A meta-analysis comparing the difference in the prevalence of hypertension between urban and rural areas in low- and middle-income countries (LMICs) concluded that the prevalence of hypertension in both urban and rural areas increased between 1990 and 2020 The study was led by the Barcelona Institute for Global Health (ISGlobal), a center supported by the La Caixa Foundation, and was recently published in the journal. plus medicine,
The research team analyzed almost 300 studies with data from more than 19.7 million people in 66 countries (LMICs) and found a slightly higher prevalence of hypertension in urban areas (30.5%) than in rural areas (27.9%). The combined difference was only 2.45%. This difference was smaller in the 2005–2020 period than in the 1990–2004 period, and trends suggest that hypertension increased faster in rural than in urban areas. As countries develop socio-economically, the prevalence of hypertension in rural areas exceeds that in urban areas.
This rapid growth in rural areas can be partly explained by the aging of the rural population due to the emigration of young people. With socio-economic development, in addition to air pollution in rural homes from inefficient cooking and use of light fuels, increasing outdoor air pollution may also play a role. Urbanization is also associated with a shift towards more sedentary habits (less physically demanding activities) and less healthy diets.
Although the focus of hypertension prevention research is in urban areas, “if the global burden of hypertension is to be reduced, more attention is needed in rural areas where risk factor reduction and increased hypertension awareness and control are addressed must,” says Ottavio T. Ranjani, IS Global researcher and first author of the study.
Although hypertension is one of the leading risk factors for morbidity and mortality worldwide, little is known about the impact of urban living. “It is important to better understand how the prevalence of hypertension varies with urbanity, as many LMICs, particularly in Africa and Asia, are undergoing rapid urbanization with health implications,” argues Katherine Tone, ISGlobal researcher and later author the study.
Over the past three decades, the increase in noncommunicable diseases, including hypertension, has been greater in LMICs than in high-income countries, and ischemic heart disease and stroke are now among the top four causes of death in these countries.
Our findings have a significant impact on public health. They reinforce the need for prevention and control of hypertension in LMICs, with a particular focus on rural areas where awareness, treatment and control of hypertension is significantly lower than in urban areas.”
Katherine Tone, ISGlobal researcher and lead author of the study
However, to support these interventions, further detailed characterization of urban-rural differences in hypertension prevalence is needed to better understand the underlying mechanisms behind the observed trends.
Barcelona Institute for Global Health (ISGlobal)
Ranjani, OT, and other. (2022) Urban-rural differences in the prevalence of hypertension in low- and middle-income countries, 1990–2020: a systematic review and meta-analysis. PLOS medicine. doi.org/10.1371/journal.pmed.1004079.