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Alida Corpuz

Diana Juarez
Lynn Tran

Hypertension among Californians

Section 1: Background Hypertension (also known as High Blood Pressure) is a chronic cardiac medical condition that affects approximately 1 in 3 adults in the United States. According to American Heart Association, Blood pressure is the force of blood pushing against the walls of your arteries. High blood pressure means that your blood is moving through your arteries with a pressure higher than normal. Elevated blood pressure levels can cause other serious health complications with the heart, brain, or kidneys. Hypertension (HBP) is considered a silent killer since the symptoms can be undetected or masked until serious health complications with the heart, brain, or kidneys are noticed. A report by California Department of Health Services indicates that sustained high blood pressure (chronic) results in pathological changes in the blood vessels which lead to cardiovascular disease, as well as damage to organs such as the eye and kidney. Hypertension (High Blood Pressure) is a serious illness that is plaguing our society. Although there is no specific cause for essential hypertension, there are studies that show strong evidence linking some risk factors to the likelihood of developing HBP. According to American Heart Association, essential hypertension risk factors include family history, advanced age, gender-related risk 2

patterns, lack of physical activity, poor diet (high sodium diet), overweight/obesity, and drinking too much alcohol. Hypertension is a leading cause of death in the United States and California. Millions of people are at risk for High Blood Pressure. It can affect anyone. There are numerous studies and programs created to help combat HBP but the morbidity and mortality rates still continue to rise. There are many factors and causes that further need to be researched to illustrate how significantly important HBP is. In California, studies show how hypertension is increasing among adults within ethnicity and gender. According to a research article by the California Department of Health Services, in 2004, out of 22,953 hypertension deaths in the U.S.; 2,860 of those deaths were from California. This research article illustrates the crude death rates among adults with HBP are increasing at an alarming rate. According to American Heart Association, many people assume that HBP is more common in men but nearly half of all adults with HBP are women. Older age also increases the risk of HBP since blood vessels lose flexibility with age. More than 40 percent of non-Hispanic blacks have high blood pressure. (American Heart Association, 2012). There are many contributing factors that lead to High Blood Pressure and many studies show strong evidence that ethnicity, gender, and advanced

age play a big part in developing this lifethreatening condition. Analysis Questions: 1. What is the prevalence of hypertension among adults (males and females) in California? 2. Which ethnic group has the highest probability of getting hypertension? 3. What age group has the highest risk of having high blood pressure?

of topics, therefore establishing a way for us to generalize the result. Lastly, CHIS allows for generalization because the sample data includes various geographic areas. (Source: chis.ucla.edu)

Firstly, we will look at the prevalence of high blood pressure (hypertension) among each gender to find out if gender is associated with having high blood pressure. The number of prevalence will include all of California citizens, who are adults ages 18 and over. Hypertension, in this study report, refers to

Section 2: Analysis The selected data source is the California Health Interview Survey (CHIS), a high quality source which provides information on the health status as well as health care services of California citizens. CHIS compiles their information through various techniques, including telephone survey on adults, adolescents, and children. (Source: dmh.ca.gov)

those with a blood pressure of 140/90 or higher. (Source: nlm.nih.gov) In the survey, the question is defined as ever diagnosed with high blood pressure, and answer options include, has/had high blood pressure, or doesnt have/never had high blood pressure.

Then, we will look at four different race/ethnicity groups, which is defined in the survey as White (non-Latino), African American (non-Latino), Hispanic, and Asian (non-Latino),

This website is a supported by policymakers, researchers, health experts, etc. to aid in their functioning. CHIS website is credible since it is lead by a highly ranked university, UCLA, at the Center for Health Policy Research. In addition, it is a reliable source because it is used by random telephone surveys on a vast population (50,000+ people). Also, its timeliness CHIS updates their website every two years. AskCHIS allows for narrowing down 3

to find out which ethnic group has the highest probability of getting high blood pressure/hypertension.

Thirdly, we will examine all adults ages 18 and over in specific age ranges, to determine the differences in prevalence among certain age groups. This survey groups the ages in 9 categorical levels, which includes ages 0-4, 5-

11, 12-14, 15-17, 18-24, 25-39, 40-64, 65-79, and 80+; however, only information about

adults ages 18 and over is included in the data analysis.

Section 3: Findings and Implications

Source: 2009 California Health Interview Survey Ever Diagnosed with HBP Male 95% CI Lower 95% CI Higher Female 95% CI Lower 95% CI Higher

Has/had high BP 26.6% Doesnt have/ never had high BP 73.4% 71.9 74.8 74.2% 73.1 75.3 25.2 28.1 25.8% 24.7 26.9

*Restrictions: California Health Interview Survey (CHIS) in 2009 data. Adults ages 18 and over. California Residents. When comparing the number of doesnt have or never had high blood pressure, females show a slightly greater percentage at 74.2% with a confidence interval of 73.1-75.3; as for males who have a slightly lower percentage at 73.4%, have a confidence interval of 71.9-74.8. The difference of doesnt have or never had high blood pressure between male and female is not significantly different because the confidence intervals overlap with males having a confidence interval of 71.9-74.8 and females having a confidence interval of 73.1-75.3. Overall, the difference in percent of doesnt have or never had high blood pressure 4

Based on the information given from CHIS, males have a slightly higher percentage of being diagnosed with high blood pressure (26.5%), compared to women being diagnosed with high blood pressure (25.8%). The difference between males and female however, is not significantly different because the confidence intervals overlap with males having a confidence interval of 25.2-28.1 and females having a confidence interval of 24.7-26.9. Overall, the difference in percent for those diagnosed with high blood pressure and has or had high blood pressure between male (26.6%) and female (25.8%) is 0.8.

between males (73.4%) and females (74.2%) is 0.8%.

confidence interval of 71.9-74.8, the difference is significant because the confidence intervals do not overlap. This means there is a

When comparing the number of males being diagnosed with having or had high blood pressure at 26% with confidence interval of 25.2-28.1, with males who doesnt or never had high blood pressure at 73.4% with and males who dont or never had high blood pressure. Overall, the difference in percent of males having or had high blood pressure compared to males who never or doesnt have high blood pressure is 46.8%.

drastically unbalanced number of males being diagnosed with having/had high blood pressure difference between men having or had high blood pressure is not statistically significant when compared to women. of 74.2% and confidence interval of 73.41-75.3, the difference is significantly different because the confidence interval does not overlap. This means that there is a drastically unbalanced number of females being diagnosed with having/had high blood pressure and females

In addition, when comparing the number of female who has/had high blood pressure with percentage of 25.8% with confidence interval of 24.7-26.9, with females who doesnt or never had high blood pressure with percentage

who does not or never had high blood pressure. Overall, there difference in percent of females having or had high blood pressure compared to females who does not or never had high blood pressure is 48.4%.

Ethnicity and Hypertension Percent of Hypertension in Californians by Ethnicity SES Race Group Latino White African American Asian 2009 Percent 24.0 27.4 36.4 22.4 95% CI Lower 22.1 26.4 31.9 19.4 95% CI Upper 25.9 28.4 40.9 25.4

*Restrictions: Data collected from the California Health Interview Survey (CHIS) website. The data was collected in 2009. 5

From what we noticed on our graph, there is a significant difference compared to Asians and Whites. When comparing to Whites, Asians have a lower percentage of high blood pressure at 22.4 and a 95 percent confidence interval of (19.4-25.4). There is a significant difference between whites and Latinos. When comparing to Whites, Latinos have a lower

percentage of high blood pressure at 24.0 and a 95 percent confidence interval of (22.7-25.9). There is a significant difference between Whites and African Americans. When comparing to Whites, African Americans have a higher percentage of hypertension at 36.4 and a 95 percent confidence interval of 31.9 and 40.9.

Age and Hypertension Ever Diagnosed with HBP Compared to Age - Adults 2009 95% CI Men % Women % 95% CI 5.6-12.2 8.9 6.1 3.1-9.1 9.8-15.3 25-39 40-64 65-79 80+ 12.5 32.2 56.8 58.5 29.9-34.6 53.6-60.0 54.7-62.40 10.4 28.4 59.8 65.0 8.5-12.3 26.7-30.0 57.6-62.1 61.8-68.2

Age 18-24

*Restrictions: Data collected from the California Health Interview Survey (CHIS) website. The data collected 2009. Based on the information given from CHIS, out confidence interval of 29.9-34.6 to males in the of all the age groups, ages 18-24 has the lowest percentage of high blood pressure for both genders. When comparing male ages 1824 with high blood pressure at 8.9% with confidence interval of 5.6-12.2, to male ages 25-39 at 12.5% with confidence interval of 9.815.3, the groups show no significant difference because the confidence intervals overlap. When comparing males in the age group 40-64 with high blood pressure at 32.2% with a 6 age group 65-79 at 56.8% with a confidence interval of 53.6-60.0, the groups show a significant difference because the confidence interval do not overlap. When comparing males in the age group of 80+ with high blood pressure at 58.5% with confidence interval of 54.7-62.40 to males in the age group of 65-79 at 56.8% with a confidence interval of 53.660.0, the groups show no significant difference because the confidence interval overlaps.

From this data we can conclude that women have a higher percentage of high blood pressure than the men do for ages 65-79 and 80+. According to the CDC, Women are about as likely as men to develop high blood pressure during their lifetime. However, for people under 45 years old, the condition affects more woman than men (Source CDC.gov). This statement supports the data that we obtained from CHISS from the CDCs data.

(Source: www.heart.org) Also, the Journal of Advance Nursing states that African American men have the highest blood pressure of all race groups in the United States.(Source: http://onlinelibrary.wiley.com)

Besides the fact that accurate estimates are difficult to obtain due to various scenarios, the data given from CHIS has its limitations in that there is no relation to population size. Although we have found a good number of samples, it is not enough to determine an accurate

Section 4: Conclusion For the first analysis question, the data from CHIS shows that the difference in percentage of diagnosed with high blood pressure between male and female is not statistically different. However, we found a journal which demonstrates that men (in general) have a higher prevalence of hypertension compared to women; however, as menopause occurs in women, the trend is reversed. (Source: aha.org) Therefore, we can see the limitation on the data; since the data only includes information gathered in 2009, we cannot make a conclusion about the general population.

proportion. In addition, there is no information on the health events which occur around the study population. Also, no information on how long ago they were diagnosed with high blood pressure/hypertension, nor if there is secondary high blood pressure status.

We concluded that the ethnic group who has the highest probability of getting hypertension is African Americans. According to the American Heart Association, not only is high blood pressure more severe in blacks than whites, but it also develops earlier in life. 7

References California Health Interview Survey. (2009). Retrieved May 1, 2012, from http://www.chis.ucla.edu/ Understand Your Risk for High Blood Pressure (2012, February 10). Retrieved from http://www.heart.org/HEARTORG/Conditions/H ighBloodPressure/UnderstandYourRiskforHigh BloodPressure/Understand-Your-Risk-for-HighBlood-Pressure_UCM_002052_Article.jsp Cox, D. California Departmet of Health Services, Center for Health Statistics (2004). Hypertension deaths in california. Retrieved from website: http://www.cdph.ca.gov/pubsforms/Pubs/OHIR hypertensionDeaths2004.pdf Reynen DJ, Kamigaki AS, Pheatt N, Chaput LA. The Burden of Cardiovascular Disease in California: A Report of the California Heart Disease and Stroke Prevention Program. Sacramento, CA: California Department of Public Health ( 2007). Retrieved from website: http://www.cdph.ca.gov/programs/cvd/Docume nts/CHDSP-BurdenReport-HighRes.pdf