Educational Attainment Modifies the Association of Wealth Status with Elevated Blood Pressure in the Ghanaian Population

Abstract

The relationship between wealth and blood pressure (BP) in developing countries is unclear and it is important to understand how the socioeconomic environment influences BP in an African setting. Our objective was to determine the wealth differences in BP in the Ghanaian population and to clarify whether the relationship is modified by education level. Data from the 2014 Ghana Demographic and Health Survey was analyzed. A total of 9396 women and 4388 men were sampled nationwide and interviewed for the survey. Prevalence of hypertension in the population was low (10.4%). Systolic BP, diastolic BP, and odds of elevated BP increased with increasing wealth status. A linear trend was noted. Richest respondents recorded a 2.65 mmHg (95% CI: 1.09, 4.21) and 3.14 mmHg (95% CI: 1.97, 4.31) excess in systolic BP and diastolic BP, respectively and also, a 151% (AOR ¼ 2.51, 95% CI: 1.80, 3.48) increased odds of elevated BP compared with the poorest. The wealth trend in BP was strongest among primary educated respondents (Interaction p ¼ 0.0007). We found evidence of a consistent increase in elevated BP with increasing wealth status in this African population, a trend that is contrary to what is seen in high income countries.