Spousal Concordance of Hypertension Among Middle-Aged and Older Heterosexual Couples Around the World: Evidence From Studies of Aging in the United States, England, China, and India

Abstract

Background: Health concordance within couples presents a promising opportunity to design interventions for disease management, including hypertension. We compared the concordance of prevalent hypertension within middle-aged and older heterosexual couples in the United States, England, China, and India.

Methods and results: Cross-sectional dyadic data on heterosexual couples were used from contemporaneous waves of the HRS (US Health and Retirement Study, 2016/17, n=3989 couples), ELSA (English Longitudinal Study on Aging, 2016/17, n=1086), CHARLS (China Health and Retirement Longitudinal Study, 2015/16, n=6514), and LASI (Longitudinal Aging Study in India, 2017/19, n=22 389). Concordant hypertension was defined as both husband and wife in a couple having hypertension. The prevalence of concordant hypertension within couples was 37.9% (95% CI, 35.8-40.0) in the United States, 47.1% (95% CI, 43.2-50.9) in England, 20.8% (95% CI, 19.6-21.9) in China, and 19.8% (95% CI, 19.0-20.5) in India. Compared with wives married to husbands without hypertension, wives married to husbands with hypertension were more likely to have hypertension in the United States (prevalence ratio, 1.09 [95% CI, 1.01- 1.17), England (prevalence ratio, 1.09, 95% CI, 0.98-1.21), China (prevalence ratio, 1.26 [95% CI, 1.17-1.35), and India (prevalence ratio, 1.19 [95% CI, 1.15-1.24]). Within each country, similar associations were observed for husbands. Across countries, associations in the United States and England were similar, whereas they were slightly larger in China and India.

Conclusions: Concordance of hypertension within heterosexual couples was consistently observed across these 4 socially and economically diverse countries. Couple-centered interventions may be an efficient strategy to prevent and manage hypertension in these countries.

Keywords: cross‐national study; hypertension; middle‐aged and older population; spousal concordance.

Figure 1. Flowchart for analytic sample.

DBP indicates diastolic blood pressure; and SBP, systolic blood pressure.

Figure 2. Associations of hypertension status between couples and sex differences within each country.

A, Association of hypertension status between couples (Table S4, Equation 1a and 1b). B, Sex difference in associations comparing husbands and wives (Table S4; Equation 2). All values are survey‐weighted prevalence ratios with 95% robust CIs, after adjusting for individual characteristics and household characteristics.

Figure 3. Country differences in association of hypertension status between couples across countries.

A, Statistical interaction for each country (relative to the United States) in pooled analysis of wives (Table S5; Equation 3a). B, Statistical interaction for each country (relative to the United States) in pooled analysis of husbands (Table S5; Equation (3b). Estimates of association may be numerically, but not statistically, different between models used (eg, between survey‐weighted Poisson regression of analysis separately by country and in pooled country data set) due to differences in estimation method (maximum likelihood with survey design vs generalized estimating equations), confounding adjustment, etc.