Abstract
Background
Geographic and contextual socioeconomic risk factors in adolescence may be more strongly associated with young adult hypertension than individual-level risk factors. This study examines the association between individual, neighborhood, and school-level influences during adolescence on young adult blood pressure.
Methods
Data were analyzed from the National Longitudinal Study of Adolescent to Adult Health (1994–1995 aged 11–18 and 2007–2008 aged 24–32). We categorized hypertension as systolic blood pressure ≥140 mm Hg and/or diastolic blood pressure ≥90 mm Hg. Secondary outcomes included continuous systolic and diastolic blood pressure. We fit a series of cross-classified multilevel models to estimate the associations between young adulthood hypertension with individual-level, school-level, and neighborhood-level factors during adolescence (i.e., fixed effects) and variance attributable to each level (i.e., random effects). Models were fit using Bayesian estimation procedures. For linear models, intra-class correlations (ICC) are reported for random effects.
Results
The final sample included 13,911 participants in 128 schools and 1,917 neighborhoods. Approximately 51% (7,111) young adults were hypertensive. Individual-level characteristics—particularly older ages, Non-Hispanic Black race, Asian race, male sex, BMI, and current smoking—were associated with increased hypertension. Non-Hispanic Black (OR = 1.21; 95% CI: 1.03–1.42) and Asian (OR = 1.28; 95% CI: 1.02–1.62) students had higher odds of hypertension compared to non-Hispanic White students. At the school level, hypertension was associated with the percentage of non-Hispanic White students (OR for 10% higher = 1.06; 95% CI: 1.01–1.09). Adjusting for individual, school, and neighborhood predictors attenuated the ICC for both the school (from 1.4 null to 0.9 fully-adjusted) and neighborhood (from 0.4 to 0.3).
Conclusion
We find that adolescents’ schools and individual-level factors influence young adult hypertension, more than neighborhoods. Unequal conditions in school environments for adolescents may increase the risk of hypertension later in life. Our findings merit further research to better understand the mechanisms through which adolescents’ school environments contribute to adult hypertension and disparities in hypertension outcomes later in life.
Funder
National Heart, Lung, and Blood Institute
American Heart Association
Publisher
Public Library of Science (PLoS)
Reference38 articles.
1. High Blood Pressure in Children and Adolescents;M Riley;Am Fam Physician,2018
2. Discordance in national estimates of hypertension among young adults;QC Nguyen;Epidemiology,2011
3. Hypertension in children and adolescents: epidemiology and natural history;B. Falkner;Pediatric nephrology,2010
4. Hypertension in the teenager;EI Anyaegbu;Pediatr Clin North Am,2014
5. Ostchega Y, Fryar CD, Nwankwo T, Nguyen DT. Hypertension prevalence among adults aged 18 and over: United States, 2017–2018. 2020.
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