title: Who is at higher risk of hypertension? Socioeconomic status differences in blood pressure among Polish adolescents: a population-based ADOPOLNOR study.
abstract: In Poland, there is no data on parental socioeconomic status (SES) as a potent risk factor in adolescent elevated blood pressure, although social differences in somatic growth and maturation of children and adolescents have been recorded since the 1980s. This study aimed to evaluate the association between parental SES and blood pressure levels of their adolescent offspring. A cross-sectional survey was carried out between 2009 and 2010 on a sample of 4941 students (2451 boys and 2490 girls) aged 10-18, participants in the ADOPOLNOR study. The depended outcome variable was the level of blood pressure (optimal, pre- and hypertension) and explanatory variables included place of residence and indicators of parental SES: family size, parental educational attainments and occupation status, income adequacy and family wealth. The final selected model of the multiple multinomial logistic regression analysis (MLRA) with backward elimination procedure revealed the multifactorial dependency of blood pressure levels on maternal educational attainment, paternal occupation and income adequacy interrelated to urbanization category of the place of residence after controlling for family history of hypertension, an adolescent's sex, age and weight status. Consistent rural-to-urban and socioeconomic gradients were found in prevalence of elevated blood pressure, which increased with continuous lines from large cities through small- to medium-sized cities to villages and from high-SES to low-SES familial environments. The adjusted likelihood of developing systolic and diastolic hypertension decreased with each step increase in maternal educational attainment and increased urbanization category. The likelihood of developing prehypertension decreased with increased urbanization category, maternal education, paternal employment status and income adequacy. Weight status appeared to be the strongest confounder of adolescent blood pressure level and, at the same time, a mediator between their blood pressure and parental SES.
  
  
  CONCLUSIONS
  The findings of the present study confirmed socioeconomic disparities in blood pressure levels among adolescents. This calls for regularly performed blood pressure assessment and monitoring in the adolescent population. It is recommended to focus on obesity prevention and socioeconomic health inequalities by further trying to improve living and working conditions in adverse rural environments.
authors.affiliation: Department of Human Biological Development, Institute of Anthropology, Faculty of Biology, Adam Mickiewicz University in Poznań, Umultowska 89, 61-614, Poznań, Poland. makac@amu.edu.pl.
authors.forename: Maria
authors.initials: M
authors.lastname: Kaczmarek
authors.affiliation: Department of Epidemiology, Chair of Social Medicine, Poznań University of Medical Sciences, Poznań, Poland. epidemiologia@ump.edu.pl.
authors.forename: Barbara
authors.initials: B
authors.lastname: Stawińska-Witoszyńska
authors.affiliation: Department of Epidemiology, Chair of Social Medicine, Poznań University of Medical Sciences, Poznań, Poland. akrzyzan@amp.poznan.pl.
authors.forename: Alicja
authors.initials: A
authors.lastname: Krzyżaniak
authors.affiliation: Department of Epidemiology, Chair of Social Medicine, Poznań University of Medical Sciences, Poznań, Poland. epidemiologia@ump.edu.pl.
authors.forename: Małgorzata
authors.initials: M
authors.lastname: Krzywińska-Wiewiorowska
authors.affiliation: Department of Pediatric Cardiology and Nephrology, Poznań University of Medical Sciences, Poznań, Poland. pedgastro@skp.ump.edu.pl.
authors.forename: Aldona
authors.initials: A
authors.lastname: Siwińska
mesh_terms: D000293:Adolescent; D000067697:Adolescent Health; D000886:Anthropometry; D001794:Blood Pressure / Q000502:physiology*; D001795:Blood Pressure Determination; D002648:Child; D003430:Cross-Sectional Studies; D005260:Female; D054624:Health Status Disparities; D006801:Humans; D006973:Hypertension / Q000453:epidemiology* / Q000503:physiopathology; D008297:Male; D010290:Parents; D011044:Poland / Q000453:epidemiology; D015995:Prevalence; D012307:Risk Factors; D012923:Social Class; D012959:Socioeconomic Factors
keywords: Adolescence; BMI; Diastolic blood pressure; Family size; Income adequacy; Parental education and occupation; Place of residence; Systolic blood pressure