Urbanization and Socioeconomic Disparities in Hypertension among Older Adult Women in Sudan.

BACKGROUND: Evidence from the developed world associates higher prevalence of hypertension with lower socioeconomic status (SES). However, patterns of association are not as clear in Africa and other developing countries, with varying levels of socioeconomic development and epidemiological transition. Using wealth and education as indicators, we investigated association between SES and hypertension among older adult women in Sudan and examined whether urbanicity mediates the relationship.

METHODS: The sample included women aged 50 years and over participating in the nationally representative population-based second Sudan Health Household Survey (SHHS) conducted in 2010. Principal components analysis was used to assign each household with a wealth score based on assets owned. The score was categorized into quintiles from lowest (poorest) to highest (richest).

FINDINGS: The sample included a total of 5218 women, median and mean age 55 and 59 years, respectively, with the majority not have any schooling (81.6%). The overall prevalence of reported hypertension was found to be 10.5%. After adjustment for age, marital status, work status and urban/rural location, better wealth and higher education were independently and positively associated with hypertension prevalence rates. However, when stratified by urbanicity, the relationship between wealth and hypertension lost its significance for women in urban areas but maintained it in rural areas, increasing significantly and consistently with each increase in quintile index (adjusted odds ratio, aOR1 = 1.95 95% CI = 1.08-3.52; aOR2 = 5.25, 95% CI = 3.01-9.15; aOR3 = 8.27, 95% CI = 4.78-14.3; and aOR4 = and 11.4, 95% CI = 6.45-20.0; respectively). By contrast, education played a greater role in increasing the odds of hypertension among women in urban locations but not in rural locations (aOR = 2.14, 95% CI = 1.25-7.90 vs. aOR = 0.79, 95% CI = 0.27-2.30, respectively).

CONCLUSIONS: Our findings of a socioeconomic gradient in the prevalence of hypertension among women, mediated by urbanization, call for targeted interventions from early stages of economic development in Sudan and similar settings of transitioning countries.