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Relationship between social determinants of health and systolic blood pressure in United States immigrants. Int J Cardiol Hypertens 2019 Aug;2:100011

Date

05/25/2019

Pubmed ID

33447744

Pubmed Central ID

PMC7803058

DOI

10.1016/j.ijchy.2019.100011

Scopus ID

2-s2.0-85070226762   6 Citations

Abstract

This study examined the relationship between immigrant specific social determinants of health (SDoH) and blood pressure control. Data on 181 adult immigrants from the Midwestern United States was analyzed. SDoH variables were categorized based on antecedents, predisposing, enabling, and need factors. Systolic blood pressure (SBP) was the primary outcome. Pearson's correlations for the association between SBP and SDoH variables were assessed. Then three different regression approaches were used to assess the relationship of SDoH variables with SBP: sequential model, stepwise regression with backward selection, and all possible subsets regression. About 66% were female and mean age was 45.4 years. Age (r ​= ​0.34, p ​< ​0.001), disability (r ​= ​0.20, p ​= ​0.0001), comorbidities (r ​= ​0.30, p ​< ​0.001), and chronic pain (r ​= ​0.12, p ​= ​0.02) were positively correlated with SBP, and number of hours worked per week (r ​= ​-0.11, p ​= ​0.028) was negatively correlated with SBP. The final sequential model found life-course socioeconomic status (SES) (β ​= ​1.40, p ​= ​0.039), age (β ​= ​0.39, p ​< ​0.001), and male sex (β ​= ​13.62, p ​< ​0.001) to be positively associated with SBP. Stepwise regression found that life-course SES (β ​= ​1.70, p ​= ​0.026), age (β ​= ​0.36, p ​< ​0.001), male sex (β ​= ​13.38, p ​< ​0.001), and homelessness as a child (β ​= ​13.14, p ​= ​0.034) were positively associated SBP. All possible subsets regression found that age (β ​= ​0.44, p ​< ​0.001), male sex (β ​= ​14.50, p ​< ​0.001), and homelessness as a child (β ​= ​14.08, p ​= ​0.027) were positively associated with SBP. This is the first study to use a theory-based model that incorporates social determinants of health and immigrant specific factors to examine the relationship between SDoH and blood pressure control and identifies potential targets for interventions to control BP in immigrants.

Author List

Dawson AZ, Walker RJ, Gregory C, Egede LE

Authors

Aprill Z. Dawson PhD, MPH Assistant Professor in the Medicine department at Medical College of Wisconsin
Leonard E. Egede MD Center Director, Chief, Professor in the Medicine department at Medical College of Wisconsin
Rebekah Walker PhD Associate Professor in the Medicine department at Medical College of Wisconsin