Systolic Blood Pressure, Socioeconomic Status, and Biobehavioral Risk Factors in a Nationally Representative US Young Adult Sample

In the National Longitudinal Study of Adolescent Health, a US longitudinal study of over 15,000 young adults, we examined the extent to which socioeconomic status is linked to systolic blood pressure, and whether biobehavioral risk factors mediate the association. Over 62% of the participants had systolic blood pressure >120 mmHg and 12% with systolic blood pressure >140 mmHg. Over 66% were classified as at least overweight (Body Mass Index>25 kg/m2), with over 36% meeting criteria for at least Class I obesity (Body Mass Index>30 kg/m2). Multivariate models showed that higher household income and being married were independently associated with lower systolic blood pressure. Higher body mass index, greater waist circumference, smoking, and higher alcohol intake were each independently associated with higher systolic blood pressure. Meditational analyses suggested that higher education level was associated with lower systolic blood pressure by way of lower body mass, smaller waist circumference, and lower resting heart rate. When these indirect effects were accounted for, education was not significantly associated with systolic blood pressure. In contrast, household income remained associated with systolic blood pressure even with control for all covariates. Results reinforce current public health concerns about rates of obesity and high blood pressure among young adults and suggest that disparities in education level and household income may play an important role the observed decrements in health. Identifying modifiable mechanisms that link socioeconomic status to systolic blood pressure using data from a large representative sample may improve risk stratification and guide the development of effective interventions