Skip to main content
SpringerLink
Log in

Generational differences in longitudinal blood pressure trajectories by geographic region during socioeconomic transitions in China

  • Original article
  • Published:
International Journal of Public Health

Abstract

Objectives

To examine generational differences in longitudinal blood pressure trajectories by region following socioeconomic transitions, which is important for establishing the population risk of cardiovascular diseases (CVDs).

Methods

With data from the China Health and Nutrition Survey (1991–2011), we used multilevel growth-curve models to estimate systolic/diastolic blood pressure (SBP/DBP) levels at the mean age and rates of change by cohort (born between 1931 and 1980), region, and sex.

Results

Younger cohorts generally had higher SBP/DBP levels at 44.5 years but lower growth rates in SBP/DBP than older cohorts. They became prehypertensive (SBP ≥ 120 mm Hg or DBP ≥ 80 mm Hg) at an earlier age. The upward shift of SBP/DBP trajectories across cohorts was more pronounced in the Coastal and Southern Mountainous Regions than the Northeastern and Inland Regions, and for males versus females.

Conclusions

Younger cohorts have a longer lifetime duration of being susceptible to CVDs, posing warnings for an increased burden of CVDs. Generational differences in BP trajectories and geographic and sex variations in the cohort trends highlight the need for tailored interventions to tackle the generation, region, and sex-based risk of CVDs.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  • Appelman Y, van Rijn BB, Monique E et al (2015) Sex differences in cardiovascular risk factors and disease prevention. Atherosclerosis 241(1):211–218

    Article  CAS  PubMed  Google Scholar 

  • Attard SM, Herring AH, Zhang B et al (2015) Associations between age, cohort, and urbanization with systolic and diastolic blood pressure in China: a population-based study across 18 years. J Hypertens 33(5):948

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Barker DJ (1990) The fetal and infant origins of adult disease. BMJ 301(6761):1111

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Ben-Shlomo Y, Kuh D (2002) A life course approach to chronic disease epidemiology: conceptual models, empirical challenges and interdisciplinary perspectives. Int J Epidemiol 31(2):285–293

    Article  PubMed  Google Scholar 

  • Chen F, Yang Y, Liu G (2010) Social change and socioeconomic disparities in health over the life course in China a cohort analysis. Am Sociol Rev 75(1):126–150

    Article  PubMed  PubMed Central  Google Scholar 

  • Chen Z, Peto R, Zhou M et al (2015) Contrasting male and female trends in tobacco-attributed mortality in China: evidence from successive nationwide prospective cohort studies. Lancet 386(10002):1447–1456

    Article  PubMed  PubMed Central  Google Scholar 

  • Choh AC, Nahhas RW, Lee M et al (2011) Secular trends in blood pressure during early-to-middle adulthood: the Fels Longitudinal Study. J Hypertens 29(5):838

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Curran PJ, Obeidat K, Losardo D (2010) Twelve frequently asked questions about growth curve modeling. J Cogn Dev 11(2):121–136

    Article  PubMed  PubMed Central  Google Scholar 

  • Diderichsen F, Hallqvist J, Whitehead M (2018) Differential vulnerability and susceptibility: how to make use of recent development in our understanding of mediation and interaction to tackle health inequalities. Int J Epidemiol 48(1):1–7

    Google Scholar 

  • Du S, Lu B, Zhai F et al (2002) A new stage of the nutrition transition in China. Public Health Nutr 5(1A):169–174

    Article  PubMed  Google Scholar 

  • Elder GH Jr, George LK (2016) Age, cohorts, and the life course. In: Shanahan MJ, Mortimer JT, Johnson MK (eds) Handbook of the life course. Springer, New York, pp 59–85

    Chapter  Google Scholar 

  • Ettehad D, Emdin CA, Kiran A et al (2016) Blood pressure lowering for prevention of cardiovascular disease and death: a systematic review and meta-analysis. Lancet 387(10022):957–967

    Article  PubMed  Google Scholar 

  • Fogel RW (2004) Technophysio evolution and the measurement of economic growth. J Evol Econ 14(2):217–221

    Article  Google Scholar 

  • Forouzanfar MH, Liu P, Roth GA et al (2017) Global burden of hypertension and systolic blood pressure of at least 110 to 115 mm Hg, 1990–2015. JAMA 317(2):165–182

    Article  PubMed  Google Scholar 

  • Gao M, Wang F, Shen Y et al (2018) Trajectories of Mediterranean diet adherence and risk of hypertension in China: results from the CHNS study, 1997–2011. Nutrients 10(12):2014

    Article  CAS  PubMed Central  Google Scholar 

  • Gluckman PD, Hanson MA, Cooper C et al (2008) Effect of in utero and early-life conditions on adult health and disease. N Engl J Med 359(1):61–73

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Gu D, Chen J, Wu X et al (2009) Prehypertension and risk of cardiovascular disease in Chinese adults. J Hypertens 27(4):721–729

    Article  CAS  PubMed  Google Scholar 

  • Hopstock LA, Bønaa KH, Eggen AE et al (2015) Longitudinal and secular trends in blood pressure among women and men in birth cohorts born between 1905 and 1977: The Tromsø Study 1979 to 2008. Hypertension 66(3):496–501

    Article  CAS  PubMed  Google Scholar 

  • Huang Y, Su L, Cai X et al (2014) Association of all-cause and cardiovascular mortality with prehypertension: a meta-analysis. Am Heart J 167(2):160–168

    Article  PubMed  Google Scholar 

  • Huang C, Liu CJ, Pan XF et al (2016) Correlates of unequal access to preventive care in China: a multilevel analysis of national data from the 2011 China Health and Nutrition Survey. BMC Health Serv Res 16(1):177

    Article  PubMed  PubMed Central  Google Scholar 

  • Ji CY, Cheng TO (2009) Epidemic increase in overweight and obesity in Chinese children from 1985 to 2005. Int J Cardiol 132(1):1–10

    Article  PubMed  Google Scholar 

  • Jones-Smith JC, Popkin BM (2010) Understanding community context and adult health changes in China: development of an urban city scale. Soc Sci Med 71(8):1436–1446

    Article  PubMed  PubMed Central  Google Scholar 

  • Kanbur R, Zhang X (2005) Fifty years of regional inequality in China: a journey through central planning, reform, and openness. Rev Dev Econ 9(1):87–106

    Article  Google Scholar 

  • Lewington S, Clarke R, Qizilbash N et al (2002) Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies. Lancet 360(9349):1903–1913

    Article  PubMed  Google Scholar 

  • Li C, Lumey L (2017) Exposure to the Chinese famine of 1959–61 in early life and long-term health conditions: a systematic review and meta-analysis. Int J Epidemiol 46(4):1157–1170

    Article  PubMed  Google Scholar 

  • Lynch SM (2003) Cohort and life-course patterns in the relationship between education and health: a hierarchical approach. Demography 40(2):309–331

    Article  PubMed  Google Scholar 

  • National Health Commission of the People’s Republic of China (NHCPC) (2017) China health statistical yearbook. Peking Union Medical College Press, Beijing

    Google Scholar 

  • NCD Risk Factor Collaboration (2018) Contributions of mean and shape of blood pressure distribution to worldwide trends and variations in raised blood pressure: a pooled analysis of 1018 population-based measurement studies with 88.6 million participants. Int J Epidemiol 47(3):872–883

    Article  Google Scholar 

  • O’Neil A, Scovelle AJ, Milner AJ et al (2018) Gender/sex as a social determinant of cardiovascular risk. Circulation 137(8):854–864

    Article  PubMed  Google Scholar 

  • Pes GM, Cocco F, Bibbò S, Marras G, Dore MP (2017) Cancer time trend in a population following a socio-economic transition: results of age-period-cohort analysis. Int J Public Health 62(3):407–414

    Article  PubMed  Google Scholar 

  • Popkin BM, Du S, Zhai F et al (2010) Cohort profile: the China Health and Nutrition Survey—monitoring and understanding socio-economic and health change in China, 1989–2011. Int J Epidemiol 39(6):1435–1440

    Article  PubMed  Google Scholar 

  • Popkin BM, Adair LS, Ng SW (2012) Global nutrition transition and the pandemic of obesity in developing countries. Nutr Rev 70(1):3–21

    Article  PubMed  Google Scholar 

  • Ryder NB (1965) The cohort as a concept in the study of social change. Am Soc Rev 30(6):843–861

    Article  CAS  Google Scholar 

  • Schafer MH, Kwon S (2012) Cohorts and emerging health disparities biomorphic trajectories in China, 1989 to 2006. J Health Soc Behav 53(4):515–532

    Article  PubMed  Google Scholar 

  • Tiu AC, Bishop MD, Asico LD et al (2017) Primary pediatric hypertension: current understanding and emerging concepts. Curr Hypertens Rep 19(9):70

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  • Wang J, Zhang L, Wang F et al (2014) Prevalence, awareness, treatment, and control of hypertension in China: results from a national survey. Am J Hypertens 27(11):1355–1361

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Wang W, Jiang B, Sun H et al (2017) Prevalence, incidence, and mortality of stroke in China: results from a nationwide population-based survey of 480 687 adults. Circulation 135:759–771

    Article  PubMed  Google Scholar 

  • Wang A, Zhang Y, Li J et al (2018) High SBP trajectories are associated with risk of all-cause death in general Chinese population. J Hypertens 36(6):1299–1305

    Article  CAS  PubMed  Google Scholar 

  • Yang G, Kong L, Zhao W et al (2008) Emergence of chronic non-communicable diseases in China. Lancet 372(9650):1697–1705

    Article  PubMed  Google Scholar 

  • Yang F, Qian D, Liu X (2017) Socioeconomic disparities in prevalence, awareness, treatment, and control of hypertension over the life course in China. Int J Equity Health 16:100

    Article  PubMed  PubMed Central  Google Scholar 

  • Zang J, Ng SW (2016) Age, period and cohort effects on adult physical activity levels from 1991 to 2011 in China. Int J Behav Nutr Phys Act 13(1):1

    Article  Google Scholar 

  • Zhai F, Du S, Wang Z et al (2014) Dynamics of the Chinese diet and the role of urbanity, 1991–2011. Obes Rev 15(S1):16–26

    Article  PubMed  Google Scholar 

  • Zhang X, Kanbur R (2005) Spatial inequality in education and health care in China. China Econ Rev 16(2):189–204

    Article  Google Scholar 

  • Zhang B, Zhai F, Du S et al (2014) The China health and nutrition survey, 1989–2011. Obes Rev 15(S1):2–7

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

This research used data from China Health and Nutrition Survey (CHNS). We are grateful to the National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, the Carolina Population Center, the University of North Carolina at Chapel Hill, and all the people involved in the program of China Health and Nutrition Survey.

Funding

This work was supported by National Social Science Foundation (No. 17ZDA124) and China Postdoctoral Science Foundation (No. 2019M650083). The funders had no role in study design, in the analysis and interpretation of data, in the writing of the paper, or in the decision to submit the paper for publication.

Author information

Authors and Affiliations

  1. Asian Demographic Research Institute, Shanghai University, Shanghai, China

    Jinjing Wu

  2. Department of Health Policy and Management, Mailman School of Public Health, Columbia University, New York, USA

    Peter A. Muennig

  3. Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, USA

    Katherine Keyes

  4. Institute of Population Research, Peking University, Beijing, China

    Jilei Wu

Authors
  1. Jinjing Wu
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Peter A. Muennig
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Katherine Keyes
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jilei Wu
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jilei Wu.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This study was exempt from ethical approval because it was limited to the publicly available China Health and Nutrition Survey dataset that contained no personally identifiable information beyond birthdates.

Informed consent

All participants provided informed consent before being enrolled in the China Health and Nutrition Survey.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOCX 289 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Wu, J., Muennig, P.A., Keyes, K. et al. Generational differences in longitudinal blood pressure trajectories by geographic region during socioeconomic transitions in China. Int J Public Health 64, 1375–1387 (2019). https://doi.org/10.1007/s00038-019-01276-3

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00038-019-01276-3

Keywords

Search

Navigation