Socioeconomic inequality in hypertension prevalence and care continuum: evidence from rural Bangladesh

Introduction In this study, we aimed to quantify socioeconomic inequality in hypertension prevalence and steps on the care continuum, and to identify factors contributing to inequality using a population-based sample from rural Bangladesh. Methods This study was a cross-sectional analysis of a random sample of 6489 adults aged 40 years and above. Socioeconomic status was measured by wealth score and educational attainment. The socioeconomic inequality attributable to explanatory variables was quantified by percent reduction in the regression coefficient with and without adjustment for blocks of explanatory variables, and by Blinder-Oaxaca decomposition method. Results Among participants, 50.1% were female. Compared with those from the lowest wealth index tertile, participants in the top tertile had higher hypertension prevalence across all age groups. However, among participants with hypertension, a strong wealth gradient was observed for being diagnosed (47.4%, 29.4%, and 24.8% across three wealth tertile groups), being on treatment (33.3%, 19.3%, and 15.2%), and having controlled blood pressure (14.1%, 7.1%, and 5.9%). Similar disparities were observed across education groups. Adjustment for all explanatory variables attenuated the differences in hypertension prevalence between high versus low wealth group from RR 1.27 (95% CI, 1.15–1.39) to RR 1.06 (95% CI, 0.96–1.17). These factors explained 42% to 44% of the differences in hypertension awareness between high versus low socioeconomic status groups. Among participants already diagnosed with hypertension, socioeconomic differences in hypertension treatment were less pronounced. No significant socioeconomic differences in blood pressure control were observed among those already diagnosed. Conclusion In rural Bangladesh, socioeconomic inequality in hypertension prevalence and care continuum was substantial. Lifestyle factors, family history of CVD and diabetes, cardiometabolic risk factor, and comorbid conditions were strong mediators of socioeconomic inequality in hypertension prevalence and awareness. Few socioeconomic disparities were observed in hypertension treatment and control among participants already diagnosed.