Is socio-economic development of areas associate with hypertension prevalence, awareness and treatment? A multilevel approach

Hypertension, which has been well recognized as a major independent risk factor for cardiovascular disease and stroke, is one of the most significant health problems now facing China. This study addresses how socio-economic development of areas affects hypertension prevalence, awareness and treatment by simultaneously examining individual-level socioeconomic status and community-level characteristics using a multi-level approach. The data are from China Nutrition and Health Survey: a representative sample of 7381 adults over 216 neighborhoods. A two-level Generalized Hierarchical Logit Model (GHLM) is used to combine community-level (level-2) characteristics (i.e., Comprehensive development index, CDI), and individual-level SES position and lifestyle habits (level-1) to examine the factors associated with hypertension in China. The results show the prevalence and awareness of hypertension is significantly higher in spatially clustered neighborhoods of low CDI after adjusting for individual-level characteristics. However, the treatment of hypertension is relatively lower in areas with low CDI. This suggests an association between neighborhood CDI level and blood pressure, regardless of well-known individual-level hypertension risk factors.