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Racial/Ethnic Variability in Hypertension Prevalence and Risk Factors in National Health Interview Survey

DOI: 10.5402/2013/257842

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Objective. Hypertension is one of the leading causes of death attributed to cardiovascular diseases, and the prevalence varies across racial/ethnic groups, with African Americans being disproportionately affected. The underlying causes of these disparities are not fully understood despite volume of literature in this perspective. We aimed in this current study to examine ethnic/racial disparities in hypertension utilizing Hispanics as the base racial/ethnic group for comparison. Research Design and Methods. We utilized the National Health Interview Survey (NHIS), which is a large cross-sectional survey of the United States non-institutionalized residents to investigate the racial/ethnic disparities in hypertension after the adjustment of other socio-economic, demographic, and prognostic risk factors. The study participants were adults (n = 30,852). Data were analyzed using Chi square statistic, and logistic regression model. Results. There were statistically significant differences by race/ethnicity with respect to income, education, marital status, smoking, alcohol, physical activities, body mass index, and age, P < 0.01, but not insurance coverage, P > 0.01. Hispanic ethnicity (18.9%) compared to either non-Hispanic white (27.7%) or non-Hispanic black (35.5%) was associated with the lowest prevalence of hypertension. Race/ethnicity was a single independent predictor of hypertension, with non-Hispanic black more likely to be hypertensive compare with Hispanic, prevalence odds ratio (POR), 2.38, 99% Confidence Interval (CI), 2.17–2.61 and non-Hispanic white, POR, 1.64, 99% CI, 1.52–1.77. After controlling for the confounding variables, the racial/ethnic differences in hypertension persisted. Conclusions. Racial/ethnic disparities in hypertension persisted after controlling for potential predictors of hypertension in NHIS, implying the inability of known hypertension risk factors to account for racial/ethnic variability in hypertension in US. 1. Introduction Hypertension remains one of the leading causes of cardiovascular mortality in the United States population, affecting disproportionately non-Hispanic blacks [1–4]. The etiology of hypertension is multifactorial and incidence, prevalence and mortality vary by race/ethnicity [5–7]. A study has shown that the age-adjusted prevalence of hypertension by race, in the year 2003-2004, among the United States residents of age 20 years or older was 39.1% non-Hispanic Black, 28.5% non-Hispanic White, and 27.8% Hispanic, while age-unadjusted prevalence rate was 34.4%, 30.3%, and 16.9% for three racial groups,


[1]  M. J. Wrobel, J. J. Figge, and J. L. Izzo Jr., “Hypertension in diverse populations: a New York State Medicaid clinical guidance document,” Journal of the American Society of Hypertension, vol. 5, no. 4, pp. 208–229, 2011.
[2]  L. N. Borrell, B. S. Menendez, and S. P. Joseph, “Racial/ethnic disparities on self-reported hypertension in New York City: examining disparities among Hispanic subgroups,” Ethnicity & Disease, vol. 21, no. 4, pp. 429–436, 2011.
[3]  K. N. Kershaw, A. V. Diez Roux, S. A. Burgard, L. D. Lisabeth, M. S. Mujahid, and A. J. Schulz, “Metropolitan-level racial residential segregation and black-white disparities in hypertension,” American Journal of Epidemiology, vol. 174, no. 5, pp. 537–545, 2011.
[4]  R. Cooper and C. Rotimi, “Hypertension in blacks,” American Journal of Hypertension, vol. 10, no. 7 I, pp. 804–812, 1997.
[5]  N. R. Kressin, M. B. Orner, M. Manze, M. E. Glickman, and D. Berlowitz, “Understanding contributors to racial disparities in blood pressure control,” Circulation, vol. 3, no. 2, pp. 173–180, 2010.
[6]  J. M. Mellor and J. Milyo, “Exploring the relationships between income inequality, socioeconomic status and health: a self-guided tour?” International Journal of Epidemiology, vol. 31, no. 3, pp. 685–687, 2002.
[7]  K. L. Ong, B. M. Y. Cheung, Y. B. Man, C. P. Lau, and K. S. L. Lam, “Prevalence, awareness, treatment, and control of hypertension among United States adults 1999–2004,” Hypertension, vol. 49, no. 1, pp. 69–75, 2007.
[8]  J. Currie and M. Stabile, “Socioeconomic status and child health: why is the relationship stronger for older children?” American Economic Review, vol. 93, no. 5, pp. 1813–1823, 2003.
[9]  W. H. Frist, “Overcoming disparities in U.S. health care,” Health Affairs, vol. 24, no. 2, pp. 445–451, 2005.
[10]  D. R. Williams and T. D. Rucker, “Understanding and addressing racial disparities in health care,” Health Care Financing Review, vol. 21, no. 4, pp. 75–90, 2000.
[11]  S. L. Botman, T. F. Moore, and C. L. Moriarity, “Design and estimation for the National Health Interview Survey, 1995–2004,” Vital Health Statistics Series 2, no. 130, pp. 1–31, 2000, CDC, National Center for Health Statistics.
[12]  J. A. Gazmararian, D. W. Baker, M. V. Williams et al., “Health literacy among Medicare enrollees in a managed care organization,” Journal of the American Medical Association, vol. 281, no. 6, pp. 545–551, 1999.
[13]  D. L. Downie, D. Schmid, M. G. Plescia et al., “Racial disparities in blood pressure control and treatment differences in a Medicaid population, North Carolina, 2005–2006,” Preventing Chronic Disease, vol. 8, no. 3, p. A55, 2011.
[14]  M. V. Williams, D. W. Baker, R. M. Parker, and J. R. Nurss, “Relationship of functional health literacy to patients' knowledge of their chronic disease: a study of patients with hypertension and diabetes,” Archives of Internal Medicine, vol. 158, no. 2, pp. 166–172, 1998.
[15]  B. H. Brummett, M. A. Babyak, I. C. Siegler et al., “Systolic blood pressure, socioeconomic status, and biobehavioral risk factors in a nationally representative US young adult sample,” Hypertension, vol. 58, no. 2, pp. 161–166, 2011.
[16]  N. E. Adler and J. M. Ostrove, “Socioeconomic status and health: what we know and what we don't,” Annals of the New York Academy of Sciences, vol. 896, pp. 3–15, 1999.
[17]  K. Fiscella, P. Franks, M. R. Gold, and C. M. Clancy, “Inequality in quality: addressing socioeconomic, racial and ethnic disparities in health care,” Journal of the American Medical Association, vol. 283, no. 19, pp. 2579–2584, 2000.
[18]  R. E. Hurley, H. H. Pham, and G. Claxton, “A widening rift in access and quality: growing evidence of economic disparities,” Health Affairs, Web Exclusives, no. 2005, pp. W5-566–W5-576, 2005.
[19]  “Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care,” Institute of Medicine, 2002,
[20]  J. P. Smith and R. Kington, “Race, socioeconomic status and health in late life,” in Racial and Ethnic Differences in the Health of Older Americans, L. G. Martin and B. J. Soldo, Eds., pp. 106–162, National Academy Press, Washington, DC, USA, 1997.
[21]  L. I. Pearlin and J. S. Johnson, “Marital status, life-strains and depression,” American Sociological Review, vol. 42, no. 5, pp. 704–715, 1977.
[22]  M. L. Thompson, J. E. Myers, and D. Kriebel, “Prevalence odds ratio or prevalence ratio in the analysis of cross sectional data: what is to be done?” Occupational and Environmental Medicine, vol. 55, no. 4, pp. 272–277, 1998.
[23]  Y. C. Klimentidis, A. Dulin-Keita, K. Casazza, A. L. Willig, D. B. Allison, and J. R. Fernandez, “Genetic admixture, social-behavioural factors and body composition are associated with blood pressure differently by racial-ethnic group among children,” Journal of Human Hypertension, vol. 26, no. 2, pp. 98–107, 2011.
[24]  M. S. Mujahid, A. V. Diez Roux, R. C. Cooper, S. Shea, and D. R. Williams, “Neighborhood stressors and race/ethnic differences in hypertension prevalence (the Multi-Ethnic Study of Atherosclerosis),” American Journal of Hypertension, vol. 24, no. 2, pp. 187–193, 2011.
[25]  C. Russo, Z. Jin, S. Homma et al., “Race/ethnic disparities in left ventricular diastolic function in a triethnic community cohort,” American Heart Journal, vol. 160, no. 1, pp. 152–158, 2010.
[26]  G. S. Berenson, W. Chen, P. Dasmahapatra et al., “Stimulus response of blood pressure in black and white young individuals helps explain racial divergence in adult cardiovascular disease: the Bogalusa Heart Study,” Journal of the American Society of Hypertension, vol. 5, no. 4, pp. 230–238, 2011.
[27]  A. Selassie, C. S. Wagner, M. L. Laken, M. L. Ferguson, K. C. Ferdinand, and B. M. Egan, “Progression is accelerated from prehypertension to hypertension in blacks,” Hypertension, vol. 58, no. 4, pp. 579–587, 2011.
[28]  C. N. Bell, R. J. Thorpe Jr., and T. A. Laveist, “Race/ethnicity and hypertension: the role of social support,” American Journal of Hypertension, vol. 23, no. 5, pp. 534–540, 2010.
[29]  L. Franzini, J. C. Ribble, and A. M. Keddie, “Understanding the Hispanic paradox,” Ethnicity & Disease, vol. 11, no. 3, pp. 496–518, 2001.
[30]  N. Redmond, H. J. Baer, and L. S. Hicks, “Health behaviors and racial disparity in blood pressure control in the national health and nutrition examination survey,” Hypertension, vol. 57, no. 3, pp. 383–389, 2011.
[31]  E. Brondolo, E. E. Love, M. Pencille, A. Schoenthaler, and G. Ogedegbe, “Racism and hypertension: a review of the empirical evidence and implications for clinical practice,” American Journal of Hypertension, vol. 24, no. 5, pp. 518–529, 2011.
[32]  J. Warren-Findlow and R. B. Seymour, “Prevalence rates of hypertension self-care activities among African Americans,” Journal of the National Medical Association, vol. 103, no. 6, pp. 503–512, 2011.
[33]  L. Holmes Jr., W. Chan, Z. Jiang, and X. L. Du, “Effectiveness of androgen deprivation therapy in prolonging survival of older men treated for locoregional prostate cancer,” Prostate Cancer and Prostatic Diseases, vol. 10, no. 4, pp. 388–395, 2007.


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