title: Education, household wealth and blood pressure in Albania, Armenia, Azerbaijan and Ukraine: findings from the Demographic Health Surveys, 2005-2009.
abstract: BACKGROUND
  While socioeconomic gradients in cardiovascular disease have been well established in high-income countries, this relationship is not well understood in middle-income countries.
  
  
  METHODS
  Data from Demographic Health Surveys collected in Albania (2008-09), Armenia (2005), Azerbaijan (2006) and Ukraine (2007) were used to estimate age-adjusted differences in systolic blood pressure (SBP), diastolic blood pressure (DBP), pulse pressure (PP), hypertension (HTN), elevated blood pressure, and optimal blood pressure across a standardized wealth index, level of educational attainment, and urban versus rural residence.
  
  
  RESULTS
  The wealthiest Albanian females had lower average SBP, DBP, PP (all p<0.01) and HTN status (odds ratio [OR]=0.3, CI: 0.2-0.5, p<0.001) compared to the poorest; similar education gradients were also found. Such disparities also existed for Albanian men. Among Armenian women, urban (OR=1.4, 1.1-1.8, p<0.01), more educated (OR=0.7, CI: 0.6-0.9, p<0.01), and wealthier (OR=1.8, 1.4-2.4, p<0.001) women were more likely to have optimal blood pressure. Urban Armenian men were also more likely to have optimal blood pressure (OR=1.8, 1.2-2.9, p<0.01). Wealthier and urban Azerbaijani had lower risk of elevated blood pressure and Azerbaijani women displayed strong wealth gradients with higher quintiles of wealth associated with lower continuous blood pressure measures. There were no socioeconomic gradients for Ukrainian males or females.
  
  
  CONCLUSIONS
  There is compelling evidence that wealth and education gradients affect the probability of HTN for women in Albania, Armenia, and Azerbaijan, and for men in Albania.
authors.affiliation: University of Pennsylvania, Philadelphia, PA 19104, USA. mharhay@mail.med.upenn.edu
authors.forename: Michael O
authors.initials: MO
authors.lastname: Harhay
authors.forename: Jason S
authors.initials: JS
authors.lastname: Harhay
authors.forename: Meera M
authors.initials: MM
authors.lastname: Nair
mesh_terms: D000293:Adolescent; D000328:Adult; D000415:Albania / Q000453:epidemiology; D001136:Armenia / Q000453:epidemiology; D001382:Azerbaijan / Q000453:epidemiology; D001794:Blood Pressure / Q000502:physiology*; D004522:Educational Status; D005191:Family Characteristics; D005260:Female; D006306:Health Surveys; D006801:Humans; D006973:Hypertension / Q000453:epidemiology* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D009017:Morbidity / Q000639:trends; D012189:Retrospective Studies; D012307:Risk Factors; D012959:Socioeconomic Factors; D014455:Ukraine / Q000453:epidemiology; D055815:Young Adult