Individual and neighborhood social factors of hypertension management in a low-socioeconomic status population: a community-based case-control study in Singapore

The aim of this study was to determine hypertension awareness, treatment and control, as well as to carry out regular blood pressure (BP) screening and monitoring, in a multi-ethnic urban low-socioeconomic status (SES) Asian community; and to compare these estimates with those of a higher-SES community in the same geographic location. We studied a neighborhood of three blocks of rented public flats (lower-SES community) and three adjacent blocks of owner-occupied public flats (higher-SES community) in Taman Jurong, Singapore. BP was measured, and demographic details and reasons for irregular BP screening, monitoring and treatment were collected from 2009 to 2010. Logistic regression was used to determine predictors of hypertension management. Participation was 90.0% (359/400) for the rental flat community and 70.2% (351/500) for the owner-occupied flats. Prevalence, awareness, treatment and control in the low-SES community (rental flats) were 63.9% (228/357), 61.8% (141/228), 69.5% (98/141) and 43.9% (43/98), respectively, whereas in the neighboring community these were 65.0% (228/351), 83.3% (190/228), 85.3% (162/190) and 66.0% (107/162), respectively. Adjusting for other sociodemographic variables, awareness, treatment and control were poorer in the low-SES community. In the low-SES community, awareness was higher among diabetics, dyslipidemics, those >= 60 years and those with regular access to doctors. Treatment was more likely among those >= 60 years, but less likely among those needing financial aid. Control was less likely in the employed. High cost of screening and treatment, if diagnosed, was the most frequently cited barrier among the low-SES group. Hypertension management in those of lower SES is poorer than in those of higher SES. For the lower-SES population, financial barriers need to be addressed. Hypertension Research (2012) 35, 295-303; doi:10.1038/hr.2011.187; published online 17 November 2011