Gender with marital status, cultural differences, and vulnerability to hypertension: Findings from the national survey for noncommunicable disease risk factors and mental health using WHO STEPS in Bhutan

PLoS One. 2021 Aug 31;16(8):e0256811. doi: 10.1371/journal.pone.0256811. eCollection 2021.

Abstract

Cardiovascular disease is the leading cause of death in the Kingdom of Bhutan. Thus, the early detection and prevention of hypertension is critical for reducing cardiovascular disease. However, the influence of sociocultural factors on vulnerability to hypertension needs further investigation. This study performed secondary data analysis on 1,909 individuals in a cross-sectional study (the National survey for noncommunicable disease risk factors and mental health using World Health Organization (WHO) STEPS approach in Bhutan- 2014). Multivariate logistic regression demonstrated a significant association between gender with marital status and hypertension. Women had a higher odds ratio than men (Ref) when married (AOR: 1.27, 95% confidence intervals (CI): 1.23-1.31), and when separated, divorced, or widowed (AOR: 1.18, 95% CI: 1.12-1.26). People who speak the Tshanglakha language scored the highest odds (AOR: 1.24, 95% CI: 1.20-1.27), followed by Lhotshamkha (AOR: 1.09, 95% CI: 1.06-1.12) and Dzongkha (Ref) after adjusting for various social and biomedical factors. Additionally, tobacco use displayed decreased odds for hypertension. To promote the early detection and prevention of hypertension, these cultural factors should be considered even within small geographic areas, such as Bhutan. It is necessary to strengthen hypertension preventive strategies for people who speak Tshanglakha and Lhotshamkha. Furthermore, careful consideration should be given to preventing hypertension among adults aged 40 years or more, women who are married, separated, divorced, or widowed, and men who never married in Bhutan.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Bhutan / epidemiology
  • Cross-Sectional Studies
  • Culture*
  • Divorce / statistics & numerical data
  • Health Surveys
  • Humans
  • Hypertension / epidemiology
  • Hypertension / ethnology
  • Hypertension / etiology*
  • Male
  • Marital Status* / statistics & numerical data
  • Middle Aged
  • Risk Factors
  • Sex Factors
  • Single Person / statistics & numerical data
  • Widowhood / statistics & numerical data
  • Young Adult

Grants and funding

This study was supported by 1) Hiromi Kohori-Segawa, K. MATSUSHITA FOUNDATION, Grant Numbers 19-048 http://matsushita-konosuke-zaidan.or.jp/en/ 2) Yuichi Imanaka, Program of Collaborative Research at the Centre for Southeast Asian Studies (IPCR-CSEAS), Kyoto University 2018 type4 https://ipcr.cseas.kyoto-u.ac.jp/ 3) Hiromi Kohori-Segawa, Program of Collaborative Research at the Centre for Southeast Asian Studies (IPCR-CSEAS), Kyoto University 2020 type7 https://ipcr.cseas.kyoto-u.ac.jp/ 4) Yuichi Imanaka, JSPS KAKENHI Grant Numbers JP19H01075 from the Japan Society for the Promotion of Science https://www.jsps.go.jp/english/ The funders played no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.