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

Background: This study examines the association between socioeconomic and lifestyle factors and the prevalence of hypertension among the elderly in rural southwest China.Methods: A cross-sectional survey of 4,833 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. Structure equation modeling (SEM) was applied to analyze 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. The following associated factors had statistically significant effect on hypertension: body composition, including measures of obesity and central obesity, had the greatest total effect on hypertension (0.21), followed by family history of hypertension (0.14), gender (0.08), sleep quality (-0.07), SEP (-0.06), physical inactivity (0.06), and diabetes (0.06). Body composition, SEP, and family history of hypertension had both direct and indirect effects on hypertension, whereas those of physical inactivity, diabetes, and sleep quality were directly associated with prevalence of hypertension. Gender was indirectly associated with prevalence of hypertension. Conclusion: Individual SEP, body composition, 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.