SOCIOECONOMIC POSITION, GENDER AND HYPERTENSION IN A RURAL CANADIAN POPULATION

Background: High blood pressure is the leading risk factor for disease burden worldwide, contributing to more than 9 million deaths each year. Some research suggests that the prevalence of hypertension increases as individual/household socioeconomic position (SEP) decreases. The results of multilevel studies also suggest an association between poorer neighborhood socioeconomic circumstances and hypertension. Further, at both the individual/household- and area-level, high blood pressure may be more strongly related to SEP among women than men. Most research, however, has been restricted to urban populations. There has not been much research which examines risk factors for hypertension in rural Canada and, in particular, socioeconomic risk factors. Objectives: To examine the relationship between individual/household- and area- level socioeconomic circumstances, gender, and high blood pressure in a rural Saskatchewan population. Methods: There were two data sources for this study. Individual/household-level data were from the Saskatchewan Rural Health Study (SRHS). Analyses focused on adults (n=8,261) who completed the cross-sectional baseline questionnaire. Census subdivisions were used to link SRHS data with area-level data from the 2006 Canadian census. The dependent variable was self-reported diagnosed high blood pressure. The primary independent variables were gender and four measures of socioeconomic circumstances: household income, educational attainment, arealevel material deprivation, and area-level social deprivation. Principal components analysis was used to derive the area-level measures of deprivation. Multilevel logistic regression was the primary method of analysis. Results: Four main findings emerged: 1) low educational attainment was associated with a greater odds of high blood pressure; 2) the relationship between low household income and high blood pressure was more pronounced among women than men; 3) the relationship between higher area-level social deprivation and high blood pressure was more pronounced among men than women; and 4) area-level material deprivation was not associated with high blood pressure. iii Conclusion: Study results revealed complex relationships between SEP, gender, and high blood pressure in this rural Saskatchewan population. Future research applying a longitudinal design is needed to advance understanding of the relationship between SEP and incident hypertension in rural Canada, including the identification of vulnerable subgroups. Also needed is research examining the factors which explain (i.e. mediate) associations between SEP and hypertension in rural settings, particularly at the area-level