REGIONAL DISPARITIES IN HYPERTENSION PREVALENCE BETWEEN URBAN AND RURAL AREAS: ASSOCIATION WITH SOCIOECONOMIC STATUS

Objective: Lower socioeconomic status (SES) is associated with greater burdens of cardiovascular disease in communities. This study aims to analyze regional disparities in SES and hypertension (HTN) burden between urban and rural areas. Design and method: Using National Health and Nutrition Examination Survey (KNHANES) V-VII (2010-2018), we analyzed 11,206 subjects from Seoul, representing urban Korea, and 1,739 subjects from Gangwon-do, representing rural Korea. We compared socioeconomic characteristics and HTN distribution between regions, performing multivariate logistic regression adjusting for cardiovascular risk factors and SES. Results: Rural residents were older than urban residents (54.6 ± 0.4 vs 49.4 ± 0.2 years, p < 0.001). The proportions of low economic status (25.6 vs 14.4%, p < 0.001) and low education level (35.3 vs 16.5%, p < 0.001) were higher in rural areas. Mean systolic blood pressure was higher in rural areas (121.6 ± 0.4 vs 118.1 ± 0.2 mmHg, p < 0.001). The urban-rural difference in HTN prevalence increased longitudinally from KNHANES V to VII. Age-matched HTN prevalence was higher in rural areas (23.8 vs 21.6%, p < 0.05). In univariate analysis, rural residency was associated with HTN (OR = 1.63; 95% CI = 1.45-1.83). However, in multivariate analysis including age and SES, rural residency became non-significant, while low economic status (OR = 1.39; 95% CI = 1.17-1.67) and education level (OR = 1.88; 95% CI = 1.57-2.24) remained significant predictors of HTN. Conclusions: The prevalence of low SES and HTN was higher in rural areas, with HTN burden increasing longitudinally only in rural areas. Poor SES was significantly associated with HTN, suggesting that SES inequalities in rural areas contribute to increasing HTN prevalence. Regional and individual SES disparities should be considered in public health strategies for HTN.