Hostname: page-component-7dd5485656-kp629 Total loading time: 0 Render date: 2025-10-31T08:13:13.209Z Has data issue: false hasContentIssue false
  • English
  • Français

GENDER DIFFERENCES IN THE ASSOCIATION BETWEEN MARITAL STATUS AND HYPERTENSION IN GHANA

Published online by Cambridge University Press:  21 May 2018

Derek Anamaale Tuoyire  and
Harold Ayetey
Derek Anamaale Tuoyire
Affiliation:
Department of Community Medicine, School of Medical Sciences, College of Health and Allied Sciences, University of Cape Coast, Ghana
Harold Ayetey*
Affiliation:
Department of Internal Medicine and Therapeutics, School of Medical Sciences, College of Health and Allied Sciences, University of Cape Coast, Ghana Institute of Cardiovascular Sciences, College of Medical and Dental Sciences, University of Birmingham, United Kingdom
*
1Corresponding author. Email: harold.ayetey@uccsms.edu.gh
Get access Rights & Permissions [Opens in a new window]

Summary

Hypertension is a significant contributor to the global burden of cardiovascular and related target organ diseases such as heart failure, coronary heart disease, stroke and kidney failure, and their associated premature morbidity, mortality and disability. Marital status is an important social characteristic known to predict a range of health outcomes including cardiovascular disease. However, little is known about its impact on hypertension in sub-Saharan Africa. This study explored the relationship between marital status and hypertension among women and men in Ghana. Drawing on data from the 2014 Ghana Demographic and Health Survey (GDHS), descriptive statistics and binary logistic regression models were used to analyse the link between marital status and hypertension. About 13% of women aged 15–49 and 15% of men aged 15–59 were found to be hypertensive. After controlling for lifestyle and socio-demographic covariates, the logistic regression models showed significantly higher odds of hypertension for married (OR=2.14, 95% CI=1.30–3.53), cohabiting (OR=1.94, 95% CI=1.16–3.23) and previously married (OR=2.23, 95% CI=1.29–3.84) women. In contrast, no significant association was found between any of the marital status cohorts and hypertension for men. Other significant predictors of hypertension were age, body mass index and wealth status. The results demonstrate that marital status is an independent risk factor for hypertension in Ghana for women, rather than men. This could have immediate and far-reaching consequences for cardiovascular health policy in Ghana. In particular, the findings could lead to better targeted public health interventions, including more effective risk factor assessment and patient education in clinical settings, which could lead to more effective patient management and improved cardiovascular outcomes.

Information

Type
Research Article
Information
Journal of Biosocial Science , Volume 51 , Issue 3 , May 2019 , pp. 313 - 334
Copyright
© Cambridge University Press, 2018 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Article purchase

Temporarily unavailable

References

Adam, I. (2014) Gendered perspectives of leisure patterns and constraints of university students in Ghana. Leisure/Loisir 38(2), 181–198.10.1080/14927713.2014.985475Google Scholar
Addo, J., Agyemang, C., Smeeth, L., De-Graft Aikins, A., Edusei, A. K. & Ogedegbe, O. (2012) A review of population-based studies on hypertension in Ghana. Ghana Medical Journal 46(2), Supplement, 4.Google Scholar
Addo, J., Smeeth, L. & Leon, D. A. (2009) Hypertensive target organ damage in Ghanaian civil servants with hypertension (target organ damage in Ghana). PLoS One 4(8), e6672.10.1371/journal.pone.0006672Google Scholar
Adeoye, A. M., Adebiyi, A., Owolabi, M. O., Lackland, D. T., Ogedegbe, G. & Tayo, B. O. (2016) Sex disparity in blood pressure levels among nigerian health workers. Journal of Clinical Hypertension 18(7), 685–689.10.1111/jch.12735Google Scholar
Agyemang, C. (2006) Rural and urban differences in blood pressure and hypertension in Ghana, West Africa. Public Health 120(6), 525–533.10.1016/j.puhe.2006.02.002Google Scholar
Agyemang, C., Bhopal, R. & Bruijnzeels, M. (2005) Does nocturnal blood pressure fall in people of African and South Asian descent differ from that in European white populations? A systematic review and meta-analysis. Journal of Hypertension 23(5), 913–920.10.1097/01.hjh.0000166827.94699.f9Google Scholar
Amoah, A. G. B. (2003) Hypertension in Ghana: a cross-sectional community prevalence study in greater Accra. Ethnicity & Disease 13(3), 310.Google Scholar
Averett, S. L., Sikora, A. & Argys, L. M. (2008) For better or worse: relationship status and body mass index. Economics and Human Biology 6(3), 330–349.10.1016/j.ehb.2008.07.003Google Scholar
Brisson, C., Laflamme, N., Moisan, J., Milot, A., Masse, B. & Vezina, M. (1999) Effect of family responsibilities and job strain on ambulatory blood pressure among white-collar women. Psychosomatic Medicine 61(2), 205–213.10.1097/00006842-199903000-00013Google Scholar
Brown, D. E., James, G. D., Nordloh, L. & Jones, A. A. (2003) Job strain and physiological stress responses in nurses and nurse’s aides: predictors of daily blood pressure variability. Blood Press Monitoring 8(6), 237–242.10.1097/00126097-200312000-00003Google Scholar
Brummett, H. B., Barefoot, C. J., Siegler, C. I., Clapp-Channing, E. N., Lytle, L. B. & Bosworth, H. B. et al. (2001) Characteristics of socially isolated patients with coronary artery disease who are at elevated risk for mortality. Psychosomatic Medicine 63(2), 267–272.10.1097/00006842-200103000-00010Google Scholar
Cuspidi, C., Giudici, V., Negri, F. & Sala, C. (2010) Nocturnal nondipping and left ventricular hypertrophy in hypertension: an updated review. Expert Review of Cardiovascular Therapy 8(6), 781–792.10.1586/erc.10.29Google Scholar
Danaei, G., Finucane, M. M., Lin, J. K., Singh, G. M., Paciorek, C. J. & Cowan, M. J. et al. (2011) National, regional, and global trends in systolic blood pressure since 1980: systematic analysis of health examination surveys and epidemiological studies with 786 country-years and 5·4 million participants. The Lancet 377(9765), 568–577.10.1016/S0140-6736(10)62036-3Google Scholar
Delisle, H., Ntandou-Bouzitou, G., Agueh, V., Sodjinou, R. & Fayomi, B. (2012) Urbanisation, nutrition transition and cardiometabolic risk: the Benin study. British Journal of Nutrition 107(10), 1534.10.1017/S0007114511004661Google Scholar
Fagard, R. H., Thijs, L., Staessen, J. A., Clement, D. L., De Buyzere, M. L. & De Bacquer, D. A. (2009) Night–day blood pressure ratio and dipping pattern as predictors of death and cardiovascular events in hypertension. Journal of Human Hypertension 23(10), 645–653.10.1038/jhh.2009.9Google Scholar
Ferree, M. M. (2010) Filling the glass: gender perspectives on families. Journal of Marriage and Family 72(3), 420–439.10.1111/j.1741-3737.2010.00711.xGoogle Scholar
Frankenhaeuser, M., Lundberg, U., Fredrikson, M., Melin, B., Tuomisto, M. & Hedman, M. et al. (1989) Stress on and off the job as related to sex and occupational status in white-collar workers. Journal of Organizational Behavior 10(4), 321.10.1002/job.4030100404Google Scholar
Gasperin, D., Netuveli, G., Dias-da-Costa, J. S. & Pattussi, M. P. (2009) Effect of psychological stress on blood pressure increase: a meta-analysis of cohort studies. Cadernos de Saude Publica 25(4), 715–726.10.1590/S0102-311X2009000400002Google Scholar
Gerin, W. & James, G. D. (2010) Psychosocial determinants of hypertension: laboratory and field models. Blood Press Monitoring 15(2), 93–99.10.1097/MBP.0b013e3283380e0aGoogle Scholar
Ghana Statistical Service (GSS), Ghana Health Service (GHS) & ICF International (2015) Ghana Demographic and Health Survey 2014. Rockville, MD, USA.Google Scholar
Go, S. A., Mozaffarian, L. D., Roger, J. V., Benjamin, D. E., Berry, B. J. & Borden, W. B. et al. (2013) Heart disease and stroke statistics – 2013 update: a report from the American Heart Association. Circulation 127(1), e6–e245.Google Scholar
Graudal, N. A., Hubeck-Graudal, T. & Jurgens, G. (2017) Effects of low sodium diet versus high sodium diet on blood pressure, renin, aldosterone, catecholamines, cholesterol, and triglyceride. Cochrane Database of Systematic Reviews 4(4), CD004022.Google Scholar
Hansen, T. W., Li, Y., Boggia, J., Thijs, L., Richart, T. & Staessen, J. A. (2011) Predictive role of the nighttime blood pressure. Hypertension 57(1), 3–10.10.1161/HYPERTENSIONAHA.109.133900Google Scholar
Henderson, K. A. (1996) One size doesn’t fit all: the meanings of women’s leisure. Journal of Leisure Research 28(3), 139–154.10.1080/00222216.1996.11949767Google Scholar
House, S. J. (2001) Social isolation kills, but how and why? Psychosomatic Medicine 63(2), 273–274.10.1097/00006842-200103000-00011Google Scholar
Ice, G. H. & James, G. D. (2012) Human biology and stress. In Stinson, S. Bogin, B. & O’Rourke, D. (eds) Human Biology: An Evolutionary and Biocultural Perspective, 2nd Edition. Wiley-Blackwell Publishing, New York.Google Scholar
Ikeda, A., Iso, H., Toyoshima, H., Fujino, Y., Mizoue, T., Yoshimura, T. & Tamakoshi, A. (2007) Marital status and mortality among Japanese men and women: the Japan Collaborative Cohort Study. BMC Public Health 7(1), 73.10.1186/1471-2458-7-73Google Scholar
James, G. D. (2013) Ambulatory blood pressure variation: allostasis and adaptation. Autonomic Neuroscience 177(2), 87–94.Google Scholar
James, G. D. (2017) Understanding blood pressure variation and variability: biological importance and clinical significance. Advances in Experimental Medicine and Biology 956, 3–19.10.1007/5584_2016_83Google Scholar
James, G. D., Broege, P. A. & Schlussel, Y. R. (1996) Assessing cardiovascular risk and stress-related blood pressure variability in young women employed in wage jobs. American Journal of Human Biology 8(6), 743–749.10.1002/(SICI)1520-6300(1996)8:6<743::AID-AJHB6>3.0.CO;2-U3.0.CO;2-U>Google Scholar
James, G. D., Yee, L. S., Harshfield, G. A. & Pickering, T. G. (1988) Sex differences in factors affecting the daily variation of blood pressure. Social Science & Medicine 26(10), 1019–1023.10.1016/0277-9536(88)90219-5Google Scholar
Jiang, S. Z., Lu, W., Zong, X. F., Ruan, H. Y. & Liu, Y. (2016) Obesity and hypertension (Review). Experimental and Therapeutic Medicine 12(4), 2395–2399.10.3892/etm.2016.3667Google Scholar
Joung, I. M. A., Van De Mheen, H. D., Stronks, K., Van Poppel, F. W. A. & Mackenbach, J. P. (1998) A longitudinal study of health selection in marital transitions. Social Science & Medicine 46(3), 425–435.10.1016/S0277-9536(97)00186-XGoogle Scholar
Kaplan, R. M. & Kronick, R. G. (2006) Marital status and longevity in the United States population. Journal of Epidemiology and Community Health 60(9), 760.Google Scholar
Landsberg, L., Aronne, L. J., Beilin, L. J., Burke, V., Igel, L. I., Lloyd-Jones, D. & Sowers, J. (2013) Obesity-related hypertension: pathogenesis, cardiovascular risk, and treatment-a position paper of the Obesity Society and the American Society of Hypertension. Obesity (Silver Spring) 21(1), 8–24.10.1002/oby.20181Google Scholar
Landsbergis, P. A., Schnall, P. L., Pickering, T. G., Warren, K. & Schwartz, J. E. (2003) Life-course exposure to job strain and ambulatory blood pressure in men. American Journal of Epidemiology 157(11), 998–1006.10.1093/aje/kwg095Google Scholar
Law, R. W. & Sbarra, D. A. (2009) The effects of church attendance and marital status on the longitudinal trajectories of depressed mood among older adults. Journal of Aging and Health 21(6), 803–823.10.1177/0898264309338300Google Scholar
Laxmaiah, A., Meshram, I. I., Arlappa, N., Balakrishna, N., Rao, K. M. & Reddy, C. G. et al. (2015) Socio-economic and demographic determinants of hypertension & knowledge, practices and risk behaviour of tribals in India. Indian Journal of Medical Research 141(5), 697.Google Scholar
Lear, S. A., Teo, K., Gasevic, D., Zhang, X., Poirier, P. P. & Rangarajan, S. et al. (2014) The association between ownership of common household devices and obesity and diabetes in high, middle and low income countries. Canadian Medical Association Journal 186(4), 258–266.10.1503/cmaj.131090Google Scholar
Lee, S., Cho, E., Grodstein, F., Kawachi, I., Hu, F. B. & Colditz, G. A. (2005) Effects of marital transitions on changes in dietary and other health behaviours in US women. International Journal of Epidemiology 34(1), 69–78.10.1093/ije/dyh258Google Scholar
Lett, S. H., Blumenthal, A. J., Babyak, A. M., Strauman, J. T., Robins, J. C. & Sherwood, J. A. (2005) Social support and coronary heart disease: epidemiologic evidence and implications for treatment. Psychosomatic Medicine 67(6), 869–878.10.1097/01.psy.0000188393.73571.0aGoogle Scholar
Livingstone, K. M. & Mcnaughton, S. A. (2016) Diet quality is associated with obesity and hypertension in Australian adults: a cross sectional study. BMC Public Health 16(1), 1037.Google Scholar
Luecken, L. J., Suarez, E. C., Kuhn, C. M., Barefoot, J. C., Blumenthal, J. A., Siegler, I. C. & Williams, R. B. (1997) Stress in employed women: impact of marital status and children at home on neurohormone output and home strain. Psychosomatic Medicine 59(4), 352–359.10.1097/00006842-199707000-00003Google Scholar
Manzoli, L., Villari, P., M Pirone, G. & Boccia, A. (2007) Marital status and mortality in the elderly: a systematic review and meta- analysis. Social Science & Medicine 64(1), 77–94.Google Scholar
Molloy, G. J., Stamatakis, E., Randall, G. & Hamer, M. (2009) Marital status, gender and cardiovascular mortality: behavioural, psychological distress and metabolic explanations. Social Science & Medicine 69(2), 223–228.10.1016/j.socscimed.2009.05.010Google Scholar
Murray, C. J. L., Vos, T. & Lozano, R. et al. (2012) Disability- adjusted life years ( DALYs) for 291 diseases and injuries in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 380(9859), 2197–2223.10.1016/S0140-6736(12)61689-4Google Scholar
Ndanuko, R. N., Tapsell, L. C., Charlton, K. E., Neale, E. P. & Batterham, M. J. (2016) Dietary patterns and blood pressure in adults: a systematic review and meta-analysis of randomized controlled trials. Advances in Nutrition 7(1), 76.Google Scholar
Nyarko, S. H. (2016) Prevalence and sociodemographic determinants of hypertension history among women in reproductive age in Ghana. International Journal of Hypertension, article 3292938. doi: 10.1155/2016/3292938.Google Scholar
Okyere-Manu, B. (2015) Cohabitation in Akan culture of Ghana: an ethical challenge to gatekeepers of indigenous knowledge system in the Akan culture. Empire Religions, Theologies, and Indigenous Knowledge Systems 14, 45–60.Google Scholar
Riese, H., Van Doornen, L. J., Houtman, I. L. & De Geus, E. J. (2004) Job strain in relation to ambulatory blood pressure, heart rate, and heart rate variability among female nurses. Scandinavian Journal of Work and Environmental Health 30(6), 477–485.10.5271/sjweh.837Google Scholar
Scafato, E., Galluzzo, L., Gandin, C., Ghirini, S., Baldereschi, M. & Capurso, A. et al. (2008) Marital and cohabitation status as predictors of mortality: a 10-year follow-up of an Italian elderly cohort. Social Science & Medicine 67(9), 1456–1464.10.1016/j.socscimed.2008.06.026Google Scholar
Schnall, P. L., Pieper, C., Schwartz, J. E., Karasek, R. A., Schlussel, Y. & Devereux, R. B. et al. (1990) The relationship between ‘job strain,’ workplace diastolic blood pressure, and left ventricular mass index. Results of a case-control study. JAMA 263(14), 1929–1935.Google Scholar
Schoenbach, V. J., Kaplan, B. H., Fredman, L. & Kleinbaum, D. G. (1986) Social ties and mortality in Evans County, Georgia. American Journal of Epidemiology 123(4), 577–591.10.1093/oxfordjournals.aje.a114278Google Scholar
Schwandt, H. M., Coresh, J. & Hindin, M. J. (2010) Marital status, hypertension, coronary heart disease, diabetes, and death among African American women and men: incidence and prevalence in the Atherosclerosis Risk in Communities (ARIC) study participants. Journal of Family Issues 31(9), 1211–1229.10.1177/0192513X10365487Google Scholar
Sparrenberger, F., Cichelero, F. T., Ascoli, A. M., Fonseca, F. P., Weiss, G. & Berwanger, O. et al. (2009) Does psychosocial stress cause hypertension? A systematic review of observational studies. Journal of Human Hypertension 23(1), 12.Google Scholar
Sterling, P. (2004) Principles of allostasis optimal design, predictive regulation, pathophysiology, and rational therapeutics. In Schulkin, J. (ed.) Allostasis, Homeostasis, and the Costs of Physiological Adaptation. Cambridge University Press, Cambridge, pp. 17–64.10.1017/CBO9781316257081.004Google Scholar
Steptoe, A., Cropley, M. & Joekes, K. (1999) Job strain, blood pressure and response to uncontrollable stress. Journal of Hypertension 17(2), 193–200.Google Scholar
Umberson, D., Chen, M., House, J., Hopkins, K. & Slaten, E. (1996) The effect of social relationships on psychological well-being: are men and women really so different? American Sociological Review 61(5), 837.10.2307/2096456Google Scholar
Van den Berg, N., Meinke-Franze, C., Fiss, T., Baumeister, S. E. & Hoffmann, W. (2013) Prevalence and determinants of controlled hypertension in a German population cohort. BMC Public Health 13, 594.10.1186/1471-2458-13-594Google Scholar
Wang, H. (2005) Effects of marital status and transition on hypertension in Chinese women: a longitudinal study. Presented at the 2005 Annual Meeting of the Population Association of America, Philadelphia, Pennsylvania, March 31st–April 2nd 2005. URL: http://www.paa2005.princeton.edu/papers/51669 Google Scholar
Welin, L., Larsson, B., Svärdsudd, K., Tibblin, B. & Tibblin, G. (1992) Social network and activities in relation to mortality from cardiovascular diseases, cancer and other causes: a 12 year follow up of the study of men born in 1913 and 1923. Journal of Epidemiology and Community Health 46(2), 127.10.1136/jech.46.2.127Google Scholar
WHO (2010) Global Status Report on Non-Communicable Diseases. WHO, Geneva. RL: www.who.int/nmh/publications/ncd_report2010/en/ Google Scholar
WHO (2013) A Global Brief on Hypertension: Silent Killer, Global Public Health Crisis. WHO, Geneva. URL: http://www.who.int/cardiovascular_diseases/publications/global_brief_hypertension/en/ Google Scholar
WHO (2014) Noncommunicable Diseases (NCD) Country Profiles. WHO, Geneva. URL: www.who.int/nmh/publications/ncd-profiles-2014/en/ Google Scholar
Wickrama, K. A. S., Lorenz, F. O., Wallace, L. E., Peiris, L., Conger, R. D. & Elder, G. H. (2001) Family influence on physical health during the middle years: the case of onset of hypertension. Journal of Marriage and Family 63(2), 527–539.10.1111/j.1741-3737.2001.00527.xGoogle Scholar
Williams, E. A., Keenan, K. E., Ansong, D., Simpson, L. M., Boakye, I. & Boaheng, J. M. et al. (2013) The burden and correlates of hypertension in rural Ghana: a cross-sectional study. Diabetes & Metabolic Syndrome: Clinical Research & Reviews 7(3), 123–128.Google Scholar