Factors associated with



Factors associated with elevated blood pressure or hypertension in Afro-Caribbean youth: a cross-sectional studyTrevor S Ferguson1*, Novie OM Younger-Coleman1, Marshall K Tulloch-Reid1, Nadia R. Bennett1, Amanda E. Rousseau1, Jennifer M Knight-Madden1, Maureen E Samms-Vaughan2, Deanna E Ashley3, Rainford J. Wilks1Supplementary TablesInstitutions: 1Caribbean Institute for Health Research, The University of the West Indies, Mona, Kingston, Jamaica2Department of Child Health, The University of the West Indies, Mona, Kingston, Jamaica3School of Graduate Studies and Research, The University of the West Indies, Mona, Kingston, Jamaica *Submitting Author/Author for correspondence:Dr. Trevor FergusonEpidemiology Research Unit, Caribbean Institute for Health Research, University of the West Indies, Mona, Kingston 7, Jamaica.Telephone: (876) 927 2471Fax: (876) 927 2984Email: trevor.ferguson02@uwimona.edu.jm, trevor.ferguson02@ Table S1: Distribution of Individual Household Possession ItemsItemNumber with item%Television set88198.2Cable television / Satellite TV61668.8Gas / Electric Stove 88098.1Refrigerator85094.8Freezer 29232.7Living room set68776.6Stereo equipment73081.5Washing machine50656.47Cars or other vehicles40645.5Telephone 81791.3Video Cassette Recorder 52358.5DVD / CD player74382.8Computer41646.3Internet 24227.1Radio / Cassette Player 81691.0Microwave oven62870.0Air-conditioning 677.5Table S2: Odds ratio for elevated blood pressure or hypertension from logistic regression models assessing sex interaction for risk factors potentially associated with elevated blood pressure Males n = 409Females n = 489P-value for sex interactionVariableOdds Ratio95% CIOdds Ratio95% CIBMI CategoryNormal weight (18.5 -24.9 kg/m2) 1.0-1.0--Underweight (<18.5 kg/m2)0.530.17 – 1.58 1.310.61 – 2.840.179Overweight (25-29.9 kg/m2)1.540.83 – 2.851.580.82 – 3.060.948Obese (≥30kg/m2)7.82.98 – 20.51.960.89 – 4.310.030Central Obesity16.572.48 – 17.41.520.86 – 2.670.011High Glucose (upper quintile)2.131.34 – 3.371.180.48 – 2.950.263High triglycerides (upper quintile)1.801.08 – 2.981.951.09 – 3.480.839HOMA-IR (log transformed, upper quintile)3.481.78 – 6.751.680.92 – 3.080.115Occupation of Household HeadProfessionals/Managers1.0-1.0--Office, Service, or Trade Workers0.760.44 – 1.301.370.66 – 2.840.201Semi-Skilled/Unskilled 0.920.50 – 1.692.150.99 – 4.710.093No. of Household PossessionHigh (15-17 items)1.0-1.0--Moderate (10-14 items)0.580.33 – 1.024.321.30 – 14.40.003Low (0-9 items)0.800.43 – 1.512.740.78 – 9.650.088Alcohol ConsumptionNever Drank Alcohol1.0-1.0--Rarely Drinks Alcohol1.010.38 – 2.650.600.29 – 1.230.392Drinks 1-2 times/week1.340.52 – 3.460.580.25 – 1.320.190Drinks ≥3 times/week 1.160.45 – 2.940.460.19 – 1.120.1641Central obesity defined as waist circumference ≥ 94 cm in males and ≥80 cm in femalesEstimates derived from separate models for each risk factor with test for interaction between sex and the given risk factor. Table S3: Number of missing values and number of observations for variables used in the analysis.Variables MalesFemalesNumber MissingNumber of ObservationsNumber Missing valuesNumber of ObservationsWaist circumference04091488Waist to hip Ratio04091488White blood cell count1239717472Fasting Glucose1739216473Total cholesterol1939013476HDL Cholesterol2838122467LDL cholesterol3237723466Triglycerides1939013476Creatinine2138824465Urine albumin1739221468High sensitivity CRP4136866423Glomerular filtration rate2138825464Fasting Insulin5735258431Family History of HTN8632383406Chronic Kidney Disease2938035454Albuminuria1739221468Parental Education6934050439Parental Occupation3437527462Household Possessions14080489Physical Activity Level14080489Current Smoking14080489Current Marijuana use34061488Alcohol use44054485Table S4: Summary values for observed and imputed data used in the analysesCharacteristicObservedImputedN1Mean / Percentage2N1Mean / Percentage2White blood cell count (cells X 109/L)8695.87 (1.87)295.97 (1.92)Creatinine (mmol/L)85367.7 (24.7)4566.5 (24.8)Elevated waist circumference3 89715.6%120.0%High glucose (upper quintile)86517.6%3315.6%High cholesterol (≥5.2 mmol/l) 87714.4%2112.0%Low HDL484846.1%5040.0%High triglycerides (upper quintile)86620.6%3218.9%High HOMA-IR5 (upper quintile)75019.5%14820.5%Albuminuria68606.9%389.1%High hsCRP7 (>3 mg/L)79114.4%10721.4%Family history of hypertension72921.4%16945.1%Current Cigarette Smoking8979.6%128.0%Current Marijuana Smoking89418.1%445.0%Highest Education of Parent/Guardian779119Post-Secondary28.2%19.2%Secondary58.2%59.2%Less than Secondary13.6%21.6%Occupation of Household Head83761Professionals/Managers24.1%21.6%Office, Service or Trade Workers50.2%52.5%Semi-Skilled/Unskilled Workers25.7%25.9%Number of Household Possession8971High (15-17 items)15.28.0Moderate (10-14 items)55.452.0Low (0-9 items)29.440.0Physical Activity Level8971High24.252.0Moderate41.732.0Low34.116.0Alcohol Consumption8908Never Drank Alcohol10.111.5Rarely Drinks Alcohol36.633.0Drinks Alcohol 1-2 times/week25.420.0Drinks Alcohol ≥3 times/week 29.935.5 1N represents number of observed values and number of imputed values for each of 25 imputed datasets2Summary statistics are mean and standard deviations for continuous variables (white blood cell count and creatinine and percentage with characteristic for categorical variables. Values for imputed data represent the pooled values over 25 imputations3Elevated waist circumference defined as ≥94 cm for males and ≥80 cm for females 4HDL = High density lipoprotein cholesterol; defined as <1.0 mmol/l for males and <1.3 mmol/l for females 5HOMA-IR = Homeostasis model assessment insulin resistance6Albuminuria = albumin to creatinine ratio ≥30 mg/g7hsCRP = high sensitivity C-reactive proteinTable S5: Complete Case Analysis: Factors Associated with Elevated Blood Pressure or hypertension (BP ≥120/80) in Multivariable Logistic Regression Models among Male and Female Young Adults in the Jamaica 1986 Birth Cohort Males (n=306)Females (n=409)VariableOdds Ratio95% CIP-ValueOdds Ratio95% CIP-ValueAge (years)1.691.05 - 2.710.0302.671.62 – 4.40<0.001Height (cm)---1.081.03 - 1.130.003BMI CategoryNormal weight (18.5 -24.9 kg/m2) 1.0--1.0--Underweight (<18.5 kg/m2)0.470.13 – 1.710.2502.000.84 – 4.730.117Overweight (25-29.9 kg/m2)1.610.76 – 3.410.2141.430.65 – 3.160.371Obese (≥30kg/m2)9.582.26 – 40.50.0021.650.62 – 4.410.3.17High Glucose (upper quintile)1.941.08 – 3.480.027---High Triglycerides (upper quintile)---1.820.88– 3.730.104HOMA-IR (log transformed, upper quintile)2.080.91 – 4.780.0831.950.96 – 3.930.063High hsCRP0.310.10 – 0.930.037---White blood cell count--1.100.95 – 1.290.209Household possessionsHigh (15-17 items)1.0--1.0--Moderate (10-14 items)0.630.30 – 1.340.2323.641.01 – 13.10.047Low (0-9 items)1.320.58 – 3.020.5092.310.61 – 8.830.220Physical Activity LevelHigh Physical Activity Level1.0--1.0--Moderate Physical Activity Level 0.500.28 – 0.910.0260.880.35 – 2.260.798Low Physical Activity Level0.440.20 – 0.960.0400.500.19 – 1.310.159Alcohol ConsumptionNever Drank Alcohol---1.0--Rarely Drinks Alcohol (<once/week)---0.470.19 – 1.130.091Drinks Alcohol 1-2 times/week---0.500.18– 1.360.174Drinks Alcohol ≥3 times/week --0.430.15 – 1.220.113BMI = Body mass Index; HOMA-IR = Homeostasis Model Assessment Insulin Resistance; hsCRP = high sensitivity C-reactive protein.Separate models created for males and females. Models for males included age, BMI category, high glucose, high HOMA-IR, High hsCRP, possession category and physical activity levels. Models for females included age, height BMI category, high triglycerides, high HOMA-IR, possession category. physical activity levels and alcohol consumption categories. Table S6: Summary statistics for participant characteristics and factors putatively associated with hypertension for males and females stratified by blood pressure categoryCharacteristicMalesFemalesNormal BPMean ± SDn = 287EBP/HTNMean ± SDn = 122P-valueNormal BPMean ± SDn =423EBP/HTNMean ± SDn = 66P-valueAge (years)18.8 ± 0.6018.9 ± 0.560.02918.7 ± 0.6219.0 ± 0.59<0.001Weight (kg)68.5 ± 10.877.2 ± 18.8<0.00161.8 ± 15.165.9 ± 17.80.079Height (cm)176.6 ± 6.2177.3 ± 7.00.330163.3 ± 6.0165.4 ± 6.40.012Body mass index (kg/m2)22.0 ± 3.124.5 ± 5.9<0.00123.2 ± 5.524.0 ± 6.20.295Systolic BP (mmHg)109.0 ± 6.9125.2 ± 8.3<0.001105.5 ± 7.3119.0 ± 8.8<0.001Diastolic BP (mmHg)66.6 ± 8.675.5 ± 11.5<0.00165.3 ± 8.077.5 ± 9.4<0.001Waist circumference (cm)73.2 ± 6.979.8 ± 15.9<0.00173.4 ± 11.776.6 ± 14.00.085Hip circumference (cm) 92.8 ± 6.998.0 ± 11.7<0.00196.0 ± 10.898.8 ± 12.00.078Waist-to-Hip ratio 0.79 ± 0.040.81 ± 0.130.0310.77 ± 0.150.77 ± 0.060.659White blood cells (cells X 109/L)5.3 ± 1.65.3 ± 1.40.8486.3 ± 2.06.8 ± 1.90.079Glucose (mmol/L)4.7 ± 0.54.9 ± 0.70.0054.4 ± 0.44.5 ± 0.40.102Total cholesterol (mmol/L)4.1 ± 0.84.3 ± 0.80.0014.5 ± 0.94.6 ± 1.10.312HDL cholesterol (mmol/L)1.1 ± 0.21.1 ± 0.20.8071.3 ± 0.31.2 ± 0.30.438LDL cholesterol (mmol/L)2.7 ± 0.72.9 ± 0.70.0033.0 ± 0.83.1 ± 1.00.410Triglycerides (mmol/L)0.58 ± 0.230.66 ± 0.330.0140.55 ± 0.240.65 ± 0.330.028Creatinine (mol/L)81.0 ± 15.979.3 ± 16.40.34356.8 ± 27.157.3 ± 12.30.805Median (p25, p75)Median (p25, p75)Urinary albumin (mg/g)4 (3, 7)4 (3, 8)0.8385 (3, 11)4.9 (3, 10)0.923hsCRP (mg/L) 0.5 (0.3, 1.3)0.5 (0.3, 1.3)0.6750.9 (0.3, 2.2)1.3 (0.5, 2.9)0.061Fasting Insulin (pmol/L)4.0 (2.5, 6.3)5.9 (3.3, 8.6)0.0016.8 (4.2, 10)6.8 (3.4, 12.2)0.847HOMA-IR0.5 (0.3, 0.8)0.7 (0.4, 1.1)0.0050.9 (0.5, 1.2)0.9 (0.5, 1.5)0.914EBP/HTN = elevated blood pressure or hypertension; HDL = high density lipoprotein; LDL = low density lipoprotein; eGFR = estimated glomerular filtration rate. IQR = interquartile range There were missing values for some participants (maximum n= 66 for hsCRP among women. Full list of number of missing values for each variable is shown in Table S4 HDL = high density lipoprotein; LDL = low density lipoprotein; hsCRP = high sensitivity C-reactive protein.Table S7: Proportion of participants with CVD risk factors by blood pressure category for males and females stratified by blood pressure categoryCharacteristicMalesFemalesNormal BP% (n)n = 287EBP/HTN% (n)n = 122P-valueNormal BP% (n)n =423EBP/HTN% (n)n = 66P-valueBody Mass Index categoriesUnderweight (<18.5 kg/m2)7.3 (21)3.3 (4)<0.00114.2 (61)15.2 (10)0.294Normal weight (18.5 -24.9 kg/m2)78.8 (226)67.2 (82)56.7 (240)45.5 (30)Overweight (25-29.9 kg/m2)11.8 (34)15.6 (19)19.2 (81)24.2 (16Obese (≥30kg/m2)2.1 (6)13.9 (17)9.7 (41)15.2 (10)Central obesity1 2.1 (6)12.3 (15)<0.00123.2 (98)31.8 (21)0.130High waist-to-hip ratio20 (0)3.3 (4)0.00819.9 (84)22.7 (15)0.596Albuminuria4.8 (13)5.9 (7)0.6438.2 (33)9.2 (6)0.778Highest Education of Parent/Guardian3Post-Secondary25.4 (62)28.1 (27)0.78130.7 (117)24.1 (14)0.591Secondary61.9 (151)61.5 (59)54.6 (208)60.3 (35)Less than Secondary12.7 (31)10.4 (10)14.7 (56)15.5 (9)Occupation of Household HeadProfessionals/Managers22.3 (58)26.1 (30)0.55125.8 (104)17.7 (11)0.130Office, Service or Trade Workers51.2 (133)45.2 (52)51.3 (205)48.4 (30)Semi-Skilled/Unskilled Workers26.5 (69)28.7 (33)23.0 (92)33.9 (21)Number of Household PossessionHigh (15-17 items)15.0 (43)21.5 (26)0.12215.0 (64)4.6 (3)0.019Moderate (10-14 items)59.9 (172)49.6 (60)52.0 (220)68.2 (45)Low (0-9 items)25.1 (72)28.9 (35)32.9 (139)27.3 918)Physical Activity LevelHigh35.9 (103)41.3 (50)0.52012.5 (53)16.7 (11)0.449Moderate45.0 (129)43.0 (52)39.0 (165)42.4 (28)Low19.2 (55)15.7 (19)48.5 (205)40.9 (27)Current Cigarette Smoking13.6 (39)14.1 (17)0.9026.2 (26)6.1 (4)0.978Current Marijuana Smoking31.2 (89)31.4 (38)0.9727.3 (31)6.2 (4)0.733Alcohol ConsumptionNever Drank Alcohol6.7 (19)5.8 (7)0.78512.2 (51)19.7 (13)0.360Rarely Drinks Alcohol27.5 (78)24.0 (29)45.4 (190)43.9 (29)Drinks Alcohol 1-2 times/week27.8 (79)32.2 (39)22.4 (94)21.2 (14)Drinks Alcohol ≥3 times/week 38.0 (108)38.0 (46)20.1 (84)15.2 (10)EBP/HTN = elevated blood pressure or hypertension;1Central obesity defined as waist circumference ≥ 94 cm in males and ≥80 cm in females2High waist-to-hip ratio ≥0.95 for males and ≥0.80 for females3Education category “post-secondary” includes persons with vocational training, college, or university education; secondary corresponds to high school (up to grade 11); less than secondary corresponds to persons who had only elementary school education or persons who did not complete high school (i.e. high school grade 10 or below)Table S8A: Regression Coefficients for variables in Multivariable ANOVA Models of Systolic Blood Pressure among Male and Female Young Adults in the Jamaica 1986 Birth Cohort Males (n=409)Females (n=489)Variableβ coefficient95% CIP-Valueβ coefficient95% CIP-ValueAge (years)1.960.30, 3.620.0211.990.75, 3.240.002Height (cm)---0.140.02, 0.260.026BMI CategoryNormal weight (18.5 -24.9 kg/m2) 0---Underweight (<18.5 kg/m2)-1.28-5.28, 2.710.529-1.11-3.33, 1.110.326Overweight (25-29.9 kg/m2)4.031.14, 6.910.0060.86-1.14, 2.870.398Obese (≥30kg/m2)9.765.01, 14.5<0.0015.192.48, 7.91<0.001High Glucose (upper quintile)4.812.61, 7.00<0.0012.32-0.54, 5.180.112High Cholesterol (≥5.2 mmol/l)1.57-0.37, 3.500.113White blood cell count---0.31-0.08, 0.700.122High hsCRP-2.20-5.70, 1.300.218---HOMA-IR (log transformed, upper quintile)2.68-0.81, 6.180.1311.66-0.38, 3.710.110Physical Activity LevelHigh----Moderate-0.41-2.59, 1.770.713---Low-2.41-2.56, 4.030.088---Parental OccupationProfessionals/Managers--Office, Service or Trade 0.37-2.05, 2.800.7611.11-0.79, 3.010.250Semi-Skilled/Unskilled 2.50-0.23, 5.240. 0732.260.04, 4.490.046Alcohol ConsumptionNever Drank Alcohol--Rarely Drinks Alcohol----2.41-4.78, -0.050.045Drinks Alcohol 1-2 times/week----1.89-4.53, 0.740.158Drinks Alcohol ≥3 times/week ----2.58-5.29, 0.120.061Current Cigarette Smoking3.000.24, 5.760.033---Separate multiple imputation models created for males and females. Each sex-specific model included variables as shown in the table. Table S8B: Regression Coefficients for variables in Multivariable ANOVA Models of Diastolic Blood Pressure among Male and Female Young Adults in the Jamaica 1986 Birth Cohort Males (n=409)Females (n=489)Variableβ coefficient95% CIP-Valueβ coefficient95% CIP-ValueAge (years)4.943.28, 6.60<0.0013.081.81, 4.37<0.001Height (cm)---0.160.03, 0.290.015BMI CategoryNormal weight (18.5 -24.9 kg/m2) --Underweight (<18.5 kg/m2)0.94-1.38, 3.270.426Overweight (25-29.9 kg/m2)1.88-0.19, 3.940.075Obese (≥30kg/m2)2.11-0.56, 4.790.122High Glucose (upper quintile)2.20-0.02, 4.430.052---High Triglycerides (upper quintile)---2.01-4.01, -0.020.048High HOMA-IR (log transformed, upper quintile)2.44-0.78, 5.660.137---Low HDL2.24-0.03, 4.520.054---Family history of hypertension1.89-0.23, 4.000.080---White blood cell count----0.28-0.70, 0.130.177Household possessionsHigh (15-17 items)--Moderate (10-14 items)0.87-1.83, 3.580.528---Low (0-9 items)2.70-0.37, 5.770.085---Physical Activity LevelHigh--Moderate-0.89-3.04, 1.260.416-1.32-3.85, 1.210.306Low-2.29-5.05, 0.470.1042.56-5.05, -0.060.044Alcohol ConsumptionNever Drank Alcohol--Rarely Drinks Alcohol5.110.92, 9.300.017-3.42-5.90, -0.950.007Drinks Alcohol 1-2 times/week5.921.76, 10.10.005-1.24-4.00, 1.510.377Drinks Alcohol ≥3 times/week 6.492.32, 10.70.002-4.35-7.18, -1.530.003Currently smokes marijuana-3.31-5.59, -1.030.004---Separate multiple imputation models created for males and females. Each sex-specific model included variables as shown in the table.Table S9: Factors Associated with hypertension (BP ≥130/80) in Multivariable Logistic Regression Models among Male and Female Young Adults in the Jamaica 1986 Birth Cohort Males (n=409)Females (n=489)VariableOdds Ratio95% CIP-ValueOdds Ratio95% CIP-ValueAge (years)2.411.47- 3.970.0012.571.48 – 4.470.001Height (cm)---1.061.00 - 1.120.035Central obesity2.560.85 – 7.710.095---High Glucose (upper quintile)2.301.26 – 4.180.007---High Triglycerides (upper quintile)---2.561.23 – 5.310.012HOMA-IR (log transformed, upper quintile)2.100.88 – 5.010.094---Household possessionsHigh (15-17 items)1.0--1.0--Moderate (10-14 items)0.580.28 – 1.200.1437.040.93 – 53.40.059Low (0-9 items)0.780.34 – 1.810.5663.520.43 – 28.70.240Physical Activity LevelHigh Physical Activity Level1.0-----Moderate Physical Activity Level 0.630.34– 1.170.144---Low Physical Activity Level0.350.14 – 0.890.027---BMI = Body mass Index; HOMA-IR = Homeostasis Model Assessment Insulin Resistance; hsCRP = high sensitivity C-reactive protein.Separate multiple imputation models created for males and females. Models for males included age, BMI category, high glucose, high HOMA-IR, High hsCRP, possession category and physical activity levels. Models for females included age, height BMI category, high triglycerides, high HOMA-IR, possession category. physical activity levels and alcohol consumption categories. ................
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