Abstract
Hypertension is a common and costly public health burden in China, while the interaction effects of individual and contextual level factors on the risk of hypertension remain unclear. This study aimed to investigate whether the interaction effects between individual education and regional chemical fertilizer consumption are associated with the risk of hypertension based on a cross-level interaction perspective. Data was from the China Hypertension Survey (CHS) study, which used a nationally representative sample, and was conducted between 2012 and 2015. A total of 379 467 participants aged over 18 years from 221 counties in 31 provinces were included. A cross-sectional study design and two-level logistic models were conducted to investigate the cross-level interaction between individual education and regional chemical fertilizer consumption on the risk of hypertension after adjusting for potential confounding variables. Compared to individuals with high education (college or more), the adjusted OR (95%CI) for hypertension among those in the high school, middle school, and elementary school or less was 1.16 (1.12–1.21), 1.25 (1.20–1.30), and 1.49 (1.43–1.55), respectively. The association between regional chemical fertilizer consumption and hypertension was not significant. Interaction analysis showed that regional chemical fertilizer consumption was associated with an increased risk of hypertension for individuals with lower education. These patterns were consistent after stratified by sex. This study provided evidence from the Chinese population that interaction between individual education and regional chemical fertilizer was associated with risk of hypertension. Future research and policy aimed to improve population health and reduce hypertension could address the regional context of population as well as individual factors.
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Acknowledgements
We thank all the colleagues involving in the survey and gratefully acknowledge Suning Li and Linlin Jiang for help in maintaining the data. We are grateful to OMRON Corporation, Kyoto, Japan, for supporting the BP Monitor (HBP-1300) and body fat and weight measurement device (V-body HBF-371); Henan Huanan Medical Science & Technology Co., Ltd, China, for Digital ECG device (GY-5000); Microlife, Taibei, Taiwan, for automated ABI device (Watch BP Office device); Buchang Pharma, **an, China; Kinglian Technology, Guangzhou, China; Merck Serono; Pfizer China; and Essen Technology (Bei**g) Company Limited for their support to fund the project.
Funding
This work was supported by the Projects in the Chinese National Science & Technology Pillar Program during the Twelfth Five-Year Plan Period (No. 2011BAI11B01), the National Natural Science Foundation of China (No.41871360), the Chinese National Special Fund for Health Scientific Research in the Public Interest (No.201402002), and the CAMS Innovation Fund for Medical Sciences (grant 2017-I2M-1–004).
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Jiajia Li and Shiqi Lin, statistical analysis and visualization, literature search, and writing (original draft); Zengwu Wang, Linfeng Zhang, **n Wang, Zuo Chen, Congyi Zheng, Yuting Kang, Lu Chen, and Haoqi Zhou, data acquisition; Jiajia Li, Zengwu Wang, Lijun Pei, and Runlin Gao, conceptualization, funding acquisition, and writing (review and editing).
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Li, J., Wang, Z., Lin, S. et al. Cross-level interaction between individual education and regional chemical fertilizer consumption on the risk of hypertension: evidence from the China hypertension survey. Environ Sci Pollut Res 30, 6390–6400 (2023). https://doi.org/10.1007/s11356-022-22441-x
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DOI: https://doi.org/10.1007/s11356-022-22441-x