A Structural Equation Modeling Approach for the Impact of Socioeconomic Status on Blood Pressure among Older Adults in India and the Role of Mediators - Evidence from the Longitudinal Aging Study of India - Wave 1.

Background: Raised blood pressure (BP) is an important risk factor for cardiovascular diseases. Research has shown a negative gradient of BP with socioeconomic status (SES) in developed countries. However, studies in India reveal conflicting results.

Objectives: To examine the association between SES and BP among older adults in India and to explore the mediating mechanisms.

Methods: Structural Equation Modeling was employed to investigate the association of SES indicators (monthly per-capita expenditure and education) with systolic and diastolic BP using the cross-sectional data from Longitudinal Aging Study of India- Wave-1 (2017-2019). Separate models were fitted for rural men, rural women, urban men, and urban women to capture the residence- and gender-based variations. Mediating effects of bio-behavioral risk factors and antihypertensive medication use were explored.

Results: The sample size under analysis was 59,333. After adjusting for age, SES was positively associated with systolic and diastolic BP in both rural men and women. A clear pattern was not observed in urban men, while a negative association was observed in urban women. The hypothesized mediators exhibited a harmful mediating effect in all associations, with Body Mass Index being the strongest. There existed a significant protective effect of raising SES on BP in urban women which was not explained by the mediators.

Conclusion: In a country like India undergoing rapid socioeconomic changes, BP complexly interacts with SES, varying between residence and genders. This underscores the need for further exploration to inform effective public health interventions.