Gender differences in the association of individual and contextual socioeconomic status with hypertension in 230 Latin American cities from the SALURBAL study: a multilevel analysis

Background: Despite global interest in gender disparities and social determinants of hypertension, research in urban areas and regions with a high prevalence of hypertension, such as Latin America, is very limited. The objective of this study was to examine associations between the individual- and area-level socioeconomic status and hypertension in adults living in 230 cities in eight Latin America countries. Methods: In this cross-sectional study, we used harmonized data from 109,184 adults (aged 18-97 years) from the SALURBAL (Salud Urbana en America Latina/Urban Health in Latin America) project. Hypertension was assessed by self-report. The individual-, sub-city- and city-level education were used as proxies of socioeconomic status. All models were stratified by gender. Results: While individual-level education was positively associated with higher odds of hypertension among men (university education or higher versus less than primary: Odds Ratio [OR] = 1.63; 95% confidence interval [CI] = 1.45-1.83) the reverse was true among women (university education or higher versus lower than primary: OR = 0.66, 95%CI = 0.60-0.73), with both associations showing a dose-response pattern. For both genders, living in sub-city areas with higher educational achievement was associated with higher odds of hypertension (OR per standard deviation [SD] = 1.05, 95%CI = 1.01-1.10; OR = 1.09 per SD, 95%CI = 1.03-1.16, for women and men, respectively). The association of city-level education with hypertension varied across countries. In Peru, there was an inverse association (lower proportion of hypertension with a better education at the city level) in women and men, in other countries, no association was observed. Conclusion: The social patterning of hypertension differs by gender and by the level of analysis highlighting the importance of context- and gender-sensitive approaches and policies to reduce the prevalence of hypertension in Latin America.