Associated factors and educational and economic inequalities with raised blood pressure in Cambodia: analysis of the data from a national household survey

TL;DR

This study finds that high blood pressure in Cambodia is linked to aging, obesity, and lack of education, with significant inequalities based on education and economic status.

Contribution

The study quantifies educational and economic inequalities in raised blood pressure in Cambodia using national survey data and multilevel regression.

Findings

Raised blood pressure prevalence was 16.2% among Cambodian adults.

Educational inequality shows higher RBP in those without formal schooling.

Economic inequality shows higher RBP in poor urban and rural households.

Abstract

The prevalence of raised blood pressure (RBP) in Cambodia has nearly doubled over the past decade. This study aimed to examine the associated factors and quantify the magnitude of educational and economic inequalities in relation to the prevalence of RBP among Cambodian adults.

Data were obtained from the 2023 STEPwise approach to noncommunicable disease risk factor surveillance. The study included 3,186 adults aged 18–69 years. Multilevel logistic regression models were used to identify potential associated factors for RBP. The magnitude of educational and economic inequalities was assessed using the regression-based slope index of inequality (SII) and relative index of inequality (RII).

Overall, the prevalence of RBP was 16.2% (95% confidence interval [CI]: 14.5%–18.1%). The main associated factors for RBP were age 40–49 years (odds ratio [OR]: 4.97, 95% CI: 2.51–9.85), 50–59 years (OR:10.67, 95%CI: 5.52–20.62), and 60–69 years (OR:12.92, 95%CI: 6.55–25.48), overweight (OR:1.66, 95%CI:1.19–2.33), obesity (OR: 3.52, 95% CI: 2.38–5.21), and comorbid diabetes (OR: 2.53, 95% CI:1.81–3.54). Female sex (OR: 0.39, 95% CI: 0.25–0.63), current usage of smoking tobacco products (OR: 0.47, 95% CI: 0.27–0.83), adequate consumption of fruits and vegetables (OR: 0.63, 95%CI: 0.46–0.85), and underweight (OR:0.33, 95%CI:0.18–0.61) were associated with reduced risk of RBP. Substantial educational inequality was observed in relation to the prevalence of RBP, with RBP disproportionately affecting individuals without formal schooling at the national (SII: -18.9, 95% CI: -24.80 to -12.90, p < 0.001), rural-urban, and regional levels. Nationally, individuals with higher education levels were 67% less likely to have RBP than those without formal schooling (RII: 0.33, 95% CI: 0.17–0.66). Significant absolute economic inequalities in RBP prevalence, to the disadvantage of poor households, were also observed among urban residents (SII: -10.8, 95% CI: -20.10 to -1.50, p < 0.05) as well as those living in the plateau and mountain regions (SII: -13.8, 95% CI: -26.10 to -1.40, p < 0.05).

RBP remains a major public health challenge in Cambodia, with substantial educational and context-specific economic inequalities. Addressing these social determinants through equity-oriented, context-sensitive interventions is essential to reduce the burden of RBP and prevent cardiovascular diseases in the Cambodian population.

The online version contains supplementary material available at 10.1186/s12889-026-26522-1.

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