title: Association of Household Wealth Index, Educational Status, and Social Capital with Hypertension Awareness, Treatment, and Control in South Asia.
abstract: OBJECTIVE
  Hypertension control rates are low in South Asia. To determine association of measures of socioeconomic status (wealth, education, and social capital) with hypertension awareness, treatment, and control among urban and rural subjects in these countries we performed the present study.
  
  
  METHODS
  We enrolled 33,423 subjects aged 35-70 years (women 56%, rural 53%, low-education status 51%, low household wealth 25%, low-social capital 33%) in 150 communities in India, Pakistan, and Bangladesh during 2003-2009. Prevalence of hypertension and its awareness, treatment, and control status and their association with wealth, education, and social capital were determined.
  
  
  RESULTS
  Age-, sex-, and location-adjusted prevalence of hypertension in men was 31.5% (23.9-40.2%) and women was 32.6% (24.9-41.5%) with variations in prevalence across study sites (urban 30-56%, rural 11-43%). Prevalence was significantly greater in urban locations, older subjects, and participants with more wealth, greater education, and lower social capital index. Hypertension awareness was in 40.4% (urban 45.9, rural 32.5), treatment in 31.9% (urban 37.6, rural 23.6), and control in 12.9% (urban 15.4, rural 9.3). Control was lower in men and younger subjects. Hypertension awareness, treatment, and control were significantly lower, respectively, in lowest vs. highest wealth index tertile (26.2 vs. 50.6%, 16.9 vs. 44.0%, and 6.9 vs. 17.3%, P < 0.001) and lowest vs. highest educational status tertile (31.2 vs. 48.4%, 21.8 vs. 42.1%, and 7.8 vs. 19.2%, P < 0.001) while insignificant differences were observed in lowest vs. highest social capital index (38.2 vs. 36.1%, 35.1 vs. 27.8%, and 12.5 vs. 9.1%).
  
  
  CONCLUSIONS
  This study shows low hypertension awareness, treatment, and control in South Asia. Lower wealth and educational status are important in low hypertension awareness, treatment, and control.
authors.affiliation: Department of Medicine, Eternal Heart Care Centre and Research Institute, Mount Sinai New York Affiliate, Jaipur, India.
authors.forename: Rajeev
authors.initials: R
authors.lastname: Gupta
authors.affiliation: School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
authors.forename: Manmeet
authors.initials: M
authors.lastname: Kaur
authors.affiliation: Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, Canada.
authors.forename: Shofiqul
authors.initials: S
authors.lastname: Islam
authors.affiliation: Madras Diabetes Research Foundation, Chennai, India.
authors.forename: Viswanathan
authors.initials: V
authors.lastname: Mohan
authors.affiliation: Department of Community Medicine, St John's Medical College and Research Institute, Bangalore, India.
authors.forename: Prem
authors.initials: P
authors.lastname: Mony
authors.affiliation: School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
authors.forename: Rajesh
authors.initials: R
authors.lastname: Kumar
authors.affiliation: Health Action by People, Thiruvananthapuram, India.
authors.forename: Vellappillil Raman
authors.initials: VR
authors.lastname: Kutty
authors.affiliation: Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan.
authors.forename: Romaina
authors.initials: R
authors.lastname: Iqbal
authors.affiliation: School of Life Sciences, Independent University, Dhaka, Bangladesh; and.
authors.forename: Omar
authors.initials: O
authors.lastname: Rahman
authors.affiliation: Madras Diabetes Research Foundation, Chennai, India.
authors.forename: Mohan
authors.initials: M
authors.lastname: Deepa
authors.affiliation: Department of Community Medicine, St John's Medical College and Research Institute, Bangalore, India.
authors.forename: Justy
authors.initials: J
authors.lastname: Antony
authors.affiliation: Health Action by People, Thiruvananthapuram, India.
authors.forename: Krishnapillai
authors.initials: K
authors.lastname: Vijaykumar
authors.affiliation: Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan.
authors.forename: Khawar
authors.initials: K
authors.lastname: Kazmi
authors.affiliation: School of Life Sciences, Independent University, Dhaka, Bangladesh; and.
authors.forename: Rita
authors.initials: R
authors.lastname: Yusuf
authors.affiliation: Department of Medicine, Eternal Heart Care Centre and Research Institute, Mount Sinai New York Affiliate, Jaipur, India.
authors.forename: Indu
authors.initials: I
authors.lastname: Mohan
authors.affiliation: Administrative Office, Rajasthan University of Health Sciences, Jaipur, India.
authors.forename: Raja Babu
authors.initials: RB
authors.lastname: Panwar
authors.affiliation: Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, Canada.
authors.forename: Sumathy
authors.initials: S
authors.lastname: Rangarajan
authors.affiliation: Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, Canada.
authors.forename: Salim
authors.initials: S
authors.lastname: Yusuf
mesh_terms: D000328:Adult; D000368:Aged; D001459:Bangladesh / Q000453:epidemiology; D015331:Cohort Studies; D004522:Educational Status; D005191:Family Characteristics; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D006973:Hypertension / Q000453:epidemiology*; D007194:India / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010154:Pakistan / Q000453:epidemiology; D011446:Prospective Studies; D066270:Social Capital; D012923:Social Class
keywords: adherence; blood pressure; hypertension; hypertension control; hypertension epidemiology; social determinants; socioeconomic status.