Hypertension, also known as high blood pressure, stands as a significant risk factor for non-communicable diseases (NCDs) worldwide. It is not considered a disease on its own but rather a medical condition characterized by elevated blood pressure levels and is often classified as a risk factor for various cardiovascular diseases and other health complications rather than a standalone disease. However, uncontrolled or prolonged hypertension can lead to serious health problems such as heart disease, stroke, kidney damage, and other conditions. Therefore, while hypertension is not a disease in itself, it requires careful management and treatment to prevent associated health risks.
Studies suggest that approximately one-third of the adult population worldwide grapple with hypertension. This condition is not only prevalent but also carries substantial implications for mortality rates, contributing to an estimated 7.6 million premature deaths each year [1]. The burden of hypertension is not uniform across populations and regions, with variations observed based on factors such as age, sex, ethnicity, and lifestyle behaviors. Recent research by Rahman et. al. indicates that hypertension is becoming a growing concern among young adults, mirroring its prevalence in the older demographic. Among the risk factors identified, hypertension was slightly more common in males (10.6%) than females (9.2%). Additionally, individuals aged 25–30 years and 31–34 years, male gender, and higher body mass index (BMI), indicative of overweight or obesity, were associated with increased risk of prehypertension and hypertension in Bangladesh [2]. Additionally, socioeconomic status plays a crucial role in shaping the prevalence of hypertension, highlighting the complex interplay between social determinants and health outcomes [3]. The multifactorial nature of hypertension underscores the need for comprehensive approaches to its prevention, diagnosis, and management on a global scale [4].
Socioeconomic status stands as a fundamental determinant shaping the prevalence and management of hypertension, wielding significant influence across diverse populations and settings [5]. Extensive research has consistently underscored the association between low socioeconomic status and heightened prevalence of hypertension, alongside suboptimal treatment outcomes, particularly evident in low- and middle-income countries (LMICs). Studies conducted in various countries, including Kenya, China, South Africa, and Bangladesh, have highlighted socioeconomic inequities in the screening and treatment of hypertension [5,6,7,8]. In China, Elwell-Sutton et al. revealed marked pro-rich inequalities in the utilization of treatment services for hypertension, emphasizing the role of socioeconomic status in healthcare access [7]. Similarly, studies in Bangladesh have shown that income, wealth status, and education level are significant predictors of NCD treatment inequalities [9].
Moreover, analyses of hypertension prevalence in Kenya and Iran have demonstrated socioeconomic disparities favoring the affluent population, with factors such as BMI and regional differences contributing significantly to inequality [5, 10]. Inequities arise from a complex interplay of need-based factors, such as sex and body mass index (BMI), and non-need-based factors, including area of residence, wealth, and employment status, which drive disparities in healthcare access and utilization [6]. Socioeconomic factors like income, education, and occupation shape vulnerability to hypertension and the ability to manage it. Income-based barriers to treatment exemplify avoidable and unjust health inequities, where financial constraints deny individuals access to necessary care despite equal health needs. Addressing these disparities is essential for achieving health equity and ensuring equitable opportunities for optimal health outcomes for all.
Studies in Bangladesh and other low- and middle-income countries (LMICs) reveal a complex relationship between socioeconomic status and hypertension, highlighting that individuals from lower-income households disproportionately face uncontrolled hypertension and significant barriers to healthcare access [11, 12]. These findings emphasize how financial constraints and limited healthcare access worsen challenges for marginalized groups in managing hypertension effectively. Disparities in hypertension treatment utilization present a critical public health issue, contributing to adverse outcomes and perpetuating healthcare inequalities. Socioeconomic factors, including income, education, and employment, heavily influence access to healthcare. Financial barriers prevent many individuals from affording essential medications, diagnostic tests, and follow-ups necessary for effective hypertension management. Moreover, gaps in health insurance coverage and affordable healthcare facilities exacerbate these inequities, disproportionately impacting disadvantaged populations [7].
Hypertension prevalence varies across regions and is shaped by factors such as age, sex, ethnicity, and socioeconomic status. Research in Bangladesh has provided valuable insights into its prevalence among adults, historically guided by frameworks like the Joint National Committee 7 (JNC 7) and the WHO-International Society of Hypertension (WHO-ISH). However, the updated hypertension definition by the American College of Cardiology/American Heart Association (ACC/AHA) in 2017 prompted a reevaluation of prevalence estimates and risk factors. Studies adopting the ACC/AHA guidelines have offered a more nuanced understanding of hypertension determinants in Bangladesh, informing public health strategies and policy development [9].
Emerging evidence highlights a troubling trend of socio-economic inequality in hypertension prevalence and healthcare access in Bangladesh. Biswas et al. (2016) revealed significant socio-economic disparities in the burden of hypertension, particularly among urban populations, noting a higher prevalence among wealthier individuals. This suggests a complex interplay between socio-economic status and disease distribution [13]. Similarly, Ali et al. (2019) examined sex-specific prevalence and inequalities in hypertension, diabetes, and their comorbidities, reporting a significant prevalence of hypertension (29.7%) and socio-economic disparities in accessing healthcare services. These findings underscore the urgent need for targeted interventions to address healthcare inequities and improve disease management [14].
Nujhat et al. (2020) focused on rural populations and identified gaps in knowledge and practice regarding non-communicable disease (NCD) prevention, despite high awareness of hypertension and diabetes. This highlights the critical need for comprehensive health education and promotion strategies [15]. Chowdhury et al. (2021) analyzed nationally representative survey data and reported a marked increase in hypertension prevalence over time, particularly among obese individuals. The study identified key risk factors such as age, BMI, sex, marital status, education, geographic region, wealth index, and diabetes status, reflecting disparities in healthcare-seeking behaviors and risk profiles among different subpopulations [16]. Additionally, Ahmed et al. (2019) investigated undiagnosed hypertension among Bangladeshi adults, revealing a significant prevalence among poorer and less-educated groups. The study emphasized the need for enhanced screening and diagnostic services to ensure early detection and effective management of hypertension [17].
Notably, the interaction between socioeconomic status, health outcomes, and NCD burden underscores the need for comprehensive strategies to address hypertension disparities [18]. Disadvantaged populations face multiple barriers to healthcare access, including financial constraints, limited infrastructure, and inadequate health literacy, exacerbating health inequities. Furthermore, disparities in hypertension prevalence and treatment utilization are compounded by geographic disparities, with rural communities bearing a disproportionate burden of inequitable access to healthcare resources compared to their urban counterparts.
The 2030 Agenda for Sustainable Development, encapsulated in the Sustainable Development Goals (SDGs), underscores the imperative of addressing health inequity as a core component of global development efforts. Objective 10 and Goal 3.8 of SDGs epitomize this commitment, emphasizing the urgent need to confront disparities across all facets of society and ensure Universal Health Coverage (UHC) for all individuals, irrespective of their socio-economic status or geographical location. Goal 3.8 of SDGs specifically underscores the critical importance of achieving Universal Health Coverage (UHC), which entails ensuring that everyone has access to essential healthcare services without experiencing financial hardship. UHC represents a fundamental human right and a cornerstone of equitable health systems. By guaranteeing access to quality healthcare for all individuals, UHC not only promotes health and well-being but also serves as a powerful mechanism for reducing health inequities. Achieving health equity requires recognizing and addressing the intersecting forms of discrimination and disadvantage that contribute to disparities in health outcomes such as use of hypertension treatment.
Structural barriers within the healthcare system also impede individuals’ ability to access hypertension treatment services. These barriers may include geographic disparities, limited availability of healthcare providers, long wait times for appointments, and inadequate infrastructure in rural and underserved areas.
In contrast, non-need factors, encompassing socio-demographic and economic characteristics, exert a substantial influence on disparities in treatment utilization for hypertension. “50 years of the inverse care law” by Haines et al. (1971) discusses Tudor Hart’s observation that disadvantaged populations, despite having greater healthcare needs, receive less care [19]. Geographic disparities in access to healthcare services, driven by differences in urban-rural divide, healthcare infrastructure, and healthcare workforce distribution, can limit individuals’ ability to receive timely and appropriate treatment [20]. Furthermore, disparities in wealth distribution and income levels can create financial barriers, hindering access to medications, diagnostic tests, and specialist consultations necessary for effective hypertension management. Similarly, employment status may affect individuals’ access to employer-sponsored health insurance coverage or paid sick leave, impacting their ability to seek hypertension treatment.
Inequalities in hypertension treatment utilization persist globally, driven by a complex interplay of socioeconomic factors, healthcare system characteristics, and individual-level determinants. This study addresses a critical research gap by examining socioeconomic inequalities in hypertension care utilization in Bangladesh using nationally representative data. Specifically, it investigates disparities in screening and treatment services, employing robust methodologies to understand the multifaceted dimensions of these inequalities. The findings aim to inform targeted interventions and policy strategies to promote equitable healthcare delivery in Bangladesh and highlight the pressing need for targeted interventions to address disparities in its management.
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