Spatial Distribution and Determinants of Hypertension Prevalence at The Subdistrict Level: A Small-Area Ecological Cross-Sectional Study

Purpose: This study aimed to analyze the spatial distribution of hypertension prevalence and identify the demographic, behavioral, and community environmental factors associated with regional variation across 153 eup-myeon-dong administrative units in Chungcheongbuk-do, South Korea.Methods: Secondary data analysis was performed using Community Health Survey data from 62,411 adults aged ≥ 30 years (2017-2021). The prevalence of hypertension was defined as the proportion of individuals diagnosed with hypertension by a physician. Spatial statistical indicators were obtained from the Statistical Geographic Information Service (SGIS). Descriptive statistics, Pearson’s correlation, choropleth mapping, global Moran’s I, local indicators of spatial association (LISA), and ordinary least-squares (OLS) regression analyses were performed.Results: The prevalence of hypertension showed statistically significant spatial clustering (global Moran’s I=0.442, p<.001), with high-high clusters concentrated in rural eup-myeon areas and low-low clusters in urban dong areas. Despite confirmed clustering, the LM lag and error tests indicated no statistically significant spatial dependence in the regression residuals. The regression analysis showed that the prevalence of hypertension increased in areas with a higher proportion of older adults, greater obesity prevalence, and higher satisfaction with public transportation, whereas stronger trust among neighbors and greater satisfaction with healthcare access were associated with a lower prevalence.Conclusion: These findings support a shift toward tailored nursing and public health interventions at the sub-district level, prioritizing rural high-risk areas and reflecting the distinct demographic, behavioral, and environmental contexts of each community.