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Social disparities in prevalence, treatment and control of
hypertension in Iran: Second National Surveillance of Risk
Factors of Noncommunicable Diseases, 2006
Mitra Ebrahimi
a,M
, Mohammad A. Mansournia
b
, Ali A. Haghdoost
c
,
Arash Abazari
d
, Farshid Alaeddini
e
, Ali Mirzazadeh
c
and Masud Yunesian
b,f,M
Objective Assessing hypertension prevalence, treatment
and control by sociodemographic factors in Iran.
Methods We analyzed data from the 2006 National
Surveillance of Risk Factors for Noncommunicable Diseases
of Iran with a population-based sample of almost 30000
people aged 15–64 years. Multiple logistic regression
models were used to explore differences in hypertension
prevalence, treatment and control, adjusting for
sociodemographic factors, comorbidities and behavioral
factors.
Results Hypertension prevalence was 17.37%. Among
hypertensive patients, 33.35% were under treatment, and,
among treated people, 35.10% had hypertension controlled.
In multiple-regression analysis, age, male sex, low level of
education, Kurd ethnicity, overweight and obesity, diabetes
mellitus, lower level of physical activity and high-Human
Development Index provinces were independently
associated with higher prevalence of hypertension. Income
and living in rural or urban area were not related to
hypertension prevalence. Treatment rates were lower in men,
younger people and people of low education and low income,
but there were no treatment rate disparities connected to
living area, ethnicity and provinces (by Human Development
Index). In addition, diabetic patients, obese people and past
daily smokers had higher treatment rates. Lower control rates
were independently associated with male sex, higher age and
lower education, but not with other variables.
Conclusion In Iran, there is comparatively higher
prevalence of hypertension among people of Kurdish
ethnicity, people of low education and in high-Human
Development Index provinces; a lower treatment
rate among men, younger people, people of
low education and low income; and a lower control
rate among men and people of low education.
These disparities should be addressed by
researchers and health policy makers. J Hypertens
28:1620–1629 Q 2010 Wolters Kluwer Health | Lippincott
Williams & Wilkins.
Journal of Hypertension 2010, 28:1620–1629
Keywords: educational status, epidemiology, ethnic groups, health status
disparities, income, Iran, residence characteristics, rural health,
socioeconomic factors, urban health
Abbreviations: aOR, adjusted odds ratio; CI, confidence interval; HDI,
Human Development Index; NCD, noncommunicable disease; NHANES,
National Health and Nutrition Examination Survey; OR, odds ratio; STEPS,
STEPwise approach to chronic disease risk factor surveillance
a
Student’s Scientific Research Centre,
b
School of Public Health, Tehran
University of Medical Sciences (TUMS),
c
Physiology Research Centre, Kerman
University of Medical Sciences, Kerman,
d
School of Medicine, Tehran University
of Medical Sciences (TUMS),
e
Health Researchers Research and Development
Institute and
f
Centre for Environmental Research, Tehran University of Medical
Sciences (TUMS), Tehran, Iran
Correspondence to Mitra Ebrahimi, MD, MPH, Student’s Scientific Research
Centre, Tehran University of Medical Sciences (TUMS), Poursina St., P.O. Box
#14155-6537, Tehran, Iran
Tel: +98 21 66495948; fax: +98 21 66418588;
e-mail: ebrahimi_m@razi.tums.ac.ir
Received 11 June 2009 Revised 15 March 2010
Accepted 22 March 2010
Introduction
In recent years, social disparities in health, especially in
developed countries, have been extensively investigated.
It is not surprising that the health measure of many of
these studies has been hypertension. Hypertension is one
of the leading contributors to the burden of disease and
mortality throughout the world [1]. Many studies have
investigated the association of hypertension prevalence,
treatment and control with race/ethnicity, socioeconomic
status and residential environment. For example, a higher
prevalence of hypertension in African–Americans has
been consistently demonstrated in the United States
[2]. In most studies [3–8], the hypertension prevalence
is inversely related to the socioeconomic status, edu-
cation and income. However, associations between hy-
pertension and these measures were absent, or some-
times even positive, in another investigation [5].
Additionally, a study [9] has shown that the people
who live in more disadvantaged areas are more likely
to have high blood pressure (BP).
Until now, the relation of social factors and health in Iran
has been poorly represented in literature. The current
study analyzes data from an Iranian national survey in
2006 in order to explore the association of sociodemo-
graphic factors (sex, age, living in rural or urban
area, ethnicity, income, education and the province of
1620 Original article
M
M.E. and M.Y. contributed equally to the writing of this article.
0263-6352 ß 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins DOI:10.1097/HJH.0b013e32833a38f2