title: Association of hypertension and hyperglycaemia with socioeconomic contexts in resource-poor settings: the Bangladesh Demographic and Health Survey.
abstract: BACKGROUND
  Cardiovascular diseases and risk factors are disproportionally concentrated among the socioeconomically disadvantaged in high-income countries; however, this relationship is not well-understood or documented in resource-limited countries.
  
  
  METHODS
  We analysed data from the 2011 Bangladesh Demographic and Health Survey to estimate age-, sex- and location-adjusted differences in blood pressure and blood glucose outcomes by categories of a standardized wealth index and education levels. Body mass index (BMI) was examined as a secondary outcome and also assessed as a potential confounder.
  
  
  RESULTS
  There was strong evidence that the prevalence of hypertension was higher among Bangladeshi women than among men (33.6% vs 19.6%, P < 0.001), whereas the overall prevalence of hyperglycaemia was 7.1% with no evidence of sex differences. The likelihood of having hypertension was more than double for individuals in the highest vs lowest wealth quintile [odds ratio (OR) for men: 2.82, 95% confidence interval (CI): 2.32-3.44; OR for women: 2.25, 95% CI: 1.90-2.67], and for individuals with the highest level of education attained vs those with no education (OR for men: 2.55, 95% CI: 2.06-3.16; OR for women: 1.42, 95% CI: 0.99-2.03). Likewise, the likelihood of having hyperglycaemia was more than four times higher in the wealthiest compared with the poorest individuals (OR for men: 6.48, 95% CI: 5.11-8.22; OR for women: 4.77, 95% CI: 3.72-6.12), and in individuals with the highest level of education attained vs those with no education (OR for men: 4.68, 95% CI: 3.56-6.15; OR for women: 5.02, 95% CI: 3.30-7.64). There were no appreciable differences in these trends when stratified by geographical location. BMI did not attenuate these associations and exhibited similarly positive associations with education and wealth.
  
  
  CONCLUSIONS
  Increasing levels of wealth and educational attainment were associated with an increased likelihood of having hypertension and hyperglycaemia in Bangladesh.
authors.affiliation: Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.
authors.forename: Eric
authors.initials: E
authors.lastname: Harshfield
authors.affiliation: Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.
authors.forename: Rajiv
authors.initials: R
authors.lastname: Chowdhury
authors.affiliation: Division of Nephrology, Department of Medicine, Drexel University College of Medicine, Philadelphia, Pennsylvania, USA, Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Meera N
authors.initials: MN
authors.lastname: Harhay
authors.affiliation: Leonard Davis Institute of Health Economics, and Wharton School of Business, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Henry
authors.initials: H
authors.lastname: Bergquist
authors.affiliation: Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA, Leonard Davis Institute of Health Economics, and mharhay@upenn.edu.
authors.forename: Michael O
authors.initials: MO
authors.lastname: Harhay
mesh_terms: D000328:Adult; D001459:Bangladesh / Q000453:epidemiology; D001786:Blood Glucose / Q000032:analysis*; D001794:Blood Pressure; D015992:Body Mass Index; D005260:Female; D006306:Health Surveys; D006801:Humans; D006943:Hyperglycemia / Q000453:epidemiology*; D006973:Hypertension / Q000453:epidemiology*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D012307:Risk Factors; D012424:Rural Population; D012737:Sex Factors; D012959:Socioeconomic Factors; D014505:Urban Population
chemical_list: D001786:Blood Glucose
keywords: Cardiovascular disease; demographic health surveys; hyperglycaemia; hypertension; socioeconomic