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ORIGINAL ARTICLE
Gender differences in prevalence and
socioeconomic determinants of
hypertension: findings from the WHO
STEPs survey in a rural community
of Vietnam
H Van Minh1, P Byass2, NTK Chuc1 and S Wall2
1
Faculty of Public Health, Hanoi Medical University, Hanoi, Vietnam and 2Umeå International School of
Public Health, Umeå University, Umeå, Sweden
In Vietnam, hypertension was estimated to cause a large economic conditions. Descriptive techniques and multi-
number of deaths in hospitals. However, population- variate logistic regression were used. The prevalence of
based knowledge about the magnitude of hypertension hypertension was 14.1%. Of hypertensives, only 17.4%
in Vietnam and its relationship with socioeconomic were aware of their hypertensive status. Men were
status, especially in the rural communities, still remains hypertensive more often than women and age was
scarce. This paper, taking advantage of a study on positively associated with hypertension. The associa-
noncommunicable disease (NCD) risk factors in Bavi tion between hypertension and socioeconomic status
district, Vietnam, using the WHO STEPs approach, was complex and differed between men and women.
estimates the prevalence of hypertension in the setting Among men, those with lower educational and occupa-
and examines its association with some socioeconomic tional status but who were richer were more likely to be
factors. A representative sample comprising 2000 adults hypertensive. More women with lower occupational and
aged 25–64 years were selected randomly and surveyed economic status were hypertensive.
in 2002. The JNC VII criteria for hypertension were Journal of Human Hypertension (2006) 20, 109–115.
used. Socioeconomic status of the study subjects was doi:10.1038/sj.jhh.1001942; published online 29 September 2005
estimated by assessing their education, occupation and
Occupationa
Figures are means (95% CI). Government staffs 21.2 (12.7–35.8) 7.0 (1.7–16.5)
Farmers 13.1 (10.3–16.0) 5.9 (5.2–8.8)
Other jobs 24.2 (19.8–28.8) 24.1 (17.7–32.4)
and age. Both the mean SBP and mean DBP were Economic a
Poor 15.5 (9.1–21.9) 18.2 (11.5–24.9)
significantly higher in men than in women (mean Average 16.6 (13.7–19.6) 8.5 (6.4–10.6)
SBP and DBP were 124.9 and 76.9 mmHg in men Rich 21.2 (16.2–26.2) 10.1 (6.4–13.8)
and 117.7 and 72.0 in women, respectively). Both
SBP and DBP of men and women increased a
Figures were age-adjusted using overall age structure.
progressively with age.
The overall prevalence of hypertension in Bavi
was found to be 14.1% (281/1996) (95% CI 12.5–
15.7). Using the age structure of the WHO standard (respective age-adjusted prevalence was 31 vs 18%
population,19 the age-standardized prevalence of among men and 13 vs 11% among women).
hypertension was 16.4% (95% CI 14.8–18.1). In terms of the relationship between hypertension
Of 281 hypertensive subjects, only 49 cases and occupation, in both genders, people doing other
(17.4%), 25 men (8.9%) and 24 women (8.5%), were jobs had the highest hypertension and farmers had
aware of their hypertensive status and the remaining the lowest prevalence. The difference in prevalence
232 (82.6%) were unaware. Of the hypertensive of hypertension between government staff and
subjects who were aware of their blood pressure farmers was greater among men (respective age-
condition, only 18 cases (6.4%), 10 men (3.5%) and adjusted prevalence was 21 vs 13% among men and
eight women (2.9%), were being treated with drugs. 7 vs 6% among women), while the disparity
The proportion of unaware hypertensive subjects between people doing other jobs and farmers was
was significantly higher among men (86.1%) than greater among women (respective age-adjusted pre-
among women (76.0%). It was inversely correlated valence was 24 vs 13% among men and 23 vs 6%
with age (92.3, 86.5, 82.5 and 69.6% among among women).
hypertensive people aged 25–34, 35–44, 45–54 and The patterns of hypertension according to eco-
55–64 years, respectively) but was not different nomic status also varied and were inconsistent by
across socioeconomic groups (data not shown). gender. Affluent men and poor women had the
The prevalence of hypertension according to highest prevalence of hypertension as compared
gender, age and socioeconomic status is presented with other economic groups of the same gender (age-
in Table 3. After adjustments for age, the prevalence adjusted prevalence was 21, 17 and 16% in rich,
of hypertension remained significantly higher average and poor men, respectively; while it was 10,
among men (18.1%) than among women (10.1%). 9 and 18% in rich, average and poor women,
In both genders, the prevalence of hypertension respectively).
increased significantly with age (from 10.8% among Multivariate logistic regression models were
men and 4.2% among women in the age group 25– constructed to further analyze the association of
34 years to 27.3 and 17.3% among men and women hypertension with socioeconomic indicators among
of 55–64 years, respectively). men and women. As shown in Table 4, in both men
Men and women with the lowest educational and women, age was a significant determinant of
levels were more likely to be hypertensive than the hypertension. The prevalence increased with age
two higher education categories. However, the and was statistically different among people aged
difference in hypertension between low and high 35–44, 45–54 and 55–64 years old as compared with
educational groups was only significant in men the 25–34 age group.