Sociodemographic variations of the temporal trends in treatment of hypertension and stroke mortality in the United States, 1962-1980.

摘要

This aggregate level study examines the association between temporal trends in pharmacologic control of hypertension and declines in stroke mortality among ninety-six race-sex-age-region-metropolitan specific groups in the United States during the years 1962-1980.;Pharmacologic control of hypertension is defined as the percent of hypertensives with controlled hypertension (DBP ;Directly age-adjusted annual stroke mortality rates were computed for each sociodemographic group using the 1970 population as the standard. The average annual percent change in stroke mortality was calculated with a piecewise log linear regression model for the time periods 1962-1972 and 1973-1980.;Results of population weighted linear regression models suggest that during the pre-1972 time period there was virtually no association between the trends in pharmacologic control of hypertension and the declines in stroke mortality among the ninety-six identified sociodemographic groups (beta = 0.04, p =.69), and that during the post-1972 years the groups with the largest increases in pharmacologic control of hypertension experienced slightly slower rates of decline in stroke mortality (beta = 0.16, p =.003). However, with the passage of time the distributions of both the change in pharmacologic control of hypertension and the declines in stroke mortality improved. Therefore a stronger association between the trends in pharmacologic control of hypertension and trends in stroke mortality is observed over the entire time period 1962-1980 (beta = ;Further evaluation of potential covariates and effect modifiers of the association within each time period suggests that various combinations of mass level conditions, including the treatment of hypertension and socioeconomic profile, may have facilitated the widespread declines in stroke mortality, and that the combinations of conditions may have varied by sociodemographic group and time period. From a public health perspective, these results suggest that although treatment of hypertension has contributed to the declines in stroke mortality most of the declines are due to factors other than treatment of hypertension. Further attention should be given towards understanding the role of secular trends in characteristics such as educational resources, dietary patterns, occupational opportunities, cigarette smoking and living conditions on the declining stroke mortality rates in the United States.