Joint Associations of Multidimensional Socioeconomic Status and Healthy Lifestyle with Prevalent Hypertension: A Large Population-Based Study in Northwest China

Background/Objectives: The roles of healthy lifestyle and socioeconomic status (SES) in prevalent hypertension, as well as their joint patterns, remain incompletely understood. This study examined the independent, interactive, and joint associations of multidimensional SES and multiple healthy behaviors with prevalent hypertension. Methods: We conducted a cross-sectional analysis of baseline data from 80,218 adults enrolled in the Regional Ethnic Cohort Study in Northwest China between 2017 and 2019. The mean age of the participants was 53.9 years. SES was classified as high, middle, or low according to household per capita income, occupation, and educational attainment. Healthy lifestyle was assessed using five factors: non-smoking, moderate alcohol intake, regular physical activity, adequate coarse-grain intake, and healthy sleep patterns. Logistic regression models were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for the associations of SES and healthy behaviors with prevalent hypertension. Results: Hypertension prevalence was higher in the low-SES group than in the high-SES group (45.1% vs. 28.8%). Each additional healthy behavior was associated with 16% lower odds of hypertension (OR: 0.84; 95% CI: 0.82–0.86). Within each SES stratum, participants with 0–1 healthy behaviors had the highest odds of hypertension compared with those with 4–5 healthy behaviors (high SES: OR = 1.58, 1.31–1.92; middle SES: OR = 1.62, 1.39–1.89; low SES: OR = 1.58, 1.22–2.05). A similar but weaker pattern was observed among those with 2–3 healthy behaviors (ORs ranging from 1.18 to 1.32). Among participants with 4–5 healthy behaviors, the odds of prevalent hypertension increased as SES decreased (middle SES: OR = 1.06, 95% CI: 0.97–1.16; low SES: OR = 1.29, 95% CI: 1.17–1.42; reference: high SES). This gradient was more pronounced among those with 2–3 healthy behaviors (ORs ranging from 1.24 to 1.55). Conclusions: Both socioeconomic disadvantage and unhealthy lifestyle were associated with higher odds of prevalent hypertension. Although adherence to a healthy lifestyle was associated with lower odds of prevalent hypertension, it did not fully attenuate the excess odds associated with socioeconomic disadvantage.