Socioeconomic gradients in hypertension prevalence and management: a cross-sectional study.
BACKGROUND Despite advances in hypertension treatment, achieving optimal blood pressure control remains a major public health challenge. Socioeconomic status (SES) may influence hypertension management; however, evidence on its associations with pharmacotherapy, lifestyle modification, and self-management education remains limited. In this study, the association between SES and hypertension-related outcomes in the Republic of Korea was investigated. METHODS In this nationwide cross-sectional study, data from the 2023 Korea Community Health Survey were analyzed, comprising 231,584 and 228,608 adults for educational attainment and household income analyses, respectively. Hypertension-related outcomes included diagnosed hypertension, pharmacotherapy, lifestyle modification, and self-management education. Crude and age- and sex-adjusted rates were calculated, followed by multivariable logistic regression analyses, adjusting for potential confounders. RESULTS Overall, the prevalence of diagnosed hypertension was 31.3%. Among participants with hypertension, the rates of pharmacotherapy, lifestyle modification, and self-management education were 95.9%, 23.8%, and 15.5%, respectively. The multivariable analyses showed a dose-response relationship between SES and outcomes: participants with primary school education or less had higher odds of diagnosed hypertension (odds ratio, 1.79; 95% confidence interval, 1.71-1.88) and pharmacotherapy use (2.04; 1.67-2.50) but lower odds of lifestyle modification engagement (0.47; 0.43-0.50) and receiving self-management education (0.34; 0.31-0.38) compared to those with college degree or higher. Notably, these socioeconomic gradients remained robustly consistent across all strata, while significantly steeper gradients were observed among females and younger adults (< 65 years). Analyses by household income showed similar patterns of associations, although with slightly weaker magnitudes. CONCLUSIONS Lower SES was associated with a higher prevalence of diagnosed hypertension and pharmacotherapy use but lower participation in lifestyle modifications and self-management education. Strengthening tailored self-management education and lifestyle modification support for socioeconomically disadvantaged groups may be an important strategy to reduce hypertension-related disparities.