| Background:The hypertension prevalence rate was increased continuously in Chinese population, which has been one of serious public health problems. Socioeconomic Status (SES) was considered as a common factor which could affect health and disease. It was proposed in 1940s, since then the use of SES as an explanatory variable or as a control variable in health research has increased dramatically. However, research on how to measure SES itself has remained relatively rare, not only on theoretical, but also on methodological. Measure scale for SES was still unavailablein China. Meanwhile, no research on the relationship between SES and blood pressure and hypertension were found in China.Objective:To investigate the trends of systolic blood pressure (SBP), diastolic blood pressure (DBP) and hypertension prevalence among Chinese adults from 1991 to 2009. To explore the impact factors of blood pressure and hypertension prevalence. To build the measure scale of socioeconomic status (SES) for Chinese asults. To analysis the effects of SES on blood pressure and hypertension rate.Subjects and Methods:This study was based on the data of China Health and Nutrition Survey which was conducted in 1991,1993,1997,2000,2004,2006 and 2009. Adult subjects aged 18 to 74 years old in each round were included, which were 8218,7850,10037,9183, 9232,9145 and 9287 respectively.The cross-sectional analysis was conducted between dietary factors, physical activity factors, individual-level factors and community-level factors and blood pressure and hypertension.Based on the results and experiences of previous researches, the measure scale of socioeconomic status (SES) for Chinese adults was built. The reliability and validity of SES scale was assessed by internal consistency test and Criterion related validity test.The relationship between SES and blood pressure and hypertension prevalence was analyzed using ststistical method of single factor and multi-factor.Results:1. The means of SBP, DBP and the prevalence of hypertension among male were higher than that of female. The means of blood pressure among both male and female increased continually. During the eighteen-year follow up, the SBP and DBP increased 8.5mmHg and 6.4mmHg in males,9.7mmHg and 5.9mmHg in females, respectively.2. The crude rate and adjusted rate by age of hypertension increased gradually. From 1991 to 2009, the crude rate increased from 14.6% to 28.7%, and the adjusted rate by age increased from 14.6% to 32.2% among males. Crude rate increased from 12.0% to 24.6%, and age adjusted rate from 12.0% to 24.6% among females. The hypertension rate was almost times in 2009 than those of in 1991.3. Adults who lived in northern China had the highest mean of SBP, DBP and the highest prevalence of hypertension than those of people who lived in center and southern China. The mean of SBP, DBP and the prevalence of hypertension was highest among city residents, the second level was those who lived in county town, the third level was those who lived in suburb, the lowest level was those who lived in village. Positive correlation was found between SBP, DBP, the prevalence of hypertension and the urbanization index.4. It was found that SBP and DBP, as well as hypertension rate was positively related with BMI, WC, WHR, and WHtR.5. No association was found between salt intake and SBP, DBP, the prevalence of hypertension. Both male and female, the group whose proportion of energy from fat below 25% has the lowest prevalence of hypertension.6. The group whose drinking frequency below 2 times per weeks, had lower SBP, DBP, the prevalence of hypertension than nondrinkers. The group whose drinking frequency more than 3 times per weeks, had higher SBP, DBP, the prevalence of hypertension than nondrinkers.7. Smoking was only associated with systolic blood pressure, diastolic blood pressure and the prevalence of hypertension among female subjects, female smokers had higher SBP, DBP and the prevalence of hypertension than nonsmokers. 8. Negative association was found between blood pressure, the prevalence of hypertension and the physical activity level for both men and women.9. Internal consistency test was conducted for the SES measure scale. The Chronback's coefficient alpha were high (>0.9) among 7 wave surveys. Statistic significant was found among every item-scale correlations in each year. Criterion related validity was tested between SES score and urban, suburb, county and rural. The results of nonparametric Wilcoxon signed-rank test indicated that all P value was below 0.0001 in each year.10. Negative association was found between blood level, the prevalence of hypertension and educational level among male and female. The prevalence of hypertension was decreased yearly among adults with higher educational level.11. The effect of occupation on blood level and prevalence of hypertension was different between male and female. The SBP, DBP and the prevalence of hypertension was lowest in male group who without job, and the highest group was existed at administers and officers group. The SBP, DBP and the prevalence of hypertension was highest in female group who without job, the second higher group was administers and officers group.12. Income were associated with SBP, DBP and hypertension prevalence both men and women. The male groups who got a higher income level had a higher SBP, DBP and the hypertension prevalence. And the female group who got a lowest income level had a lowest blood pressure and hypertension prevalence at 1993 and 1997. However, the group got highest blood pressure and hypertension prevalence since 1997.13. No matter how many rooms they possessed, no significant difference of blood pressure level was found among male groups. SBP, DBP level of female who possessed 1 room and equal to or above 5 rooms was the lowest group before 1997. After 2000, SBP, DBP level of female who possessed 5 or above 5 rooms remained the lowest level, however, those female who possessed 1 room, blood level increased.From 2000, the hypertension prevalence of those male and female who possessed 1 room were highest. Among the female group who possessed 5 or above 5 rooms, the hypertension prevalence was becoming lowest group from 1997.14. The increasing trend of blood pressure was observed among male, with the increasing of the number of family electric appliances. The opposite result was observed in female group.15. SBP, DBP were highest among the male group with highest SES score. The difference of the other groups were not significant. The highest SES score group with highest hypertension prevalence was observed in male subjects. The negative association was observed between SES score and female blood pressure. From 1997, the hypertension prevalence of female with highest SES score was lowest, and the group with lowest SES score was highest hypertension prevalence in female group from 1993.16. The results of multi factor analysis indicated that SES was a protect factor for female hypertension at 1997,2000,2004, and 2009, after controlling factors such as age, BMI, physical activity, urbanization index, the total energy intake, the proportion of energy from fat and salt intake. Negative association was found between SES score and female SBP at 2000. At 2004 and 2009, negative association was found between SES score and either SBP or DBP in female group. Negative association between SES score and SBP in male group was found only at 2009.Conclusions:1. The blood pressure level and the prevalence of hypertension among Chinese adults had a continual increase with age during the period from 1991 to 2009.2. Blood pressure level was associated with BMI, adults with the higher BMI had the higher blood pressure. And the prevalence of hypertension also increased with BMI.3. Abdominal adiposity was associated with SBP, DBP and the prevalence of hypertension. SBP, DBP and the prevalence of hypertension in abdominal adiposity adults were higher than that of normal body forms.4. Drinking with lower frequency could decrease the blood level and the prevalence of hypertension, while higher frequency drinking could increase the blood level and the prevalence of hypertension both male and female.5. The measure scale of SES is an effective scale for Chinese adults, with good reliability and validity.6. There was a close association between SES and blood pressure, hypertension prevalence in female group. Negative association was found between SES and blood level and hypertension prevalence. SES was a protect factor on hypertension for female. 7. The shift of high blood level and hypertension prevalence towards adults with low SES was found among women apparently. SES is a weak determinant of blood pressure among males. The mean of blood pressure and the prevalence of hypertension among Chinese women have been similar to the situation of women in developed country.
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