Risk Factors in Adolescence for the Development of Elevated Blood Pressure and Hypertension in American Indian and Alask
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ORIGINAL PAPER
Risk Factors in Adolescence for the Development of Elevated Blood Pressure and Hypertension in American Indian and Alaskan Native Adults Anna Zamora‑Kapoor1 · Luciana E. Hebert2 · Morgan Montañez3 · Dedra Buchwald2 · Ka’imi Sinclair4 Accepted: 17 November 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract To examine risk factors for elevated blood pressure and hypertension in American Indians and Alaska Natives (AI/ANs), compared to three other ethnic groups in the US. Weighted relative risk regression models, stratified by race/ethnicity, were used to measure the associations between risk factors and elevated blood pressure and hypertension in AI/ANs, compared to non-Hispanic Whites, non-Hispanic Blacks and Hispanics, with data from the National Longitudinal Study of Adolescent to Adult Health. In all groups, females had a lower risk of both elevated blood pressure and hypertension than males. Increasing body mass index raised hypertension risk in all groups. In AI/ANs, financial instability increased the risk of hypertension by 88% (95% CI: 1.27–2.77), but not in other groups. No other statistically significant associations were found. Future interventions should include socio-economic factors in efforts to prevent hypertension in AI/ANs. Keywords American Indian · Alaska Native · Risk factors · Blood pressure · Hypertension
Introduction American Indians and Alaska Natives (AI/ANs) are 1.5 times more likely to be obese than non-Hispanic Whites (NHWs) [1], and this disparity is widening [2, 3]. Since AI/ ANs have a high prevalence of obesity, hypertension in this population is 1.3 times as prevalent as in NHWs. Hypertension is a major risk factor for cardiovascular disease (CVD), kidney disease, and stroke, all of which are health disparities experienced by AI/ANs [4–6]. Other risk factors associated with an increased risk of hypertension include family history of hypertension or CVD, metabolic factors (greater waist * Anna Zamora‑Kapoor anna.zamora‑[email protected] 1
Departments of Sociology and Medical Education and Clinical Sciences, Washington State University, Pullman, WA, USA
2
Department of Medical Education and Clinical Sciences, Washington State University, Spokane, WA, USA
3
Department of Sociology, Washington State University, Pullman, WA, USA
4
College of Nursing, Washington State University, Spokane, WA, USA
circumference), poor diet, lack of physical activity, sedentary habits, alcohol consumption, smoking, lower household income, and food insecurity [7, 8]. Research with adult cohorts has shown that AI/ANs experience a disproportionate burden of these risk factors compared to other populations, which are known to contribute to the high prevalence of hypertension in AI/ANs [7, 8]. Even in adolescence, AI/ ANs are more likely to have hypertension than their counterparts of other races/ethnicities, because they are more likely to be obese [9–11]. However, no study to date has analyzed the most important risk factors in adolescence for th
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