Prevalence and correlates of self-reported hypertension among Zambians aged 15–59 years: Analysis of the 2024 DHS

Background Hypertension is a leading risk factor for cardiovascular disease, stroke, and premature mortality, with low- and middle-income countries bearing the greatest burden. In Zambia, evidence on hypertension remains limited to small regional studies. Self-reported hypertension, a previous diagnosis by a health professional, offers a scalable approach for monitoring awareness and health system engagement in national surveys. This study estimated the prevalence of self-reported hypertension and identified its individual- and community-level correlates among Zambian adults. Methods Data were drawn from the 2024 Zambia Demographic and Health Survey, comprising 26,536 adults aged 15 years and older. Weighted descriptive statistics estimated prevalence across demographic, socioeconomic, and geographic strata. Multilevel logistic regression models identified independent correlates while accounting for clustering within enumeration areas. Results are reported as adjusted odds ratios (aOR) with 95% confidence intervals. Between-cluster heterogeneity was quantified using the intraclass correlation coefficient (ICC) and median odds ratio. Results The weighted prevalence of self-reported hypertension was 7.8%. Hypertensive individuals were older (36.7 vs 28.7 years; p < 0.001), predominantly female (64.0% vs 51.6%; p < 0.001), and more likely to reside in urban areas (63.8% vs 47.5%; all p < 0.001). Lusaka (21.1%) and Copperbelt (20.4%) provinces had the highest proportions. In multilevel models, each additional year of age increased odds by 6% (aOR = 1.064; 95% CI: 1.058–1.070). Men had substantially lower odds than women (aOR = 0.432; 95% CI: 0.387–0.481). Rural residence was protective (aOR = 0.806; 95% CI: 0.678–0.958). Higher education (aOR = 1.735; 95% CI: 1.325–2.273) and household wealth (rich vs poor: aOR = 1.761; 95% CI: 1.451–2.137) were positively associated. Married (aOR = 1.706; 95% CI: 1.465–1.986) and formerly married adults (aOR = 1.456; 95% CI: 1.194–1.776) had elevated odds. Significant provincial variation persisted after adjustment. The ICC decreased from 0.091 to 0.040, indicating that included covariates explained substantial between-cluster variation. Conclusion Self-reported hypertension among Zambian adults is shaped by age, sex, urbanisation, socioeconomic status, and geography. These findings identify priority populations and regions for targeted screening and awareness programmes to reduce the growing cardiovascular disease burden in Zambia.