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Intragenerational Social Mobility and Changes in Blood Pressure: Longitudinal Analysis From the ELSA-Brasil Study.

Guimarães, Joanna M N; Griep, Rosane H; Clarke, Philippa J; Fonseca, Maria J M; Barreto, Sandhi M; Giatti, Luana; Lotufo, Paulo A; Mill, Jose G; Pacheco, Antonio G; Chor, Dora.
Am J Hypertens; 31(6): 672-678, 2018 May 07.
Artículo en Inglés | MEDLINE | ID: mdl-29438464

BACKGROUND:

During the past 4 decades, the highest worldwide blood pressure (BP) levels have shifted from high-income countries to low- and middle-income countries. We investigated the association of intragenerational social mobility with changes in BP and also with the incidence of hypertension over a 4-year follow-up.

METHODS:

Data for 6,529 baseline participants from ELSA-Brasil born between 1938 and 1975 were used. Based on a social mobility matrix, occupational social mobility was defined as the change in occupational social class between participants' first occupation and current occupation (stable high; upward; downward; stable low). Incident hypertension was defined as systolic blood pressure (SBP) ≥ 140 mm Hg or diastolic blood pressure (DBP) ≥ 90 mm Hg or use of antihypertensive medication. Hypertensive participants at baseline were excluded. Mixed effects regression models were used.

RESULTS:

Compared to the stable high group, the downwardly mobile group showed a higher increase over time in both SBP (ß = 1.49, 95% CI 0.60; 2.37) and DBP (ß = 0.96, 95% CI 0.32; 1.59) after adjustments for background characteristics and also proximal risk factors such as health-related behaviors and body mass index as time-dependent covariates, and diabetes. In contrast, upward mobility had no influence on BP changes (ß = 0.67, 95% CI -0.07; 1.41 for SBP, and ß = 0.47, 95% CI -0.05; 1.00 for DBP). Social mobility was not associated with the incidence of hypertension.

CONCLUSIONS:

We showed socioeconomic inequalities in BP progression over the life course. The longitudinal changes in BP varied by social mobility groups in the context of low- and middle-income countries, where high BP has become most prevalent.
Selo DaSilva