Association of household wealth and education level with hypertension and diabetes among adults in Bangladesh: A propensity score-based analysis

Abstract

Objective: To determine the association of household wealth and education level with hypertension and diabetes in Bangladesh using propensity score (PS) analyses.

Methods: A nationally representative sample of the Bangladesh Demographic and Health Survey 2017-18 was analysed to explore the research question. A weighted sample of 11 320 individuals was considered. Hypertension and diabetes were the outcomes of interest, and household wealth status (non-poor and poor) and education level (secondary/higher education and no secondary/higher education) were the exposure variables of interest. A person was defined as hypertensive if their average blood pressure was ≥140/90 mmHg or self-reported history of taking antihypertensive medications. Individuals were classified as diabetic if they had a Fasting Blood Glucose level of ≥7 mmol/l or reported taking prescribed medication for reducing high blood glucose or diabetes. We used the 1:1 nearest neighbour PS matching without replacement and PS weighting approaches to assess the association between the exposures and the outcome variables.

Results: Wealth status was significantly associated with diabetes but not with hypertension, while education status was significantly associated with neither diabetes nor hypertension. We also observed a significant interaction effect between household wealth status and education level with diabetes. The odds of diabetes were approximately 60% higher among adults from non-poor households and those without secondary/higher education.

Conclusion: Diabetes prevention and control programs should focus on non-poor individuals, while hypertension prevention programs should target populations irrespective of educational attainment and wealth status.