title: Analysing the socioeconomic determinants of hypertension in South Africa: a structural equation modelling approach.
abstract: BACKGROUND
  Epidemiological research has long observed a varying prevalence of hypertension across socioeconomic strata. However, patterns of association and underlying causal mechanisms are poorly understood in sub-Saharan Africa. Using education and income as indicators, we investigated the extent to which socioeconomic status is linked to blood pressure in the first wave of the National Income Dynamics Study--a South African longitudinal study of more than 15,000 adults--and whether bio-behavioural risk factors mediate the association.
  
  
  METHODS
  In a cross-sectional analysis, structural equation modelling was employed to estimate the effect of socioeconomic status on systolic and diastolic blood pressure and to assess the role of a set of bio-behavioural risk factors in explaining the observed relationships.
  
  
  RESULTS
  After adjustment for age, race and antihypertensive treatment, higher education and income were independently associated with higher diastolic blood pressure in men. In women higher education predicted lower values of both diastolic and systolic blood pressure while higher income predicted lower systolic blood pressure. In both genders, body mass index was a strong mediator of an adverse indirect effect of socioeconomic status on blood pressure. Together with physical exercise, alcohol use, smoking and resting heart rate, body mass index therefore contributed substantially to mediation of the observed relationships in men. By contrast, in women unmeasured factors played a greater role.
  
  
  CONCLUSIONS
  In countries undergoing epidemiological transition, effects of socioeconomic status on blood pressure may vary by gender. In women, factors other than those listed above may have substantial role in mediating the association and merit investigation.
authors.affiliation: School of Public Health and Family Medicine, University of Cape Town, Anzio Road, Observatory 7925, Cape Town, South Africa. Annibale.Cois@uct.ac.za.
authors.forename: Annibale
authors.initials: A
authors.lastname: Cois
authors.forename: Rodney
authors.initials: R
authors.lastname: Ehrlich
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000428:Alcohol Drinking / Q000009:adverse effects; D001794:Blood Pressure; D015992:Body Mass Index; D003430:Cross-Sectional Studies; D004522:Educational Status; D005260:Female; D006801:Humans; D006973:Hypertension / Q000453:epidemiology / Q000209:etiology*; D007182:Income; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D044469:Racial Groups; D012307:Risk Factors; D012737:Sex Factors; D012907:Smoking / Q000009:adverse effects; D012923:Social Class; D012959:Socioeconomic Factors; D013019:South Africa / Q000453:epidemiology; D055815:Young Adult