Mechanisms linking SES to hypertension: Findings from three longitudinal studies among the pre-retirement-age and older populations

Hypertension is the most prevalent cardiovascular disease among middle-aged older people in the United States. Socioeconomic status (SES) has been found to be inversely associated with hypertension, however, little is known about the underlying mechanisms of this inverse association.;The main purposes of this dissertation include investigation of the nature of relationship between SES and hypertension among the pre-retirement-age and older population and examination of the possible pathways linking SES to hypertension. Three longitudinal surveys are used for this study. They are The Health and Retirement Survey (HRS), The Survey of Asset and Health Dynamics of the Oldest Old (AHEAD), and The MacArthur Study of Successful Aging.;Findings of this study suggest that SES is not an independent cause of hypertension. It is linked to hypertension through other psychosocial and environmental risk factors. Health behaviors and psychological stress are two major pathways linking SES to hypertension. Findings also show that the extent of the association between SES and hypertension varies between different age, sex, and race/ethnicity groups. The SES differences in hypertension are found to be large and stable from middle to early old age and become smaller at about age 75--79. Psychosocial and environmental risk factors partially explain the SES-hypertension association in all age groups except for that of the oldest group. In the oldest group, the SES-hypertension association is strengthened rather than reduced by risk factors.;The association between SES and hypertension is stronger in women than in men, and in Blacks than in Whites. Among women, SES influences hypertension mainly through affecting a person's health behaviors and level of psychological stress. In men, psychological stress is the major link between SES and hypertension. In women, financial hardship is the major source of psychological stress associated with hypertension, where in men, job-related stress plays a significant role in hypertension. In both men and women, depression is an important psychological risk factor for hypertension. Whites are more likely than Blacks to be affected by psychosocial and environmental risk factors. White-Black differences in hypertension can be partially explained by measured risk factors, suggesting that some of the rest might be the result of genetic or other biological differences.