State Socioeconomic Indicators and Self-Reported Hypertension Among US Adults, 2011 Behavioral Risk Factor Surveillance System

INTRODUCTION: Hypertension is the leading cause of chronic disease and premature death in the United States. To date, most risk factors for hypertension have been identified at the individual (micro) level. The association of macro-level (area) socioeconomic factors and hypertension prevalence rates in the population has not been studied extensively. METHODS: We used the 2011 Behavioral Risk Factor Surveillance System to examine whether state socioeconomic status (SES) indicators predict the prevalence of self-reported hypertension. Quintiles of state median household income, unemployment rate among the population aged 16 to 64 years, and the proportion of the population under the national poverty line were used as the proxy for state SES. Hypertension status was determined by the question “Have you ever been told by a doctor, nurse, or other health professional that you have high blood pressure?” Logistic regression was used to assess the relationship between state SES and hypertension with adjustment for individual covariates (demographic and socioeconomic factors and lifestyle behaviors). RESULTS: States with a median household income of $43,225 or less (odds ratio [95% confidence interval] = 1.16 [1.08–1.25]) and states with 18.7% or more of residents living below the poverty line (odds ratio [95% confidence interval] = 1.14 [1.04–1.24]) had a higher prevalence of hypertension than states with the most residents in the most advantageous quintile of the indicators. CONCLUSION: The observed state SES–hypertension association indicates that area SES may contribute to the burden of hypertension in community-dwelling adults.