 (0.64–1.28) |
| Routine place for healthcare | ||||||
| Yes | 1.0 | 1.0 | 1.0 | 1.0 | 1.0 | 1.0 |
| No | 0.91 (0.84–0.99) | 0.99 (0.79–1.23) | 0.28 (0.16–0.49) | 0.93 (0.82–1.06) | 1.03 (0.78–1.36) | 0.44 (0.24–0.78) |
| Family income–poverty ratio | ||||||
| FIPR ≥4 | 1.0 | 1.0 | 1.0 | 1.0 | 1.0 | 1.0 |
| FIPR 2–3.99 | 1.02 (0.94–1.11) | 0.95 (0.78–1.15) | 0.92 (0.72–1.18) | 1.02 (0.94–1.11) | 1.00 (0.85–1.19) | 0.92 (0.72–1.16) |
| FIPR 1–1.99 | 1.01 (0.93–1.10) | 1.07 (0.85–1.36) | 0.80 (0.62–1.04) | 1.01 (0.92–1.10) | 1.02 (0.84–1.24) | 0.93 (0.72–1.18) |
| FIPR <1 | 1.04 (0.95–1.14) | 1.10 (0.85–1.41) | 0.79 (0.59–1.07) | 0.99 (0.90–1.08) | 1.08 (0.88–1.34) | 0.90 (0.70–1.18) |
| Education | ||||||
| College graduate and above | 1.0 | 1.0 | 1.0 | 1.0 | 1.0 | 1.0 |
| Some college | 1.09 (1.00–1.20) | 1.04 (0.87–1.24) | 1.08 (0.86–1.37) | 1.15 (1.06–1.25) | 1.24 (1.03–1.49) | 1.01 (0.80–1.28) |
| High school | 1.09 (1.00–1.19) | 1.14 (0.96–1.36) | 1.14 (0.90–1.44) | 1.17 (1.09–1.26) | 1.32 (1.09–1.61) | 0.91 (0.71–1.17) |
| Employment status | ||||||
| Employed | 1.0 | 1.0 | 1.0 | 1.0 | 1.0 | 1.0 |
| Unemployed | 1.02 (0.95–1.09) | 0.98 (0.81–1.18) | 1.16 (0.95–1.41) | 1.05 (0.99–1.11) | 1.18 (1.01–1.38) | 1.22 (1.04–1.44) |
| Insurance status | ||||||
| Insured | 1.0 | 1.0 | 1.0 | 1.0 | 1.0 | 1.0 |
| Uninsured | 0.92 (0.84–1.00) | 0.97 (0.76–1.23) | 0.66 (0.44–0.99) | 0.91 (0.83–0.99) | 1.13 (0.93–1.38) | 0.67 (0.51–0.88) |
| Married | ||||||
| Yes | 1.0 | 1.0 | 1.0 | 1.0 | 1.0 | 1.0 |
| No | 0.99 (0.93–1.06) | 1.10 (0.94–1.28) | 0.94 (0.75–1.17) | 1.02 (0.96–1.08) | 0.95 (0.82–1.09) | 1.23 (1.05–1.43) |
| Nativity status | ||||||
| US-born | 1.0 | 1.0 | 1.0 | 1.0 | 1.0 | 1.0 |
| Foreign-born | 0.99 (0.89–1.08) | 1.01 (0.80–1.26) | 0.86 (0.64–1.15) | 0.91 (0.81–1.01) | 0.89 (0.74–1.07) | 0.86 (0.64–1.15) |
| Covariates | ||||||
| Age categories | ||||||
| 18–39 years | 1.0 | 1.0 | 1.0 | 1.0 | 1.0 | 1.0 |
| 40–59 years | 1.71 (1.56–1.88) | 2.40 (2.00–2.87) | 4.10 (2.64–6.38) | 3.19 (2.79–3.64) | 4.34 (3.36–5.60) | 1.57 (1.17–2.12) |
| 60–79 years | 2.03 (1.84–2.23) | 3.32 (2.73–4.03) | 5.15 (3.26–8.14) | 4.55 (3.94–5.26) | 8.56 (6.27–11.68) | 1.71 (1.26–2.32) |
| ≥80 years | 2.33 (2.09–2.61) | 4.95 (3.68–6.67) | 4.52 (2.64–7.74) | 5.63 (4.82–6.57) | 14.83 (10.65–20.65) | 0.99 (0.63–1.54) |
| BMI categories | ||||||
| Normal | 1.0 | 1.0 | 1.0 | 1.0 | 1.0 | 1.0 |
| Overweight | 1.36 (1.21–1.53) | 1.37 (1.13–1.66) | 1.40 (1.02–1.92) | 1.30 (1.19–1.43) | 0.98 (0.83–1.16) | 1.32 (1.03–1.68) |
| Class 1 obesity | 1.57 (1.40–1.75) | 1.62 (1.31–2.02) | 1.42 (1.04–1.94) | 1.48 (1.35–1.62) | 0.93 (0.77–1.13) | 1.64 (1.30–2.07) |
| Class 2 obesity | 1.83 (1.59–2.11) | 2.07 (1.58–2.72) | 1.54 (1.09–2.17) | 1.65 (1.50–1.82) | 1.21 (0.99–1.48) | 1.76 (1.35–2.29) |
| Class 3 obesity | 2.09 (1.82–2.40) | 2.88 (2.22–3.73) | 1.29 (0.84–1.99) | 2.00 (1.81–2.22) | 1.46 (1.17–1.82) | 1.54 (1.17–2.03) |
| Diabetes | ||||||
| No | 1.0 | 1.0 | 1.0 | 1.0 | 1.0 | 1.0 |
| Yes | 1.14 (1.07–1.22) | 1.01 (0.83–1.23) | 1.31 (1.05–1.63) | 1.13 (1.06–1.20) | 0.94 (0.81–1.08) | 1.40 (1.15–1.71) |
| Smoking status | ||||||
| Never smoker | 1.0 | 1.0 | 1.0 | 1.0 | 1.0 | 1.0 |
| Former smoker | 1.06 (0.99–1.14) | 0.99 (0.85–1.16) | 1.07 (0.89–1.29) | 1.05 (0.97–1.13) | 1.13 (0.98–1.29) | 1.00 (0.85–1.16) |
| Current smoker | 1.03 (0.94–1.12) | 1.05 (0.91–1.22) | 1.20 (0.90–1.61) | 1.11 (1.02–1.22) | 1.06 (0.85–1.33) | 1.19 (1.10–1.41) |
| Chronic kidney disease | ||||||
| No | 1.0 | 1.0 | 1.0 | 1.0 | 1.0 | 1.0 |
| Yes | 1.20 (1.14–1.27) | 1.42 (1.20–1.68) | 1.11 (0.92–1.33) | 1.21 (1.14–1.29) | 1.57 (1.37–1.81) | 0.97 (0.82–1.16) |
| Survey cycle | ||||||
| 2011–2012 | 1.0 | 1.0 | 1.0 | 1.0 | 1.0 | 1.0 |
| 2013–2014 | 0.92 (0.84–1.01) | 1.01 (0.81–1.27) | 0.96 (0.81–1.15) | 0.97 (0.90–1.03) | 0.96 (0.77–1.19) | 1.16 (0.89–1.51) |
| 2015–2016 | 0.97 (0.88–1.07) | 1.10 (0.89–1.35) | 0.92 (0.72–1.17) | 0.99 (0.92–1.07) | 1.01 (0.83–1.22) | 1.01 (0.74–1.36) |
| 2017–2018 | 1.01 (0.91–1.12) | 1.21 (0.99–1.49) | 0.75 (0.60–0.94) | 0.99 (0.91–1.08) | 1.28 (1.05–1.56) | 0.83 (0.63–1.10) |
Hypertension defined as systolic blood pressure ≥130 mm Hg, diastolic blood pressure ≥80 mm Hg, or current use of antihypertensive medication. Stage 2 hypertension defined as systolic blood pressure ≥140 mm Hg or diastolic blood pressure ≥90 mm Hg among all adults, which excludes adults with systolic blood pressure between 130 and 139 mm Hg or diastolic blood pressure between 80 and 89 mm Hg. Controlled blood pressure defined as systolic blood pressure <130 mm Hg and diastolic blood pressure <80 mm Hg among adults with hypertension. Bold values P < 0.05. Abbreviations: BMI, body mass index; CI, confidence interval; FIPR, family income-to-poverty ratio.