|Year : 2012 | Volume
| Issue : 1 | Page : 44-48
Study of socio-demographic factors affecting prevalence of hypertension among bank employees of Surat City
Mohmmedirfan H Momin1, Vikas K Desai2, Abhay B Kavishwar3
1 Assistant Professor, Department of Community Medicine, Govt. Medical College, Surat, Gujarat, India
2 Public Health Consultant, Ex-Additional Director Family Welfare Department, Sachivalaya, Gandhinagar and Ex-Professor and Head, Department of Community Medicine, Govt. Medical College, Surat, Gujarat, India
3 Associate Professor, Department of Community Medicine, Govt. Medical College, Surat, Gujarat, India
|Date of Web Publication||6-Jun-2012|
Mohmmedirfan H Momin
Assistant Professor, Department of Community Medicine, Govt. Medical College, Surat 395001, Gujarat
| Abstract|| |
Cardiovascular diseases including hypertension are increasing in developing countries especially among high-risk group people like bank employees. A cross-sectional study of 1493 bank employees of Surat city was conducted during August, 2004 to September, 2005 to study the prevalence of hypertension among bank employees and the effects of socio-demographic factors on prevalence of hypertension. Data were analyzed using epi 6 software. The χ -test was applied as a nonparametric test of statistical significance. Prevalence of hypertension was 30.4% and prehypertension was 34.5%. Out of 455 found as hypertensive, 258 (56.70%) were not having any symptoms at the time of examination. Prevalence was high among persons with age 50 years and above (48.5%); among male (32.5%) as compared to female (23.1%); among employees having small family size; among separated/divorcee person (40.0%). Prevalence of hypertension increased with seniority of the official position of bank employee with highest prevalence among managers (45.9%). Prevalence of hypertension was noted highest among the higher socioeconomic group; SEC I (35.0%) followed by class II (20.4%). Effects of different risk factors of hypertension were observed here. This study may help in identifying the common profile of hypertensive or persons at risk, which may further help in identifying the risk group and planning the group specific IEC interventions.
Keywords: Bank employees, Family, Hypertension, Social, White collar job
|How to cite this article:|
Momin MH, Desai VK, Kavishwar AB. Study of socio-demographic factors affecting prevalence of hypertension among bank employees of Surat City. Indian J Public Health 2012;56:44-8
|How to cite this URL:|
Momin MH, Desai VK, Kavishwar AB. Study of socio-demographic factors affecting prevalence of hypertension among bank employees of Surat City. Indian J Public Health [serial online] 2012 [cited 2013 Dec 8];56:44-8. Available from: http://www.ijph.in/text.asp?2012/56/1/44/96970
Hypertension is a modern day's epidemic and it is an increasingly important medical and public health issue. It has been observed that cardiovascular diseases (CVDs) are increasing in developing countries , and it has been estimated that CVD will be the major cause of morbidity and mortality in these countries by the year 2020.  Indian studies also revealed that the prevalence of hypertension has increased by 30 times among the urban population over a period of 55 years and about ten times among the rural population over a period of 36 years.  Management of hypertension requires life-long medication with some lifestyle modifications. The only way to curb the problem of hypertension is by its prevention. Decreased physical activities coupled with increased mental tension are important contributors of hypertension. They are commonly seen amongst employees of the profession where working is mostly sedentary. Bank employees fit in this picture and that is why the present cross-sectional study was carried out during August 2004 to September 2005 among 1493 bank employees of Surat city to study the prevalence of hypertension among bank employees and the effects of sociodemographic factors on the prevalence of hypertension among the employees.
Based on the reported recent prevalence rate of hypertension in the urban area  as 25%, using the formula N = 4PQ/L and taking 10% allowable error (L) a sample size of minimum 1200 bank employees was to be covered for the study.
Banks were selected by simple random sampling and then all of the employees of selected banks were studied. Banks from all sectors including government, private, and cooperative were covered. Out of 82 banks having total 1232 branches in Surat, eight banks were selected randomly having near about 123 branches. Among 1632 employees, 1493 (91.4%) could be examined at the time of survey. One hundred and twenty eight employees were on leave and nine employees refused to take part in the study as they had gone through medical checkup recently. Prior permission was sought from the regional offices. The survey had two principal components: the administration of a questionnaire and clinical examination. All the employees were provided with a 'Participant information sheet' which contained information regarding hypertension. Data was collected by visiting all the branches of banks. Informed consent was obtained verbally from all the participants after explaining the purpose of the study. A pre-tested semi-structured questionnaire was used, which collected information on demographic characteristics.
Blood pressure was measured using a standard auscultatory method with the help of a pneumatically operated mercurial type random-zero sphygmomanometer. The instruments were standardized and also checked for the absence of dust in the rubber tubes linking the inflation bulb with the mercury reservoir and no foreign matter in the space above the mercury column. The deflation valve was always tested for a good working order; and the cuff itself was also checked routinely for being in a good condition. Blood pressure was measured after the questionnaire was filled in i.e. nearly 5 min after the visit, by which time the emotional reaction of the subject had stabilized. Three casual readings were taken. Average of these readings was taken as the final reading. A mercury manometer was kept in the vertical position and was reading zero when no pressure applied to the cuff. The manometer was placed on a horizontal surface. Blood pressure was measured in the sitting position with the back supported and the arm was kept at the level of fourth interspace at sternum. Blood pressure was taken on the right arm.
A pressure cuff (size 12 × 12 cm  ) was snugly applied to the right arm, its lower border being 2-3 cm above the antecubital space. Systolic blood pressure was measured using a radial palpatory method, and the brachial pulse located in the antecubital fossa and placed a stethoscope over the artery. The cuff is then inflated rapidly to 20-30 mmHg above the pressure at which the radial pulse disappeared to palpation. The cuff was then gradually deflated at a constant rate of 2-3 mm of Hg per second. The mercury column is watched continuously and carefully. Systolic pressure is taken as the pressure at which the ear distinguished the first arterial sound (phase I). Near the diastolic blood pressure, the sound first becomes muffled (phase IV) and then disappears (phase V). Blood pressure was reported to the nearest 2 mm of height. The point of disappearance of sounds (phase V Korotkoff) is preferable to the point of muffling (phase IV) because direct arterial pressure measurement indicates that the phase of muffling is 5-10 mmHg higher than actual DBP.
Hypertension was defined on the basis of the Seventh report of Joint National Committee of Hypertension which provides a classification of blood pressure for adults aged 18 years or older.  They defined hypertension as person having systolic blood pressure (SBP) ≥140 mmHg or diastolic blood pressure (DBP) ≥100 mmHg. A new category designated as prehypertension (SBP 120-139 mmHg or DBP 80-89 mmHg) are at increased risk for progression to hypertension. Moreover, individuals with prehypertension, who also have diabetes or kidney disease, should be considered candidates for appropriate drug therapy if a trial of lifestyle modification fails to reduce their BP to 130/80 mmHg or less.  The χ -test was applied to test the association between different factors. Data were analyzed using window excel and epi 6.
Out of 1632 employees, 1493 (91.4%) could be studied as few of the employees were on casual leave. The majority of the employees were between the age group of 40-49 years (38.5%) and belonged to the Hindu religion (94.7%). There were 1177 males (78.8%) and 316 (21.2%) females. Among different categories of the employees, the highest proportion was clerks (35.8%). As per modified Prasad classification,  91.8% (1370) of the employees belonged to class I and II.
Overall prevalence of hypertension was found to be 30.5% (455/1493). Almost half of remaining 69.5% of employees (34.5%) were pre-hypertensives. Among 455 hypertensives, 258 (56.7%) were asymptomatic and rest 197 (43.3%) were aware about their hypertensive status. A number of employees on regular antihypertensive treatment was 9.3% of the total employees. Among 197 known hypertensives, 139 (70.5%) were on regular treatment and among them 71 (51.1%) were found to be normotensive during the survey indicating control of blood pressure with medication.
Significant higher prevalence of hypertension (P < 0.001) was observed with increasing age [Table 1]. Prevalence of hypertension increases 3.43-fold between 20-29 and 30-39 years age; 2.09 fold between 30-39 and 40-49 years age; and 1.27 fold between 40-49 and >50 years age (χ = 158.860, df = 3, P <0.001). Prevalence of hypertension was significantly higher among men (32.5%) as compared to women (23.1%) (P < 0.01). Chances of getting hypertension among men was twofold higher as compared to women (odds ratio = 2.01). Prevalence of hypertension was lower in female employees than male employees up to 49 years of age; thereafter crossing over occurred in ≥50 years of the age group where it was higher in female employees than male employees. In male employees, the prevalence of hypertension increased 2.75-fold between 20-29 and 30-39 years, 2-fold between 30-39 and 40-49 years, and 1.24-fold between 40-49 and >50 years age group. In female employees, the prevalence of hypertension increased 2.47-fold between 30-39 and 40-49 years, and 1.49-fold between 40-49 and >50 years age group [Table 1]. Prevalence was also significantly higher (35.5%) in nuclear family than joint family (25.8%) (χ =16.36, df =1, P < 0.01). Chances of getting hypertension among nuclear family was nearly about twofold higher as compared to of joint family (odds ratio = 1.93). Employees from small sized families showed significantly higher prevalence of hypertension (P < 0.05). Chances of getting hypertension among small-sized families was near about twofold higher as compared to large-sized families (odds ratio = 1.87). Prevalence of hypertension was noted highest among separated/divorcee/widow/widower (55.5%) followed by married (31.8%) and unmarried (12.4%). Chances of getting hypertension among married was nearly about 2.5-fold higher as compared to singles (odds ratio = 2.54). Prevalence of hypertension was noted highest among managers (45.9%), followed by officers (36.8%), cashiers (34.3%), clerks (27.7%), class-IV (23.1%) and apprentices (7.3%) (P < 0.01). Chances of getting hypertension among managers was threefold higher as compared to class VI (odds ratio = 3.06). Prevalence of hypertension was noted highest among the higher socioeconomic group; SEC I (35.0%) followed by class II (20.4%). Chances of getting hypertension among SEC I was nearly about threefold higher as compared to SEC III (odds ratio = 2.96) [Table 2].
|Table 2: Prevalence of hypertension by various socio demographic risk factors|
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Screening for hypertension among adults helps in identifying asymptomatic individuals and thereby minimizing damage to vital organs and reducing complications and mortality. Secondly, it can help in early detection of prehypertensive cases, so that nontherapeutic interventions can be started earlier whereby progression of hypertension can be slowed down.
The overall prevalence of hypertension among employees in the present study was 30.4%. Among remaining 69.6% employees, almost half of them were in prehypertensive stage (34.5%). It showed that almost two-third of the employees were either suffering from or at risk of hypertension. Among 455 hypertensive cases, only 197 (43.3%) were aware about their hypertensive status. This situation may be worst if the employees of the prehypertensive phase also be considered. In a study conducted by Zachariah et al. in Thiruvanthapuram city, Kerala, the awareness rate was 39%, and in another study conducted by Bharucha et al. among the Parsi community of Bombay, 47% male and 56% female were aware of their hypertensive status. This emphasized the need for screening of hypertensive among bank employees. Among 197 known hypertensive cases, 40 (20.3%) were not under any antihypertensive treatment. Among remaining 157 employees who were under treatment; the blood pressure of 68 (43.3%) employees continued to be in stage-I or stage-II hypertension. It showed that among total 455 hypertensive cases, only 89 (19%) were having controlled blood pressure.
In the present study, significant positive association was found between age and prevalence of hypertension. Desai et al reported an increase in the prevalence of hypertension with the increasing age. There was a higher proportion of female employees in the younger age group than male employees. When the age- and sex-specific prevalence of hypertension was compared, it was seen that in each age group, the prevalence of hypertension was higher among male as compared to female except in more than 50 years of age group, where it was higher in female. Prevalence of hypertension was significantly higher among nuclear type of family (35.5%) as compared to the Joint type of family (25.8). It was seen that the prevalence of hypertension was highest among single persons who were living their life without their partner like separated/divorced/widow/widower (55.5%). The prevalence of hypertension was noted highest among higher cadre officers like mangers and officers.
This study may help in identifying the common profile of hypertensive or persons at risk among bank employees, which may further help in identifying the risk group and planning the group-specific interventions like providing health education.
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[Table 1], [Table 2]