Social inequalities in the prevalence and control of hypertension: the role of educational attainment and socioeconomic status

This study aimed to investigate the role of education level and socioeconomic status in the prevalence and control patterns of hypertension. The present cross-sectional analytic study was conducted among a sample of 2000 adults aged 30 or above years old through multistage cluster sampling in urban and rural areas. The findings indicated broad social inequalities: the prevalence of hypertension was 1.5 times higher in the most deprived socioeconomic quintile (42.7%) than in the richest quintile (28.1%) (p<0.001). The educational gap was also broad; the prevalence among illiterate individuals (46.2%) was found to be almost twice that for university graduates (24.8%). In disease management, things were worse: 31.4% of the poor ill had controlled hypertension, as opposed to 65.2% in affluent groups (p<0.001). Multivariate analysis adjusting for confounding revealed that the poorest groups had 2.3 times higher odds of acquiring the disease and 3.1 times higher odds of being uncontrolled. Mediator factors including access to care barriers (43.2% medication non-adherence because of cost), risk behaviors (too much salt in the diet, physical inactivity), and chronic stress combined explained 70% of these disparities. These results underscore the need to create responsive multilevel interventions - from improving health literacy to revising resource allocation policies - to close treatment gaps and strengthen health equity.