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Trends in associations between socioeconomic development and urban–rural disparity with high blood pressure in Chinese children and adolescents over two decades

Journal of Human Hypertension volume 36, pages 866–874 (2022)Cite this article

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Abstract

This study aimed to assess the association between the trend of urban–rural disparity in high blood pressure (HBP) in Chinese children and adolescents and socioeconomic development. Data on 1,054,602 students aged 7–18 years were obtained from five successive national surveys administered in 29 Chinese provinces in 1995, 2000, 2005, 2010, and 2014. HBP was defined as average measured systolic BP and/or diastolic BP equal to or more than 95th percentile. The socioeconomic indicators at the provincial-level included gross domestic product (GDP) per capita, the Engel coefficient, and urbanization rates. From 1995 to 2014, HBP prevalence in Chinese children and adolescents fluctuated between 6.9% and 9.2%. Rural areas had a higher prevalence of HBP than urban areas, with a diminishing trend in urban–rural disparity from 1995 to 2010 with a reduced OR from 1.45 (95% CI: 1.40–150) in 1995 to 1.09 (1.05–1.12) in 2010, whereas a widening gap in 2014 with OR of 1.23 (1.19–1.26)). A positive association existed between the improvement of socioeconomic indicators and the increase in HBP, which was demonstrated obviously by the Engel coefficient strata. The increases in the urbanization rates were accompanied by a greater increase of HBP in urban than in rural areas. The large urban–rural disparity suggests a priority of HBP control in rural children due to their current and future HBP and cardiovascular disease risks. Socioeconomic development could affect the urban–rural disparity in HBP risk, reflecting the importance of effective policy responses for preventing HBP by avoiding unhealthy lifestyles brought about by rapid economic development.

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Fig. 1: The secular trends for urban–rural disparity in HBP, SHBP and DHBP for ORs (rural versus urban) among Chinese children and adolescents in different survey years from 1995 to 2014.
Fig. 2: Correlation between the prevalence of HBP, SHBP, and DHBP and socioeconomic indicators among Chinese children and adolescents.
Fig. 3: Comparison analysis between urban and rural areas for association between socioeconomic indicators and HBP, SHBP and DHBP.

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Availability of data and material

The datasets and result computational code used and analyzed during the current study are available from the corresponding author on reasonable request.

References

  1. Li Y, Wang DD, Ley SH, Howard AG, He Y, Lu Y, et al. Potential impact of time trend of life-style factors on cardiovascular disease burden in China. J Am Coll Cardiol. 2016;68:818–33.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Lacey B, Lewington S, Clarke R, Kong XL, Chen Y, Guo Y, et al. Age-specific association between blood pressure and vascular and non-vascular chronic diseases in 0.5 million adults in China: a prospective cohort study. Lancet. Glob Health. 2018;6:e641–9.

    Google Scholar 

  3. Ingelfinger JR. The child or adolescent with elevated blood pressure. N Engl J Med. 2014;370:2316–25.

    Article  PubMed  Google Scholar 

  4. Chen X, Wang Y. Tracking of blood pressure from childhood to adulthood: a systematic review and meta-regression analysis. Circulation 2008;117:3171–80.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Daniels SR, Pratt CA, Hayman LL. Reduction of risk for cardiovascular disease in children and adolescents. Circulation 2011;124:1673–86.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Ogunsina K, Dibaba DT, Akinyemiju T. Association between life-course socio-economic status and prevalence of cardio-metabolic risk ractors in five middle-income countries. J Glob Health. 2018;8:020405.

    Article  PubMed  PubMed Central  Google Scholar 

  7. NCD Risk Factor Collaboration. Worldwide trends in blood pressure from 1975 to 2015: a pooled analysis of 1479 population-based measurement studies with 19.1 million participants. Lancet . 2017;389:37–55.

  8. Jaacks LM. The unintended consequences of economic growth on child and adolescent nutrition. Lancet Diabetes Endocrinol. 2019;7:247–8.

    Article  PubMed  Google Scholar 

  9. Wilkinson RG, Pickett KE. The problems of relative deprivation: why some societies do better than others. Soc Sci Med. 2007;65:1965–78.

    Article  PubMed  Google Scholar 

  10. Dong Y, Jan C, Ma Y, Dong B, Zou Z, Yang Y, et al. Economic development and the nutritional status of Chinese school-aged children and adolescents from 1995 to 2014: an analysis of five successive national surveys. Lancet Diabetes Endocrinol 2019;7:288–99.

    Article  PubMed  Google Scholar 

  11. Dong B, Wang Z, Ma J. Urban-rural disparity in blood pressure among Chinese children: 1985-2010. Eur J Public Health. 2016;26:569–75.

    Article  PubMed  Google Scholar 

  12. Khang YH, Lynch JW. Exploring determinants of secular decreases in childhood blood pressure and hypertension. Circulation 2011;124:397–405.

    Article  PubMed  Google Scholar 

  13. Dong Y, Ma J, Song Y, Ma Y, Dong B, Zou Z, et al. Secular trends in blood pressure and overweight and obesity in Chinese boys and girls aged 7 to 17 years from 1995 to 2014. Hypertension. 2018;72:298–305.

  14. M R. Income effects on undernutrition. Econ Dev Cult Change 1990;38:489–515.

    Article  Google Scholar 

  15. Dong Y, Ma J, Song Y, Dong B, Wang Z, Yang Z, et al. National blood pressure reference for chinese han children and adolescents aged 7 to 17 years. Hypertension 2017;70:897–906.

    Article  CAS  PubMed  Google Scholar 

  16. Ji CY, Chen TJ. Working Group on Obesity in C. Empirical changes in the prevalence of overweight and obesity among Chinese students from 1985 to 2010 and corresponding preventive strategies. Biomed Environ Sci: Bes 2013;26:1–12.

    PubMed  Google Scholar 

  17. National Bureau of Statistics of the People’s Republic of China. Statistical Yearbook of China. Beijing, 2015. (Accessed March 4, 2015, at: http://www.stats.gov.cn/tjsj/ndsj/).

  18. Wikipedia. List of countries by GDP (PPP) per capita. (Accessed June 22, 2021, at:https://en.wikipedia.org/wiki/List_of_countries_by_GDP_(PPP)_per_capita).

  19. Special Project on Poverty Statistics United Nations Statistics Division. Handbook on poverty statistics: concepts, methods and policy use. 2005. https://unstats.un.org/unsd/methods/poverty/pdf/un_book%20final%2030%20dec%2005.pdf.

  20. WHO. WHO child growth standards: length/height-for-age, weight-for-age, weight-for-length, weight -for-height and body mass index-for-age: methods and development. 2006;1.

  21. Hastie T, Tibshirani R. Generalized additive models for medical research. Stat Methods Med Res. 1995;4:187–96.

    Article  CAS  PubMed  Google Scholar 

  22. Noubiap JJ, Essouma M, Bigna JJ, Jingi AM, Aminde LN, Nansseu JR. Prevalence of elevated blood pressure in children and adolescents in Africa: a systematic review and meta-analysis. Lancet. Public Health. 2017;2:e375–86.

    PubMed  Google Scholar 

  23. Yamamoto-Kimura L, Posadas-Romero C, Posadas-Sanchez R, Zamora-Gonzalez J, Cardoso-Saldana G, Mendez, et al. Prevalence and interrelations of cardiovascular risk factors in urban and rural Mexican adolescents. J Adolesc Health. 2006;38:591–8.

    Article  PubMed  Google Scholar 

  24. Amiri P, Vahedi-Notash G, Naseri P, Khalili D, Hashemi Nazari SS, Mehrabi Y, et al. National trends of pre-hypertension and hypertension among Iranian adolescents across urban and rural areas (2007–2011). Biol Sex Differ. 2019;10:15.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Hifzur R, Singh A. Socio-economic inequalities in the risk of diseases and associated risk factors in India. J Public Health Epidemiol. 2011;3:520–8.

    Google Scholar 

  26. Sommer I, Griebler U, Mahlknecht P, Thaler K, Bouskill K, Gartlehner G, et al. Socioeconomic inequalities in non-communicable diseases and their risk factors: an overview of systematic reviews. BMC Public Health. 2015;15:914.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Montez JK, Bromberger JT, Harlow SD, Kravitz HM, Matthews KA. Life-course socioeconomic status and metabolic syndrome among midlife women. J Gerontol B Psychol Sci Soc Sci. 2016;71:1097–107.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Stringhini S, Viswanathan B, Gedeon J, Paccaud F, Bovet P. The social transition of risk factors for cardiovascular disease in the African region: evidence from three cross-sectional surveys in the Seychelles. Int J Cardiol. 2013;168:1201–6.

    Article  PubMed  Google Scholar 

  29. Fateh M, Emamian MH, Asgari F, Alami A, Fotouhi A. Socioeconomic inequality in hypertension in Iran. J Hypertens. 2014;32:1782–8.

    Article  CAS  PubMed  Google Scholar 

  30. Leng B, Jin Y, Li G, Chen L, Jin N. Socioeconomic status and hypertension: a meta-analysis. J Hypertens. 2015;33:221–9.

    Article  CAS  PubMed  Google Scholar 

  31. Zhang Z, Dong B, Li S, Chen G, Yang Z, Dong Y, et al. Exposure to ambient particulate matter air pollution, blood pressure and hypertension in children and adolescents: a national cross-sectional study in China. Environ Int. 2019;128:103–8.

    Article  CAS  PubMed  Google Scholar 

  32. Din-Dzietham R, Liu Y, Bielo MV, Shamsa F. High blood pressure trends in children and adolescents in national surveys, 1963 to 2002. Circulation 2007;116:1488–96.

    Article  PubMed  Google Scholar 

  33. Freedman DS, Goodman A, Contreras OA, DasMahapatra P, Srinivasan SR, Berenson GS. Secular trends in BMI and blood pressure among children and adolescents: the Bogalusa Heart Study. Pediatrics 2012;130:e159–66.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Pickering T. Cardiovascular pathways: socioeconomic status and stress effects on hypertension and cardiovascular function. Ann NY Acad Sci. 1999;896:262–77.

    Article  CAS  PubMed  Google Scholar 

  35. 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;71:577–84.

    Article  CAS  PubMed  Google Scholar 

  36. McGovern ME, Krishna A, Aguayo VM, Subramanian SV. A review of the evidence linking child stunting to economic outcomes. Int J Epidemiol. 2017;46:1171–91.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Messer E. Intra-household allocation of food and health care: current findings and understandings-introduction. Soc Sci Med. 1997;44:1675–84.

    Article  CAS  PubMed  Google Scholar 

  38. Headey DD. Developmental drivers of nutritional change: a cross-country analysis. World Dev. 2013;42:76–88.

    Article  Google Scholar 

  39. Dong Y, Song Y, Zou Z, Ma J, Dong B, Prochaska JJ. Updates to pediatric hypertension guidelines: influence on classification of high blood pressure in children and adolescents. J Hypertens. 2019;37:297–306.

    Article  CAS  PubMed  Google Scholar 

  40. Flynn JT, Falkner BE. New clinical practice guideline for the management of high blood pressure in children and adolescents. Hypertension 2017;70:683–6.

    Article  CAS  PubMed  Google Scholar 

  41. Flynn JT, Kaelber DC, Baker-Smith CM, Blowey D, Carroll AE, Daniels SR, et al. Clinical practice guideline for screening and management of high blood pressure in children and adolescents. Pediatrics 2017;140:e20171904.

    Article  PubMed  Google Scholar 

  42. Marmot M. Commission on Social Determinants of Health Achieving health equity: from root causes to fair outcomes. Lancet. 2007;370:1153–63.

    Article  PubMed  Google Scholar 

  43. Bixby H, Bentham J, Zhou B, Di Cesare M, Paciorek CJ, Bennett JE, et al. Rising rural body-mass index is the main driver of the global obesity epidemic in adults. Nature 2019;569:260–4.

    Article  Google Scholar 

  44. Quon EC, McGrath JJ. Province-level income inequality and health outcomes in Canadian adolescents. J Pediatr Psychol. 2015;40:251–61.

    Article  PubMed  Google Scholar 

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Acknowledgements

The authors would like to acknowledge the support from all the team members and the participated students, teachers, parents, and local education and health staff in the programs.

Funding

The present study was supported by the National Natural Science Foundation (Grant 81673192 to Jun Ma) and Humanities and Social Sciences Planning Fund Project, Ministry of Education, People’s Republic of China (Grant 19YJA890022 to Yi Song), as well as project funded by the China Postdoctoral Science Foundation (National Postdoctoral Program for Innovative Talent, BX20200019 and 2020M680266 to Yanhui Dong). The funders did not play any roles in the design of the study and collection, analysis, and interpretation of data and in writing the manuscript.

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Authors and Affiliations

  1. Institute of Child and Adolescent Health & School of Public Health, Peking University, Beijing, China

    Yanhui Dong, Manman Chen, Yanhui Li, Di Gao, Bo Wen, Yi Song & Jun Ma

  2. Institute of Population Research, Peking University/KU-APEC Health Science Academy, Beijing, China

    Binbin Sun

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Contributions

DYH conceptualized and designed the study, completed the statistical analyses, drafted the initial manuscript, and reviewed and revised the manuscript; MJ and SY contributed to the conceptualization and design of the study, supervised the data collection, the statistical analyses, and initial drafting of the manuscript, and reviewed and revised the manuscript; MC, BS, YL, DG, BW and assisted with the statistical analyses and reviewed the manuscript. All authors read and approved the final version of the manuscript.

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Correspondence to Yi Song or Jun Ma.

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The authors declare no competing interests.

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Informed consent was obtained from both parents and students before they participated in the study. The project was approved by the Medical Research Ethics Committee of Peking University Health Science Center (IRB00001052-13082).

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We have obtained consent to publish from both children and parents to report their data uninvolved in their privacy.

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Dong, Y., Chen, M., Sun, B. et al. Trends in associations between socioeconomic development and urban–rural disparity with high blood pressure in Chinese children and adolescents over two decades. J Hum Hypertens 36, 866–874 (2022). https://doi.org/10.1038/s41371-021-00592-7

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