Dissertation DOCUMENTO FINAL PDF

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HP431 – Dissertation
MSc Health Policy Planning and Finance
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DISSERTATION TITLE: Determinants of socio-economic

inequalities in the prevalence, awareness
and control of hypertension in older
Colombian adults
WORD COUNT: 6600
Excludes references and appendices.
Dissertation (HP431) submitted in partial fulfilment of the requirement for the degree of:
MSc HEALTH POLICY PLANNING AND FINANCE
Due date: 28th August 2019 at 12.00pm
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ACKNOWLEDGEMENTS
The most important achievements in life are reached thanks to the love, affection and support of
family and closest friends. For that reason, I would like to express my sincere gratitude to those
who made possible my dream of studying a master’s degree in the United Kingdom. I would
especially like to say thanks to my mom Claudia for all the love that she gives me every day, to
my dad Arturo for his vision and for teaching me how to remain calm in adverse situations, to my
brother Juan Pablo for always being there when I needed him and to my aunt Cecilia a second
mom to me, who has taught through example how to move forward and stay positive especially
during difficult times that life often presents.
I would like also to express my gratitude to a great human being that I met during the masters,
Jorge, a helpful and kind individual who always supported me during my studies, and to Rachel,
Mayisha and Gary three very kind English friends who were there offering their help with English
translation, and of course to my closest Colombian friends: Laura, Monica and Gina I love you so
much. Finally, I want to express my gratitude to Colfuturo for financial support towards my
economic studies at LSE and LSHTM.
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ABSTRACT
Background: There exists strong evidence for the correlation between socioeconomic disparities
within society and their impact on the health of the population. People living in Latin-American
countries experience huge inequalities related to the distribution of the most important social
determinants of health (such as education, occupation, income). Elderly populations have shown
to be particularly vulnerable to varying health events depending on these social determinants. For
that reason, the aim of this study is to evaluate how the socioeconomic conditions inside of
Colombia (one of the most unequal countries in the world) influence the prevalence, awareness
and control of hypertension, the leading cause of mortality worldwide, especially among elderly
people.
Objective: To evaluate the association of the social determinants on the prevalence, awareness,
and control of hypertension in the elderly population of Colombia.
Methodology: The 2015 SABE (health, well-being and ageing) population survey was analysed,
using the Commission on Social Determinants of Health (CSDH) conceptual framework proposed
by the World Health Organization (WHO). This dissertation is a secondary analysis using the
subsample of 5,760 individuals. A multivariate logistic regression model was applied to test the
impact of social determinants on the prevalence, awareness, and control of hypertension in the
elderly population of Colombia.
Results: Our results indicated that the presence of some structural determinants (such as poor
educational level, minimum monthly income, lower socioeconomic position, and living in rural
areas) and some intermediary determinants (a poor quality health care system and poor life
satisfaction), were related to poor outcomes in the prevalence, awareness and control of
hypertension among elderly Colombian people.

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Conclusion: In the Colombian context the improvements of structural determinants such as the
educational system, income distribution (pension, salaries), and better job opportunities,
especially for people living in rural regions within Colombia who experience the most adverse
socioeconomic conditions; as well as the upgrading of intermediary determinants such as
improvement in the quality of health services, and the enhancement of mental health condition
within the population, these will create the required socio economic environment necessary to
improve early detection rates of hypertension, and provide better awareness and control of this
chronic disease among older Colombian people.
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TABLE OF CONTENTS
1. INTRODUCTION 7
1.1 The relevance of tackling socioeconomic disparities 7
1.2 Social inequity in Latin-American countries 8
1.3 Research gap and aim 9
2. LITERATURE REVIEW 10
2.1 The concepts of equality and equity 10
2.2 Social justice and health Equity 11
2.3 Theories explaining relationship between social inequities and health 12
2.4 The CDSH Conceptual framework 13
3. METHODOLOGY 16
3.1 Dataset and sample 16
3.2 Relevant outcomes for the analysis 16
3.3 Statistical analysis 19
3.4 Multivariate Logistic Regression Model 19
3.5 Ethical approval 22
4. RESULTS 23
4.1 Descriptive statistics 23
4.2 Results of the Multivariate Logistic Regression 29
5. DISCUSSION 35
6. CONCLUSIONS AND POLICY IMPLICATIONS 38
7. STRENGTHS AND LIMITATION 40

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8. REFERENCES 41
9. APPENDICES 44
LIST OF TABLES
Table 1: Description of the structural and intermediary determinants 25
Table 2: Results of the Multivariate Logistic Regression 32
LIST OF FIGURES
Figure 1: The CDSH Conceptual Framework 15
Figure 2: Geographic regions of Colombia 18
LIST OF APPENDICES
Appendix 1: Prevalence of Hypertension 44
Appendix 2: Awareness of Hypertension 50
Appendix 3: Control of Hypertension 55
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1. INTRODUCTION
1.1 The relevance of tackling socioeconomic disparities
There exists strong evidence for the correlation between socioeconomic disparities within society
and their impact on the health of the population. Individuals experiencing high levels of inequity
are more likely to present poor health outcomes (1). Furthermore, social researchers have found
that those countries with huge inequalities related to the distribution of income have significantly
worse health outcomes in comparison to those with more egalitarian distribution (1,2), those
inequalities remain across the different sectors within the countries (2). For instance,
cardiovascular disease (CVD) has been shown to be strongly influenced by socioeconomic
conditions and this provides an interesting model for investigating the relationship between
inequity and health at the individual level (2).
In addition to this several studies conducted worldwide on elderly populations have shown that
this age group is particularly vulnerable to varying health events depending on social determinants
(such as education, occupation, and income). (3,4). The concept of social determinants of health
is explained by the World Health Organization (WHO) as: “the circumstances in which people are
born, grow up, live, work and the system put in place to deal with illness….” (5) Furthermore a
significant proportion of the diversity that we see in older age is due to the cumulative impact of
health inequities experienced throughout the course of life. As a result of this WHO emphasizes
the importance of addressing these inequities and encouraging governments in promoting public
policies that empower older people to retain control of their own lives and to take their own
decisions (the concept of healthy ageing) (5).
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1.2 Social Inequity in Latin-American countries
Despite relative sustainable economic growth, the Latin American region continues to be the most
unequal region in the world (6). One of the most important reasons for this is unequal income
distribution as indicated by the Gini coefficient (this describes the cumulative percentage of total
income received by different percentages of the population) showing the average for Latin-
American countries in 2010 as 0.5, this reflects the lack of specific social policies designed to
decrease income disparities among the population(6) - as is suggested by the ECLAC (Economic
Commission for Latin America and the Caribbean) : “Equity is the essential objective around
which the region future need should be reoriented…”(6). Brazil remains a successful example of
how effective social policies (designed during the period from 2000 to 2009) to improve the
socioeconomic conditions of the population (for instance: the increase in the minimum wage, and
the development of the program “Bolsa Família”, a family subsidy program with the objective of
investing in human capital specifically promoting education among poor and vulnerable
communities) can reduce income inequality and at the same time, alongside an effective primary
healthcare, can lead to enhanced health and life expectancy within society (7).
In Colombia social inequities are deep and dramatic, according to the evidence Colombia is one
of the most unequal countries in the world with a GINI index of 0.517 recorded in 2019 (8). DANE
(Colombian National Department of Statistics) in 2019 estimated a population of approximately
48 million, with 76% living in urban areas, the remaining 24% living in rural areas, of which 12%
are over 65 years old (approximately 5.2 million), life expectancy is 76.51 years, with the evidence
showing that the most unequal regions of the country have enormous social disadvantages and
the poorest health indexes, including life expectancy (9). Furthermore, because of the internal
conflict between the government and leftist guerrillas, Colombia has the highest number of
internally displaced people (IDPs) in the world, with a total number of 7.7 million recorded since
1985. The Multidimensional Poverty Index (MPI), which includes three dimensions: health,
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education, and standard of living, is currently 19.6% (13% in urban areas and 39.9% in rural
areas) and extreme poverty “a condition characterized by severe deprivation of basic human
needs, including food, safe drinking water, sanitation facilities, health, shelter, education and
information…” (8) was recorded in 2018 at 7.2% (8).
1.3 Research gap and aim
The purpose of this dissertation is to evaluate the impact of social determinants on the prevalence,
awareness, and control of hypertension in the elderly population within Colombia, using a
framework proposed by the WHO Commission on Social Determinants of Health (CSDH). I have
selected hypertension given that it is the leading cause of mortality worldwide, especially among
elderly people (10), and relatively few studies in Latin America have examined these associations
between income inequality and hypertension (1). Furthermore, the results of this study will
complement previous research made in the field, giving that to the best of my knowledge no
previous studies in Colombia have compared the relation between socio-economic inequalities
and the presence of hypertension among the elderly population.
In addition, this project will emphasize the importance of promoting public policies an intersectorial
approach to reducing health inequalities as a fundamental factor for improving the welfare of
elderly people in Colombia.
This dissertation is structured as follows: section 2 presents a literature review on the empirical
evidence related to public health concepts of equity and health, a number of theories exploring
the relationship between social inequities and their effects on health and the conceptual
framework selected for this dissertation. The methods (section 3) details the dataset utilized, the
data management and variables, the statistical analysis and the statistical techniques applied.
Section 4 details the findings, section 5 evaluates the outcomes, conclusions and policy
implications are discussed in section 6, with section 7 relating to the strengths and limitations of
the study.
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2. LITERATURE REVIEW
2.1 The concepts of equality and equity
Although for some authors the terms inequity and inequality could be interchangeable (11), for
the purpose of this document it is important to clarify the differences between both. For some
writers such as Goodman and Tougher, equality is defined as the equal distribution of a particular
variable, such as health; in contrast equity implies the elimination of the differences between
groups that are “systemic, socially produced and unjust” (12); the authors emphasize that
inequities are produced by social systems that are unjust, and remarks that in the health sector
sometimes equality is neither feasible nor desirable while equity itself is always advisable (12).
In the same way, Kawachi, Subramanian and Almeida-Filho, explain that inequality and equality
are concepts referring to “measurable quantities…”, while equity and inequity are “political
concepts, expressing a moral commitment to social justice...” (13); in fact, for those authors the
essential distinction between both terms is that health inequity imposes personal beliefs around
the concepts of justice, society and the origin of health inequalities (13). Furthermore, the concept
of health equity was described by Whitehead in 1992 as “the absence of unfair and avoidable or
remediable differences in health among population groups defined socially, economically,
demographically or geographically ” (5), this implies that if a government wants to design a public
policy for enhancing health equity among its population, each of the individuals need to have the
same opportunity to develop their maximum potential without disadvantaging any member of
society. For this reason, health equity can be defined as the lack of inequities and inequalities in
health (5), and as is specified by the WHO: “realizing health equity requires empowering people,
particularly socially disadvantaged groups, to exercise increased collective control over the
factors that shape their health…” (5), for the purpose of this thesis this relates to the elderly
population.
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2.2 Social justice and health equity
Some of the most important and recognized public health experts in the world, such as Professor
Michael Marmot have addressed why social injustice within a society is the true cause of health
inequity between and within countries (14), this concept (social injustice) refers to the unequal
distribution of resources, services, income, and goods; the lack of access to health care and
education; poor work conditions and the poor chances of leading a flourishing life for some people
inside society (14). Furthermore, Professor Marmot explains in several documents, including the
Commission on Social Determinants of Health (CSDH) created by the WHO to tackle the social
causes of poor health globally, nationally and locally, why health inequity could be avoidable
should governments create social policies and programs promoting the empowerment of the most
vulnerable people and communities, and as result, minimizing the systematic differences in health
that have been affecting people on a huge scale, especially those within the lower socioeconomic
positions (14).
It is important to mention afforded concept as emphasized by Professor Michael Marmot in the
CSDH for tackling health inequity within society, this being the relevance of the intersectorial
approach to health, meaning that health policies and programs must embrace health and non-
health governmental sectors (for instance education) (14). In conclusion, health care is just one
of the social determinants that influence the health of a population, for that reason should a policy-
maker design policy to improve health equity, he/she needs to understand other issues that can
affect the welfare of individuals in daily life and he/she should work to coordinate with non-health
sectors in order to remove the disparities that affect health within a specific context
2.3 Theories explaining the relationship between social inequities and health
Various authors have deliberated on the possible mechanism between income inequalities and
health; for instance, Wilkinson explained his theory on the relative income hypothesis, this
explores how individual health is affected by one perception of their own social position in relation
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to others, for example poorer individuals can feel stress, loss of respect and distress, when
comparing their own situation with those from more privileged backgrounds (15). These
perceptions can activate psychosocial mechanisms that can lead to chronic stress and anxiety,
and can affect, in both direct and indirect ways, negative and unhealthy lifestyle behaviours
including smoking, drinking and overeating (2). Another theory proposed by Kawachi, the income
inequality hypothesis, detailed how inequality may impact negatively on the levels of social
cohesion within a society (15), for instance an inequitable society can create distrust on an
individual level, developing antisocial behaviour and reducing social inclusion, producing the
unhealthy consequences of social isolation. Finally, Kaplan, argued that the relationship between
inequalities and detrimental health outcomes in less egalitarian societies is associated with the
lack of investment in human capital (neomaterial theory) as a consequence of the relatively low
expenditure in human, physical, health and social infrastructures (2). As an example individuals
living in a society with multiple examples of social disadvantages (such as lack of employment
opportunities) can experience high levels of chronic stress resulting in an increased risk of
developing hypertension. (1).
Relevant authors have also explored the possible association between health inequality and
cardiovascular diseases using the previously detailed theories. For example, Dr. Ana Diez-Roux
in the United States examined the Wilkinson and Kaplan theory, finding in her research a positive
correlation between three different hypotheses, with three of the most important CVD risk factors
including the recorded history of hypertension, the other two being sedentarism and Body Mass
Index (BMI) (2). The first one: income inequality, is associated with the prevalence of CVD risk
factors; the second the effects of inequality on CVD risk factors are greater at the lower than at
the higher income levels; and third being those associations between inequalities and CVD risk
factors persisting after addressing individual level-incomes (2). In Colombia Dr. Diego Lucumi
has been working on understanding the association between income inequality and hypertension
within one of the poorest regions of the country, Choco and its capital city Quibdo, a Colombian
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city characterized by high poverty levels, forced displacement, high unemployment rates, poor
urban human conditions and a lack of opportunities among its citizens (16). He concluded after
qualitative research, selecting community leaders, municipal officials, elected policymakers and
health practitioners, that: “the contextual characteristics of the place where people live, including
social and economic characteristics, play a role in shaping the risk of being hypertensive…” (1).
Using the current research, the aim is to complement such findings from previous studies within
one of the most vulnerable population groups namely the elderly of Colombia.
2.4 The CDSH Conceptual Framework
With the aim of understanding how social determinants can generate health inequities, the
Commission on Social Determinants of Health (CSDH) created a theoretical model to analyse the
influence of those social, economic, psychological and political factors which impact on the health
of the population. I decided to select this framework given that it uses a notion of health
understood as a social phenomenon in which the concepts of Social Justice and Health Equity
are at the heart of policy design (7); furthermore, the model emphasizes the importance of the
empowerment of marginalized and vulnerable communities (as in the case of elderly population)
as a way to tackle the social determinants responsible for health inequities (7).
The framework is divided into the structural and intermediary determinants that determine the
equity, health and wellbeing within the population. Socioeconomic-political contexts directly
influence the magnitude and the availability of intermediary factors, according to the model the
most influential of these is the socioecomic position (5):
Structural determinants of Health: Are defined as the social determinants of health inequities,
and are composed of: “The Context”, including all of the political and social policies that generate
or maintain the educational system, political institutions and other cultural values. “The structural
mechanism”, which generates the stratification and social class divisions in society, the most
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important are: Income, education, occupation, social class, gender, race/ethnicity. The last
component is the resultant “Socioeconomic Position” generated by the previous two factors.
Intermediary Determinants of Health:
 Material circumstances: Including factors such as housing, consumption potential and
physical environment.
 Psychosocial circumstances: Including psychosocial stressors, stressful living
circumstances, and social support.
 Behavioral and biological factors: Including nutrition, physical activity, tobacco and alcohol
consumption.
Within the framework the health system is itself considered as a social determinant, one of its
most important factors is ease of access, recognizing differences in exposure and vulnerability
when a patient is sick.
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Figure 1: The CDSH Conceptual Framework
Source: Conceptual Framework for action on the social determinants of Health
WHO, Geneva 2010
The WHO framework emphasizes the importance of including the structural determinants when
a public policy is designed to reduce health inequalities, and to not only be limited in tackling the
intermediary determinants of health (7).
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3. METHODOLOGY
3.1 Dataset and sample
The SABE study (survey on health, well-being, and aging in Colombia) is a cross-sectional study
on ageing and health of individuals over 60 years of age, it was developed by the Colombian
Ministry of Health in 2015. This was the first national study of aging taking into account a sample
of the national survey system (17). The total study sample was 23,694 elderly Colombians from
244 municipalities, including urban and rural areas across the country (17). The survey evaluated
the following social determinants: Economic, social environment, physical environment, personal
determinants (limitations and disability) behavioural (lifestyle) health and social services. The
database also includes a subsample of 5,760 individuals (24.3% of the total sample) with an
analysis of physical determinants (incorporating measurement of blood pressure, weight, size,
and waist circumference)
This dissertation is a secondary analysis using the subsample of 5,760 individuals. I decided to
use this survey because it followed the concept of healthy ageing and incorporates most of the
variables of the CDSH Conceptual Framework proposed by the WHO.
3.2 Data management and variables
Relevant outcomes for the analysis
Hypertension
Blood pressure in the original study was taken with an OMRON HEM-705 blood pressure monitor
that met calibration requirements. All those whose systolic blood pressure was ≥140 mmHg, or
whose diastolic blood pressure was ≥90 mmHg were reported as being hypertensive, after three
blood pressure measurements were taken during the survey.
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Awareness of Hypertension
Regardless of the systolic and diastolic blood pressure values, it was considered that a patient is
aware of being hypertensive if the person reported being diagnosed as hypertensive by a health
professional. The question (810 from the pollster manual) stated as: Did a doctor or nurse ever
tell you that have high blood pressure or hypertension?
Control of Hypertension
Defined as a combined outcome for this analysis to any individual who acknowledged being
hypertensive and who also currently takes medication for this condition: the question asked was
(811.1): “What medication are you receiving?". Hypertension control was defined when systolic
or diastolic blood pressure values were ≤140 mmHg and / or ≤90 mmHg.
Independent variables
The independent variables were classified following two groups within the CDSH conceptual
framework: structural determinants and intermediary determinants of health.
Structural determinants
Socioeconomic context: Colombia is a multi-ethnic country, for that reason we divided ethnicity
into 7 different categories including minority groups such as Afro Colombian, Palenquero and the
Indigenous population. We also explored geographic distribution, dividing the country into 6
different regions (Figure 1) identified by different cultural, political and socioeconomic
environments: Atlantic, Pacific, Central, Eastern, Orinoquia and Amazonia, and Bogota (the
capital city), furthermore we characterized the urban and rural residences of the people who lived
in those regions.
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Figure 2: Geographic regions of Colombia
Source: Author based on the information of SABE survey
Socioeconomic position: Owing to administrative reasons the Colombian government classify the
population in different socioeconomic positions (strata) according to the number of residential
properties that need public services, the lowest income groups are in level I while the highest
income groups are in level VI.
Education: This issue was measured using two variables, firstly the years spent in school (less
than 6 years, 7-12 years, or more than 12 years), and secondly the educational level was divided
into 7 categories: none, primary, secondary, technical, university and postgraduate, and those
who didn’t answer.
Income: This social determinant was measured with 4 different variables: if the person was listed
in a pension fund; the monthly income received by the person according to the legal minimum
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wage, estimated using the official currency of Colombia (Colombian Peso); the number of people
depending on that income and finally asking the elders whether they considered their monthly
income as enough to meet their needs.
Intermediary determinants
Material circumstances: The consumption potential of the elders was measured according to the
amount of full meals that they were able to eat per day, this was divided in 4 categories (one, two,
three or more meals, and those who didn’t answer).
Psychosocial circumstances: As a result of the negative impact of a war longer than 50 years, the
Colombian mental health is one of the most important and challenging public health issues, for
that reason I decided to include 8 different variables to measure its influence, those were: whether
the individual lived alone; if they had been displaced by the armed conflict or violence; the number
of times and the age of their first displacement; whether they felt satisfied with life; if they had
been insulted in the last year, and finally a comparative question of how they perceived their own
health compare to one year ago and with respect to the health of others.
Behavioural factors: Any restriction was measured when doing physical activity, and at the same
time the most relevant variables for lifestyle, including physical activity, tobacco and alcohol
consumption, and the number of fruit and vegetables consumed per day were noted.
Biological factors: Age was divided into five groups: 60-65, 66-70, 71-75, 76-80 and older than
80. Two physical variables which estimated cardiovascular risk were included: body mass index
classified as: underweight, normal, overweight and obese, and waist circumference abnormal
parameters being those above 90 cm for men and above 80 cm for women. Finally, we measured
the presence of other chronic diseases, conditions such as diabetes, cancer, dyslipidaemia,
myocardial infarction, osteoporosis, and mental health problems.

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Health System: The Colombian health system was measured according to the type of health
insurance offered: the most relevant being the contributory scheme (workers’ health insurance)
subsidized scheme (the most vulnerable being mainly the unemployed), special scheme (a kind
of private health insurance for teachers and members of the military and national police). Finally,
the perception of the health services provided was measured.
3.3 Statistical analysis
Quantitative variables were analysed using measures of frequency, central tendency and
dispersion; categorical data was analysed in proportion. The assumptions of normal distribution
in the variables of interest were evaluated with the non-parametric Shapiro-Wilk test and thorough
graphical analysis (frequency histograms and Q-Q graphs). Bivariate and correlation analysis with
the X2 statistic for independence in 2x2 tables. When the assumptions for the calculation of the
X2 statistic were not fulfilled, Fisher's exact test was used. According to the nature of the
distribution of the continuous variables, statistical tests of t-student or U of Mann Whitney were
applied in comparison of means or medians, respectively. In the hypothesis contrast, the
statistically considered differences of p <0.05 were considered.
3.4 Multivariate Logistic Regression Model
Because logistic regression is a statistical method that allows analysis of the result of a
dichotomous dependent variable [Y ̂ (1,0)] based on other independent variables called
predictors, this relationship is expressed using the following equation:
ln [𝑝1−𝑝]= 𝛼 +𝛽1𝜒1 +𝛽2𝜒2 +…… +𝛽𝑝𝜒𝑝
Where "ln" is the natural logarithm of the probability (p) that a given event occurs, divided by the
probability that it will not occur (1-p). Logistic models can be applied to the analysis of cross-
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sectional studies without estimating causality, although they do obtain Odds Ratios (OR) of
association. This limitation is not extremely severe since the objective of the proposed analysis
was to obtain valid estimates of one or more exposures within the framework of an exploratory
analysis of the SABE survey. The selected logistic model provides estimates that must be in the
range between zero and one, adjusting for the effect of one or several risk factors (in our case,
age and sex for each outcome). Each predictor was analysed independently and then in the
construction of the complete hierarchical model, the value of each OR in each independent
variable or cofactor included in the multivariate model was determined. The ORs were estimated
using the logit function and accompanied by their respective 95% Confidence Interval (95% CI)
to determine the size of the calculated effect measured. Given the probability of having or not
having a dichotomous outcome (prevalence, awareness and control of hypertension) the logistical
model for the analysis was defined as:
1
𝑃(𝑌̂ = 1|𝑋1 , 𝑋2 , , , 𝑋𝐾 ) =
1 + 𝑒 −(∝ + ∑ 𝛽𝑖 𝑋𝑖 )
Where "𝛼, 𝛽" are unknown parameters
We use the maximum likelihood method (MV) to estimate the parameters (α,) ̂ β ̂ in the model
and a logit transformation to estimate the ORs as follows:
𝐿𝑜𝑔𝑖𝑡 𝑃(𝑋) = 𝛼 + ∑ 𝛽𝑖 𝑋𝑖
Subsequently and with the exponentiation of the coefficient of each independent variable X_i,
the risk measure (OR) derived by the logistic model was obtained.
𝑘
𝑂𝑅 = 𝑒 ∑𝑖=1 𝛽𝑖 (𝑋1𝑖 − 𝑋0𝑖)
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3.5 Ethical approval
The SABE database administered by the Ministry of Health (MOH) is in the public domain of
Colombia, however the survey is anonymized and available on request from the MOH. This
dissertation was approved by the MSc Research Ethics Committee of the London School of
Hygiene and Tropical Medicine approved the project on the 21st of June 2019 through the CARE
form (Combined Academic, Risk assessment and Ethics approval) reference 17304.
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4. RESULTS
4.1 Descriptive statistics
A total sample of 5760 individuals were analysed, the prevalence of hypertension among them
was 40% (Appendix 1), the percentage of people aware of their condition was 56% (Appendix
2) and finally among those aware of their disease, the percentage of hypertension control was
64% (Appendix 3). According to Table 1, the following is the description of the structural and
intermediary determinants:
Structural Determinants
Except for Orinoquia and Amazonia (0.7%) all geographical regions of Colombia were almost
equally represented, Orinoquia and Amazonia being the regions most dispersed and isolated in
Colombia. 22% of the sample lived in rural areas. Related to educational levels, 83% of them had
completed less than 6 years in school, with a total of 60% having had only primary education, and
17% had received no education level at all. According to the socioeconomic position variable,
80% of them were from the lowest socioeconomic stratum (I and II) and 17.8% identified
themselves as belonging to an ethnic minority. Finally, related to income, only 9.5% were affiliated
to a pension fund, while 54.3% received less than the current legal minimum monthly wage,
61.6% considered that their income was not enough for necessities and 48% explained that other
people depended on them.
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Intermediary Determinants
Material circumstances: A total of 24.2% were unable to have more than 1 or 2 meals per day.
Psychosocial circumstances: 9.5% of the sample lived alone, 14.6% had been displaced by
armed conflict or violence, and 17% had been displaced more than once. 22.9% said that their
health was worse in comparison with the previous year, and 49% said that their health was better
in comparison with other people of the same age. 95% felt satisfied with their life.
Biological and behavioural factors: The largest age group was between 60 to 65 years (32%).
The predominant gender of the group were women with a total of 60% of the sample. 63.1% of
the sample were overweight or obese, and just 56.4% consumed at least 2 portions of fruit and
vegetables per day. 36.5% experienced some difficulty when walking 5 blocks, and just 19.3%
walked at least three times per week and between 9 and 20 blocks without stopping. 49.8% were
smokers or ex-smokers. Finally, 88.2% did not drink alcohol.
Colombian health system: 75.6% complained that they did not receive the requested care from
their health service for health problems they had presented. 42.5% belonged to the contributory
scheme, while 53.6% belonged to the subsidised scheme, the remaining percentage belonged to
the special scheme.
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Table 1: Description of the structural and intermediary determinants
Variable Categories Men Women Total

2325 3435 5760
n (%) n (%) n (%)
Socioeconomic Context
Ethnicity Indigenous 281 12,1 239 7,0 520 9,0
Gypsy / ROM 6 0,3 9 0,3 15 0,3
Root of the archipelago of San Andres y
17 0,7 20 0,6 37 0,6
Providencia
Palenquero de San Basilio 3 0,1 1 0,0 4 0,1
Black, Afro-descendant or Afro-
204 8,8 246 7,2 450 7,8
Colombian
None of the above 1325 57,0 2092 60,9 3417 59,3
Don't know / didn't answer 489 21,0 828 24,1 1317 22,9
Geographic region Atlantic 404 17,4 501 14,6 905 15,7

Eastern 318 13,7 462 13,5 780 13,5
Orinoquia y Amazonia 19 0,8 20 0,6 39 0,7
Bogota 440 18,9 655 19,1 1095 19,0
Central 663 28,5 1052 30,6 1715 29,8
Pacific 481 20,7 745 21,7 1226 21,3
Residence Urban 1738 74,8 2784 81,1 4522 78,5

Rural 587 25,3 651 19,0 1238 21,5
Socioeconomic position
I 409 39,7 489 37,4 898 38,4
(Strata)
II 439 42,6 535 40,9 974 41,7
III 157 15,2 243 18,6 400 17,1
IV 18 1,8 29 2,2 47 2,0
V - VI 7 0,7 11 0,8 18 0,8
Education
Years spent in school ≤6 years 1906 82,0 2887 84,1 4793 83,2
7 to 12 years 306 13,2 425 12,4 731 12,7
>12 years 113 4,9 123 3,6 236 4,1
Educational level None 393 16,9 642 18,69 1035 18,0

Primary 1365 58,71 2034 59,21 3399 59,0
Secundary 380 16,34 548 15,95 928 16,1
Technical 72 3,1 110 3,2 182 3,2
University 80 3,44 66 1,92 146 2,5
Postgraduate 24 1,03 19 0,55 43 0,8
Income level
Are you listed in a pension fund? No 2094 90,1 3207 93,4 5301 92,0
Yes 231 9,9 228 6,6 459 8,0
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What amount do you receive

monthly ? (Current Legal Minimum Less than one CLMW (- 644,350) 1,204 51,8 1,925 56,0 3129 54,3
Wage)
One CLMW (644,350) 385 16,6 497 14,5 882 15,3
More than 1 CLMW and 2 CLMW
311 13,4 236 6,9 547 9,5
(644.351 - 1.288.700)

100 4,3 62 1,8 162 2,8
(1.288.701 - 1.933.050)

31 1,3 27 0,8 58 1,0
(1.933.051 - 2.577.400)
More than 4 CLMW (2.577.401) 37 1,6 17 0,5 54 0,9
How many people depend totally None 784 33,8 2216 64,6 3000 52,2
or partially on your income?
1 654 28,2 563 16,4 1217 21,2

2 338 14,6 269 7,9 607 10,6
3 225 9,7 156 4,6 381 6,6
4 151 6,5 105 3,1 256 4,5
5 78 3,4 54 1,6 132 2,3
6 42 1,8 25 0,7 67 1,2
7 19 0,8 14 0,4 33 0,6
8 14 0,6 12 0,4 26 0,5
9 9 0,4 6 0,2 15 0,3
10 5 0,2 7 0,2 12 0,2
11 1 0,0 1 0,0 2 0,0
Do you consider your income is

More than enough 35 1,5 56 1,6 91 1,6
enough to meet your needs?
Enough 420 18,1 693 20,2 1113 19,3

Not enough 1121 48,2 1548 45,1 2669 46,3
Extremely Insufficient 376 16,2 507 14,8 883 15,3
Material Circumstances
How many full meals do you eat One meal 32 1,4 59 1,7 91 1,6
per day?
Two meals 500 21,5 802 23,4 1302 22,6
Three or more meals 1429 61,5 1963 57,2 3392 58,9
Psychosocial circumstances
Do you live alone? No 908 88,2 1,206 92,3 2114 90,5
Yes 122 11,8 101 7,7 223 9,5
Have you been displaced by

armed conflict or violence, at No 1924 82,7 2994 87,2 4917 85,4
anytime in your life?
Yes 401 17,3 441 12,8 842 14,6
Don't know / didn't answer 1 0,0 1 0,0
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If yes, how old were you when you Mean age ± S,D 43 ± 19 40 ± 21 42 ± 20
were first displaced?
If yes, how many times have you

been displaced from your
residence because of armed 1 333 83,5 364 82.54 697 83,0
conflict, problems with illegal
crops, fumigation?
2 53 13,3 59 13,4 112 13,3
3 5 1,3 14 3,2 19 2,3
4 1 0,3 1 0,2 2 0,2
5 3 0,8 . , 3 0,4
6 1 0,3 . , 1 0,1
7 2 0,5 1 0,2 3 0,4
8 1 0,3 . , 1 0,1
10 . . 2 0,5 2 0,2
No 100 5,1 141 5,0 241 5,0

Are you satisfied with your life?
Yes 1863 94,9 2685 95,0 4548 95,0
If you compare your current health

with that of one year ago. Would
Better 268 11,5 543 15,8 811 14,1
you say that you are now healthier,
equal or worse?
Same 1187 51,1 1456 42,4 2643 45,9
Worse 502 21,6 818 23,8 1320 22,9
In comparison with other people of

your age. Would you say your Better 957 41,2 1,52 44,3 2477 43,0
health is better, equal or worse?
Same 746 32,1 896 26,1 1642 28,5

Worse 176 7,6 275 8,0 451 7,8
In the last year, have you been

No 1794 77,2 2613 76,1 4407 76,5
insulted or mistreated by a
stranger?
Yes 167 7,2 208 6,1 375 6,5
Behavioral factors
Do you have any restriction when ¿Do you have any limitation when
doing physical activity? walking 5 blocks (400 mts)?
None 1655 71,2 1997 58,1 3652 63,4
A little restriction 302 13,0 626 18,2 928 16,1
Some restriction 152 6,5 331 9,6 483 8,4
High restriction 159 6,8 372 10,8 531 9,2
Complete restriction 57 2,5 104 3,0 161 2,8
Don't know / didn't answer . . 5 0,2 5 0,1
¿Do you walk, at least three times per

Physical activity week, between 9 and 20 blocks (1,6 Km)
without stopping?
Yes 560 24,1 553 16,1 1113 19,3
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No 1765 75,9 2882 83,9 4647 80,7

week less than 8 blocks (0,5 Km) without
stopping?
Yes 1416 60,9 1341 39,0 2757 47,9
No 906 39,0 2089 60,8 2995 52,0
Smoking Never smoked 657 28,3 2232 65,0 2889 50,2

Current smoker 337 14,5 243 7,1 580 10,1
Ex-smoker 1331 57,3 960 28,0 2291 39,8
Alcohol consumption No 1813 78,0 3266 95,1 5079 88,2

Yes 512 22,0 169 4,9 681 11,8
Serving of fruits and vegetables at

No 1076 46,3 1435 41,8 2511 43,6
least twice per day
Yes 1249 53,7 2 58,2 3249 56,4
Biological factors
Age group 60-65 700 30,1 1128 32,8 1828 31,7
66-70 552 23,7 774 22,5 1326 23,0
71-75 421 18,1 604 17,6 1025 17,8
76-80 308 13,3 479 13,9 787 13,7
80+ 344 14,8 450 13,1 794 13,8
BMI (Kg/m2) Underweight (<18,5) 58 2,8 80 2,7 138 2,7

Normal (18,5-24,9) 896 42,7 840 28,1 1736 34,1
Overweight (≥25,0-29,9) 856 40,8 1179 39,5 2035 40,0
Obese (≥30,0) 288 13,7 889 29,8 1177 23,1
Waist circumference (in cm) Normal

High (>90 cm for men y >80 cm for
824 37,3 435 13,8 1259 23,5
women)
1383 62,7 2727 86,2 411 76,6
Comorbilities
Diabetes Mellitus No 1991 85,6 2792 81,3 4783 83,0
Yes 334 14,4 643 18,7 977 17,0
Cancer No 2217 95,4 3251 94,6 5468 94,9

Yes 108 4,7 184 5,4 292 5,1
Chronic lung disease No 2076 89,3 3016 87,8 5092 88,4

Yes 249 10,7 419 12,2 668 11,6
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No 1990 85,6 2896 84,3 4886 84,8

Myocardial infarction
Yes 335 14,4 539 15,7 874 15,2
Cerebral thrombosis No 2208 95,0 3281 95,5 5489 95,3

Yes 117 5,0 154 4,5 271 4,7
Arthritis / Rheumatism No 1938 83,4 2183 63,6 4121 71,6

Yes 387 16,7 1252 36,5 1639 28,5
Osteoporosis No 2206 94,9 2797 81,4 5003 86,9

Yes 119 5,1 638 18,6 757 13,1
Dislipidemia No 1353 58,2 1624 47,3 2977 51,7

Yes 972 41,8 1811 52,7 2783 48,3
Mental or psychiatric problem No 2183 93,9 3045 88,7 5228 90,8

Yes 142 6,1 390 11,4 532 9,2
Health System
Health Insurance Contributive 961 41,3 1486 43,3 2447 42,5
Subsidized 1263 53,9 1834 53,4 3087 53,6
Exception 11 0,5 16 0,5 27 0,5
None 73 3,1 61 1,8 134 2,3
Did you receive the requested care

from your health service for the
Not 1833 78,8 2521 73,4 4354 75,6
health problems that you have
presented?
Yes 492 21,2 914 26,6 1406 24,4
Source: Author, based on the analysis of SABE survey, 2015
4.2 Results of the Multivariate Logistic Regression
The following are the most relevant outcomes of the prevalence, awareness and control of
hypertension after applying a multivariate logistic regression (Table 2):
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Prevalence of hypertension
Structural Determinants:
Geographically the group from Bogota (the Colombian capital city) had 2.02 times the odds of
presented hypertension, in comparison to people from other Colombian regions.
Intermediary Determinants:
With reference to the 60-65-year old group, there was an association between old age and the
odds of presenting hypertension, for example, the odds of having hypertension was 2.41 times
greater in the group of 66-70 years old, and 8.92 times greater in the group above 80 years old.
Regarding the limitation of physical activity, those with a complete restriction on physical activity
(unable to walk 5 blocks or 400 meters), had 2.35 times the odds of having hypertension in
comparison with those without any limitation. With respect to health insurance those of the elderly
population who confirmed receipt of the requested care from their health service for their health
problems had 1.66 times the odds of presented hypertension.
Awareness of Hypertension
The elderly who lived in urban areas, they had 1.75 times greater odds of recognizing if they
suffered from hypertension in comparison to those living in rural areas. Educationally elders who
had studied a technical or a postgraduate degree exhibited more than 7 times the odds of
recognizing whether or not they presented hypertension in comparison to those with no education,
meanwhile the odds of those with a university degree was 2.75 times greater than those without
education. Afro-Colombian ethnicity had 3.99 times the odds of recognizing hypertension in
comparison with those from an indigenous background. Elders in lower socioeconomic positions
had higher odds of non being aware of their disease in contrast to those in higher socioeconomic
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levels, as an example those people in middle socioeconomic positions (III) had 1.84 times the
odds of identifying their condition in comparison to those within a low socioeconomic level (I).
Elders who lived alone had 1.79 times the odds of recognizing whether they presented
hypertension in comparison with those who lived with other people. Elders who had more than 3
comorbidities had 3.16 times the odds of recognizing the presence of hypertension in comparison
to those without.
Control of Hypertension
With reference to socioeconomic status those elders in lower socioeconomic positions had higher
odds of presenting uncontrolled blood pressure in contrast to those in higher socioeconomic
levels, as an example those people in middle socioeconomic positions (III) had 1.69 times the
odds of having controlled blood pressure, in comparison to those within a low socioeconomic level
(I).
Those elders diagnosed as hypertensive who had completed 7 to 12 years at school displayed
1.94 times greater odds of having controlled blood pressure in comparison to those who had
completed less than 6 years in school and those over 12 years had and 3.09 times the odds
respectively. Those elders diagnosed as hypertensive who held a postgraduate degree exhibited
3.46 times the odds of controlled blood pressure in comparison to those with no degrees. Elders
with a monthly income of 1 or between 1 and 2 legal minimum wage had 1.94 and 2.34 times
respectively the odds of having controlled blood pressure in comparison with those with less than
1 legal minimum wage.
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Elders belonging to the special health insurance scheme had 1.67 times greater odds of having
controlled their blood pressure in comparison to those within the contributory health insurance
scheme. Elders living alone exhibited 1.55 times greater odds of having controlled blood pressure
in comparison to those living with another person. Elders who expressed feelings of life
satisfaction had 2.15 times greater the odds of having controlled blood pressure in comparison to
those who expressed the opposite.
Table 2. Results of the Multivariate Logistic Regression
Model I Model II Model III

Prevalence of Awareness of Control of
Variable
Hypertension Hypertension Hypertension
OR** IC*95% OR** IC*95% OR** IC95%
Etnicthy
Indigenous (Reference) - - - - - -
Gypsy / ROM 1,00 - 1,00 - 1,00 -
Palenquero de San Basilio 1,00 - 1,00 - 1,00 -
Black, Afro-descendant or Afro-Colombian 0,74 (0,28-1,95) 3,99 (1,66-9,61) 0,44 (0,16-1,15)
None of the above 0,93 (0,40-2,15) 1,49 (0,75-2,97) 0,61 (0,26-1,36)
Don't know / didn't answer 0,53 (0,17-1,60) 1,74 (0,66-4,58) 0,80 (0,26-2,43)
Geographic Region
Atlantic (Referencia) - - - - - -
Eastern 1,05 (0,45-2,41) 2,83 (1,36-5,88) 0,52 (0,23-1,16)
(0,72-
Orinoquia y Amazonia 0,74 (0,05-9,71) 29,64 0,43 (0,04-4,45)
1213,58)
Bogota 2,02 (0,79-5,11) 2,13 (0,93-4,88) 0,35 (0,14-0,85)
Central 0,84 (0,40-1,77) 2,09 (1,08-4,05) 0,65 (0,31-1,36)
Pacific 1,23 (0,56-2,70) 3,28 (1,64-6,58) 0,38 (0,17-0,81)
Area of residence (Urban cities) 1,04 (0,60-1,79) 1,75 (1,04-2,94) 0,70 (0,41-1,19)
Socioeconomic position (Strata)
I (Reference) - - - - - -
II 0,76 (0,44-1,29) 1,32 (0,82-2,14) 1,13 (0,68-1,87)
III 0,39 (0,17-0,86) 1,84 (0,87-3,93) 1,69 (0,76-3,74)
IV 1,07 (0,15-7,56) 0,3 (0,06-1,67) 1,33 (0,18-9,58)
V – VI 0,54 (0,01-16,62) 1,00 - 0,66 (0,02-21,83)
Education
Years spent in school
≤6 years (Reference) - - - - - -
7 to 12 years 1,12 (0,12-10,06) 0,56 (0,12-2,64) 1,94 (0,22-17,10)
>12 years 0,80 (0,09-6,64) 0,15 (0,02-1,22) 3,09 (0,28-33,25)
Educational level
None (Reference) - - - - - -
Primary 0,42 (0,23-0,76) 1,39 (0,84-2,31) 1,35 (0,79-2,29)
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Secundary 0,25 (0,03-2,23) 1,53 (0,33-7,24) 1,19 (0,15-9,46)

Technical 0,59 (0,07-4,89) 7,25 (0,74-71,42) 0,90 (0,09-9,08)
University 0,85 (0,13-5,27) 2,75 (0,44-17,48) 0,55 (0,10-3,04)
Postgraduate 0,40 (0,01-10,99) 7,97 (0,18-359,89) 3,46 (0,08-147,97)
Income
What is your monthly income? (Current Legal Minimum Wage -
CLMW)
Less than one CLMW (- 644,350) (Reference) - - - - - -
One CLMW (644,350) 0,53 (0,26-1,09) 1,02 (0,52-2,03) 1,92 (0,90-4,07)
More than 1 CLMW and 2 CLMW (644.351 - 1.288.700) 1,36 (0,47-3,93) 0,20 (0,08-0,55) 2,34 (0,71-7,70)
More than 2 CLMW and 3 CLMW (1.288.701 - 1.933.050) 0,86 (0,10-6,80) 0,25 (0,05-1,45) 0,87 (0,13-6,92)
More than 3 CLMW and 4 CLMW (1.933.051 - 2.577.400) 1,55 (0,04-54,58) 0,12 (0,01-1,66) 0,69 (0,03-14,43)
More than 4 CLMW (2.577.401) 0,43 (0,01-14,01) 1,00 - 1,16 (0,03-37,6)
How many people depend totally or partially of your income?
1 or 2 1,06 (0,61-1,85) 1,06 (0,64-1,78) 1,02 (0,60-1,73)
3+ 1,05 (0,51-2,13) 0,67 (0,36-1,28) 1,13 (0,57-2,23)
Do you consider your income is enough to meet your needs?
More than enough (Reference) - - - - - -
Enough 0,42 (0,03-5,97) 2,41 (0,17-34,7) 5,07 (0,24-104,47)
Not enough 0,56 (0,03-7,93) 2,02 (0,15-27,9) 4,19 (0,20-85,16)
Extremely Insufficient 0,42 (0,02-6,26) 2,38 (0,17-33,51) 5,62 (0,26-119,11)
Don't know / didn't answer 0,18 (0,00-10,27) 1,00 - 1,00 -
How many full meals do you eat per day?
One meal (Reference) - - - - - -

Two meals 0,40 (0,09-1,83) 0,67 (0,18-2,52) 2,08 (0,57-7,48)
Three or more meals 0,27 (0,06-1,21) 0,84 (0,23-3,1) 2,61 (0,73-9,19)
Don't know / didn't answer - - - - - -
Living alone 0,44 (0,20-0.,94) 1,79 (0,88-3,65) 1,55 (0,72-3,34)

Have you been displaced by armed conflict or violence, sometime
1,00 - 1,00 - 1,00 -
in your life?
How old were you when you were first displaced? 1,00 (0,99-1,01) 0,99 (0,98-1) 1,00 (0,99-1,01)
0,36 (0,10-1,21) 0,84 (0,32-2,25) 2,15 (0,78-5,91)

Are you satisfied with your life?
In the last year, have you been insulted or mistreated by a 1,34 (0,59-3,03) 1,17 (0,57-2,43) 0,79 (0,37-1,69)
stranger?
In comparison with other people of your age. Would you say your
health is better, equal or worse?
Better (Reference) - - - - - -
Same 0,99 (0,58-1,70) 1,46 (0,89-2,39) 0,63 (0,37-1,07)
Worse 0,37 (0,16-0,84) 1,13 (0,55-2,34) 1,16 (0,53-2,53)
If you compare your current health with that one a year ago. Would
you say that you are now better, equal or worse?
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Better (Reference) - - - - - -
Same 1,48 (0,74-2,94) 1,02 (0,53-1,97) 0,64 (0,31-1,31)
Worse 1,20 (0,57-2,52) 1,07 (0,53-2,19) 0,70 (0,33-1,50)
Behavioral factors
¿Do you need any special help (walking stick, ,walker,) to wak 5
blocks (400 mts)?
A Little 0,70 (0,39-1,27) 1,21 (0,68-2,17) 1,51 (0,9-2,68)
Some restriction 0,84 (0,39-1,77) 1,49 (0,73-3,04) 1,03 (0,50-2,13)
High restriction 1,32 (0,52-3,33) 0,92 (0,41-2,07) 1,40 (0,60-3,25)
Complete restriction 2,35 (0,28-19,71) 0,98 (0,13-7,41) 0,83 (0,12-5,61)
¿Do you walk, at least three times per week, between 9 and 20
1,12 (0,58-2,15) 0,79 (0,45-1,40) 1,36 (0,72-2,58)
blocks (1,6 Km) without stopping?
¿Do you walk, at least three times per week less than 8 blocks (0,5
1,06 (0,64-1,74) 0,66 (0,42-1,02) 1,28 (0,79-2,07)
Km) without stopping?
Smoking
Never smoked (Reference) - - - - - -
Current smoker 0,84 (0,35-1,96) 1,05 (0,52-2,15) 1,15 (0,51-2,57)
Exsmoker 0,69 (0,42-1,15) 1,92 (1,16-3,15) 0,90 (0,55-1,47)
Alcohol consumption 0,52 (0,23-1,18) 1,07 (0,53-2,17) 1,92 (0,82-4,52)
Serving of fruits and vegetables at least twice per day 0,65 (0,38-1,11) 1,81 (1,14-2,89) 1,27 (0,76-2,11)
Biological factors
Age (in years) 0,91 (0,79-1,03) 1,00 (0,89-1,13) 1,03 (0,91-1,17)
Gender (Men) 0,53 (0,30-0,91) 1,03 (0,62-1,71) 1,29 (0,76-2,19)
Age
60-65 (Reference) - - - -
66-70 2,41 (0,96-6,05) 1,75 (0,75-4,11) 0,46 (0,18-1,12)
71-75 6,25 1,36-28,65) 1,15 (0,29-4,59) 0,31 (0,07-1,26)
76-80 8,92 (1,01-78,35) 1,04 (0,14-7,69) 0,38 (0,04-2,94)
80+ 10,65 (0,60-186,36) 3,85 (0,26-57,25) 0,25 (0,01-3,82)
Groups of BMI (Kg/m2)
Underweight (<18,5) - - - - - -
Normal (18,5-24,9) 1,65 (0,20-13,34) 2,82 (0,51-15,56) 0,24 (0,02-2,79)
Overweight (≥25,0-29,9) 1,24 (0,14-10,44) 4,03 (0,7-23,37) 0,29 (0,02-3,47)
Obese (≥30,0) 1,46 (0,17-12,64) 5,05 (0,85-30,27) 0,27 (0,02-3,29)
Waist circumference (>90 cm for men y >80 cm for women) 0,81 (0,41-1,60) 1,53 (0,85-2,77) 0,71 (0,37-1,34)
Comorbilities (3+) 0,63 (0,40-1,01) 3,16 (2,02-4,96) 0,91 (0,58-1,44)
Health insurance
Contributive (reference) - - - - - -
Subsidized 1,19 (0.67-2,13) 0,86 (0,49-1,53) 1,07 (0,60-1,90)
Special 0,81 (0,10-6,36) 0,80 (0,1-6,69) 1,67 (0,23-11,96)
None 0,76 (0,18-3,09) 1,31 (0,37-4,65) 0,75 (0,20-2,74)
Did you receive the requested care from your health service for the
1,66 (0,99-2,78) 0,70 (0,44-1,12) 0,74 (0,45-1,21)
health problems that you have presented?
Are you taking some medical treatment for your disease? 0,31 (0,16-0,60) 9,30 (5,57-15,51) 0,32 (0,17-0,59)
*Confidence Interval
** Odds Ratio
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5. DISCUSSION
The objective of this dissertation was to evaluate the association of the social determinants on
the prevalence, awareness, and control of hypertension in the elderly population of Colombia,
using the framework proposed by the WHO Commission on Social Determinants of Health
(CSDH). Our results indicate that the presence of some structural determinants (such as poor
education level, poor monthly income, lower socioeconomic position, and living in rural areas)
and some intermediary determinants (poor quality health care system and poor life satisfaction),
were related to poor outcomes in the prevalence, awareness and control of hypertension among
elderly Colombian people. These findings are correlated with previous social theories as exposed
by Wilkinson, Kaplan and Kawachi, of how social inequities can lead to increased poor health
outcomes.
With reference to some structural determinants, those elders living in Bogota showed greater
prevalence of hypertension, perhaps due to increased access to health care services within the
Colombian capital city, in comparison to other regions across the country. Moreover, elders with
less time spent in educational establishments demonstrated less awareness of the presence or
not of chronic conditions such as hypertension, and a lesser control of their condition in
comparison to those with a longer education. Elders living in urban areas were more aware of the
presence of hypertension in comparison to those living in rural areas. Those elders receiving low
monthly incomes of less than 1 legal minimum wage and belonging to a lower socioeconomic
position had poorer control of their blood pressure in comparison to those with a higher monthly
income and associated with a higher socioeconomic position. Intermediary determinants such
as a limitation on physical activity and those who expressed their health insurance services as
adequate were associated with a higher prevalence of hypertension, and those belonging to the
special health insurance (those with access to more sophisticated treatments) as well as those
expressing life satisfaction demonstrated a higher level of blood pressure control.
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On the other hand, some contradictory results showed that some variables associated with poor
health outcomes, such as living alone or belonging to a minority ethnicity (such as Afro
descendant), were related to greater odds of awareness and control of hypertension, when
compared to people who lived with someone or who belonged to other ethnic groups (indigenous),
although the survey did not measure the extent of the external support for those who responded
as living alone. Finally, there were no significant indicators associated with being displaced or
with those who considered themselves as having poor health, this is contrary to findings within
the Wilkinson theory.
Our study supports the main findings of previous studies evaluating the relationship between
social determinants and the prevalence, awareness and control of hypertension. One of the most
important of these is the PURE study, a cross sectional study which examines hypertension
among 153,996 adults aged between 35 and 70 years old, taken between 2003 and 2009 from
more than 17 countries around the world (including Colombia), the study found that: “greater
education was associated with greater awareness and treatment of hypertension in low income
countries, AND with greater rates of control of hypertension in high income countries and low
income countries… especially among older participants” (20). This study also found that:
“awareness and treatment rates of hypertension were significantly lower in rural areas vs urban
areas in low income countries” (20). Similar conclusions were mentioned in a Nepal study
published in 2019 which examined socioeconomic inequalities and their relevance to
hypertension, the study found that “higher levels of education were associated with higher odds
of hypertension awareness and treatment”(21), also the researchers found that “urban residents
had : higher prevalence of hypertension, higher odds of being aware of hypertension (nearly 30%)
and higher odds of receiving treatment (57% more), compared with rural participants…”(21); they
mentioned as a possible explanation for the lower awareness and treatment among the rural
Nepalese, that in their rural context (as well as in the Colombia context) the people have low
literacy and limited availability of health services (21). Another important study of Chinese adults
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with hypertension found that those people from lower socioeconomic levels were less likely to be
aware, treated or in control of their disease when compared to individuals within a higher
socioeconomic level (22). Finally, this study complements research done in Colombia especially
that completed by Professor Lucumi who explored the previous association between income
inequality and high blood pressure using individual data from the Colombian National Survey of
Health of 2007, the sample included people between 18 and 69 years old, and the GINI coefficient
was used to measure income inequality at the department level, he found a significant association
among Colombian women living in departments with high levels of inequality, with higher odds of
having hypertension in comparison with those living in regions of lower inequality, although these
results were not found among men (1). Other results from the same study proved that between
1.4% and 2.4% of the hypertension in Colombian adults could be attributed to contextual factors
at the department level (1). According to his explanation these associations were the results of
the unequal distribution of a number of social determinants at the Colombian department level,
some of which were: lack of health infrastructure, lack of opportunities, lack of food availability,
and lack of recreational facilities. Although in contrast to the results of this dissertation, Professor
Lucumi did not find any association resulting from the educational level of the individuals (1).
This study contributes to a better understanding of how huge socio economic inequalities
throughout Colombia can negatively impact the aging process particularly in the most vulnerable
groups of society such as: people belonging to the rural communities (who displayed later
detection and poor awareness of their disease), people with poor educational levels (this group
demonstrated poor awareness and control of hypertension) and people classified as from lower
socioeconomic position (presented a lower awareness and control of their condition).
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6. CONCLUSIONS AND POLICY IMPLICATIONS
The current demographic shift in Latin-American countries such as Colombia, where in contrast
to some European countries, the population over 60 years old will double in just 20 years as
opposed to 100, this will impose primary responsibility on the national governments of the region,
related to the promotion and implementation of social policies seeking to empower the elderly
population; and at the same time establish the necessity to dignify individual social circumstances
through the course of life. This is imperative in order to decrease the huge social inequalities
which are currently responsible for poor health within the most vulnerable groups of society.
According to the results of this research and referencing some of the literature previously
mentioned, in the Colombian context the improvements of structural determinants such as the
educational system, income distribution ( pension, salaries), and better job opportunities
especially for people living in rural regions within Colombia, who experience the most adverse
socioeconomic conditions; as well as the upgrading of intermediary determinants such as
improvement in the quality of health services, and the enhancement of mental health conditions
within the population, will create the required socio economic environment necessary to improve
early detection rates of hypertension and provide better awareness and control of this chronic
disease among the elderly Colombian people.
However, while addressing these inequalities among Colombians, it is essential not only to
promote and improve the relevant social determinants, but also to ensure and improve distribution
of them among the most vulnerable groups allowing these disadvantaged groups to access equal
social benefits available to those from a higher social position, and to emphasize the responsibility
of each individual to develop to their maximum potential throughout their life. In my opinion the
most relevant factor in order to achieve social empowerment, specifically among more deprived
groups within the society is education, this is understood as the essential tool to change and
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transform society, leading to improve concepts of social justice and health equity within the
community. If education of a good quality is available to all people a number of other structural
determinants such as working conditions and income would be improved and at the same time
will result in better long term health outcomes (5). Improved education would in turn lead to better
health outcomes, as evidenced in numerous documents higher levels of education can also lead
to more awareness of the diseases and at the same time would provide more awareness of the
benefits offered by health systems in order to take care and address health concerns.
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7. STRENGTHS AND LIMITATIONS
As previously highlighted this dissertation aims to furnish a better understanding of the socio-
economic inequalities and their impact on the prevalence, awareness and control of hypertension
in older Colombian adults, this is the first study to investigate this association among this age
group in Colombia. One of the most important characteristics of this project is the use of the SABE
database, given that it represents all Colombian regions, including the most important socio
demographic variables for estimating social inequities such as: ethnicity, displacement,
geographic location, monthly income, access to pensions, educational levels, and socioeconomic
position as well as anthropometric, biological and lifestyle measurements; for this reason, this
finding can be applied to the national and sub-regional levels of Colombia.
On the other hand, this study has important limitations. Firstly, the SABE database is a cross-
sectional study, and for that reason it is not possible to define causal association with our results,
furthermore some of the data collected during the survey was self-reported, this could contribute
to recall bias among the participants affecting the validity of the final results. Secondly, I decided
to select a subsample of the survey, owing to the fact that in only 24.3% of the total participants
was it possible to analyse physical determinants including blood pressure measurement. Thirdly,
the aim of the SABE database was related to understanding the ageing process of the Colombian
people as a whole, and was not solely focused on chronic disease conditions such as
hypertension, for that reason some of the variables related with hypertension could lead to
misclassification and would affect the analysis of the outcomes measured in this dissertation.
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Nieuwlaat R, et al. Patients’ Knowledge, Attitudes, Behaviour and Health Care Experiences on
the Prevention, Detection, Management and ContrLegido-Quigley, H., Camacho Lopez, P. A.,
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mortalidad por VIH/ sida en Cali, Colombia (1986-2012). Vol. 15, Revista Gerencia y Politicas
de Salud. Pontificia Universidad Javeriana; 2016. p. 216–31.
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LIST OF APPENDICES
Appendix 1: Prevalence of Hypertension
Prevalence of total hypertension (TAS≥ 140 mmHg y/o TAD TAS≥ 90 Prevalence of non hypertension (TAS <140 mmHg y/o TAD TAS <90
Variable Categories
mmHg) mmHg)
Men Women Men Women
n = 1030 n = 1307 n = 1295 n = 2128
Hypertensive % Hypertensive % Hypertensive % Hypertensive % p-

n n p-value n n
(IC95%) (IC95%) (IC95%) (IC95%) value
Total 1030 1307 1295 2128
p= p=
Ethnicity Indigenous 128 12,4 (10,5-14,5) 98 7,5 (6,1-9,0) 153 11,81 (10,1-13,6) 141 6,63 (5,6-7,7)
0,000 0,016
Gypsy / ROM 3 0,2 (0,0-0,8) 3 0,2 (0,0-0,7) 3 0,23 (0,0-0,71) 6 0,28 (0,0-0,62)
Root of the archipelago of San Andres
9 0,8 (0,0-1,6) 11 0,8 (0,4-1,5) 8 0,62 (0,03-1,2) 9 0,42 (0,2-0,81)
y Providencia
Palenquero de San Basilio 2 0,1 (0,0-0,7) - - 1 0,08 (0,0-0,54) 1 0,05 (0,0-0,33)
94 9,1 (7,5-11,0) 95 7,2 (5,9-8,8) 110 8,49 (7,0-10,1) 151 7,10 (6,0-8,2)
Colombian
None of the above 569 55,2 (52,1-58,2) 763 58,3 (55,6-61,0) 756 58,38 (55,6-61,0) 1329 62,45 (60,3-64,4)
Don't know / didn't answer 225 21,8 (19,4-24,4) 337 25,7 (23,4-28,2) 264 20,39 (18,2-22,6) 491 23,07 (21,3-24,9)
p= p=
Geographic region Atlantic 191 18,5 (16,2-21,0) 200 15,3 (13,4-17,3) 213 16,45 (14,5-18,5) 301 14,14 (12,7-15,6)
0,257 0,321
Eastern 128 12,4 (10,5-14,5) 148 11,3 (9,7-13,1) 190 14,67 (12,8-16,7) 314 14,76 (13,3,16,3)
Orinoquia y Amazonia 6 0,5 (0,2-1,2) 8 0,6 (0,3-1,2) 13 1,00 (0,5-1,7) 12 0,56 (0,3-0,9)
Bogota 227 22,0 (19,6-24,6) 287 21,9 (19,7-24,2) 213 16,45 (14,5-18,5) 368 17,29 (15,7-18,9)
Central 247 23,9 (21,4-26,6) 339 25,9 (23,6-28,3) 416 32,12 (29,6-34,7) 713 33,51 (31,5-35,5)
Pacific 231 22,4 (19,9-25,0) 325 24,8 (22,5-27,2) 250 19,31 (17,2-21,5) 420 19,74 (18,0,21,4)
p= p=
Residence Urban 732 71,1 (68,2-73,7) 998 76,3 (73,9-78,5) 1006 77,68 (75,3-79,8) 1786 83,93 (82,3-85,4)
0,002 0,000
Rural 298 28,9 (26,2-31,7) 309 23,6 (21,426,0) 289 22,32 (20,1-24,6) 342 16,07 (14,5-17,6)
Socioeconomic position p= p=
I 409 39,71 (36,7-42,7) 489 37,41 (34,8-40,0) 448 34,59 (32,0-37,2) 611 28,71 (26,8-30,6)
(Strata) 0,216 0,000
II 439 42,62 (39,6-45,6) 535 40,93 (38,2-43,6) 518 40,00 (37,3-42,6) 900 42,29 (40,2-44,4)
III 157 15,24 (13,1-17,5) 243 18,59 (16,5-20,7) 293 22,63 (20,4-24,9) 506 23,78 (22,0-25,6)
IV 18 1,75 (1,1-2,7) 29 2,22 (1,5-3,1) 30 2,32 (1,6-3,2) 86 4,04 (3,2-4,9)
V – VI 7 0,68 (0,3-1,4) 11 0,84 (0,4-1,5) 6 0,46 (0,2-1,0) 25 1,17 (0,7-1,7)
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Education
p= p=
Years spent in school ≤6 years 856 83,1 (80,6-85,2) 1152 88,1 (86,2-89,7) 1050 81,08 (78,8-83,1) 1735 81,53 (79,8-83,1)
0,001 0,528
7 to 12 years 127 12,3 (10,4-14,4) 123 9,4 (7,9-11,1) 179 13,82 (12,0-15,8) 302 14,19 (12,7-15,7)
>12 years 47 4,5 (3,4-6,0) 32 2,4 (1,7-3,4) 66 5,10 (4,0-6,4) 91 4,28 (3,4-5,2)
p= p=
Educational level None 209 20,29 (17,9-22,8) 299 22,88 (20,6-25,2) 184 14,21 (12,4-16,2) 343 16,12 (14,6-17,7)
0,020 0,016
Primary 579 56,21 (53,1-59,2) 784 59,98 (57,3-62,6) 786 60,69 (58,0-63,3) 1250 58,74 (56,6-60,8)
Secundary 160 15,53 (13,4-17,8) 169 12,93 (11,2-14,8) 220 16,99 (15,0-19,1) 379 17,81 (16,2-19,4)
Technical 35 3,4 (2,4-4,6) 28 2,14 (1,4-3,0) 37 2,86 (2,0-3,9) 82 3,85 (3,1-4,7)
University 35 3,4 (2,4-4,6) 12 0,92 (0,5-1,6) 45 3,47 (2,6-4,6) 54 2,54 (1,9-3,2)
Postgraduate 7 0,68 (0,3-1,4) 7 0,54 (0,2-1,1) 17 1,31 (0,8-2,1) 12 0,56 (0,3-0,9)
Income
What is the range in which
you receive your monthly p= p=
Less than one CLMW (- 644,350) 561 54,47 (51,4-57,4) 787 60,21 (57,5-62,8) 643 49,65 (46,9-52,3) 1138 53,48 (51,3-55,5)
income? (Current Legal 0,019 0,016
Minimum Wage-CLMW)
One CLMW (644,350) 163 15,83 (13,7-18,1) 171 13,08 (11,3-15,0) 222 17,14 (15,1-19,2) 326 15,32 (13,8-16,9)
113 10,97 (9,2-13,0) 85 6,5 (5,2-7,9) 198 15,29 (13,4-17,3) 151 7,1 (6,0-8,2)
(644.351 - 1.288.700)
44 4,27 (3,1-5,6) 21 1,61 (1,0-2,4) 56 4,32 (3,3-5,5) 41 1,93 (1,4-2,6)
(1.288.701 - 1.933.050)
12 1,17 (0,6-2,0) 6 0,46 (0,2-1,0) 19 1,47 (0,9-2,2) 21 0,99 (0,6-1,5)
(1.933.051 - 2.577.400)
More than 4 CLMW (2.577.401) 11 1,07 (0,5-1,9) 4 0,31 (0,1-0,8) 26 2,01 (1,3-2,9) 13 0,61 (0,3-1,0)
How many people depend p= p=

None 352 34,31 (31,4-37,2) 848 64,98 (62,3-67,5) 432 33,38 (39,8-36,0) 1368 64,44 (62,3-66,4)
totally or partially of your 0,018 0,015
income?
1 295 28,75 (26,0-31,6) 220 16,86 (14,9-18,9) 359 27,74 (25,3-30,2) 343 16,16 (14,6-17,7)
2 154 15,01 (12,9-17,3) 95 7,28 (5,9-8,8) 184 14,22 (12,4-16,2) 174 8,2 (7,1-9,4)
3 88 8,58 (7,0-10,4) 60 4,6 (3,5-5,8) 137 10,59 (9,0-12,3) 96 4,52 (3,7-5,4)
4 72 7,02 (5,6-8,7) 40 3,07 (2,2-4,1) 79 6,11 (4,9-7,5) 65 3,06 (2,4-3,8)
5 31 3,02 (2,1-4,2) 20 1,53 (0,9-2,3) 47 3,63 (2,7-4,8) 34 1,6 (1,1-2,6)
6 17 1,66 (1,0-2,6) 9 0,69 (0,3-1,3) 25 1,93 (1,3-2,8) 16 0,75 (0,4-1,2)

7 8 0,78 (0,3-1,5) 5 0,38 (0,1-0,9) 11 0,85 (0,4-1,5) 9 0,42 (0,2-0,8)
8 4 0,39 (0,1-1,0) 5 0,38 (0,1-0,9) 10 0,77 (0,4-1,4) 7 0,33 (0,1-0,6)
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9 3 0,29 (0,0-0,9) 2 0,15 (0,0-0,6) 6 0,46 (0,2-1,0) 4 0,19 (0,0-0,5)

10 2 0,19 (0,0-0,7) 1 0,08 (0,0-0,5) 3 0,23 (0,0-0,7) 6 0,28 (0,1-0,6)
11 - - - - 1 0,08 (0,0-0,5) 1 0,05 (0,0-0,3)
Do you consider your
p= p=
income is enough to meet More than enough 20 1,94 (1,2-2,9) 23 1,76 (1,1-2,6) 15 1,16 (0,6-1,9) 33 1,55 (1,1-2,1)
0,005 0,581
your needs?
Enough 169 16,41 (14,2-18,7) 260 19,89 (17,8-22,1) 251 19,38 (17,3-21,6) 433 20,35 (18,6-22,1)
Not enough 494 47,96 (44,9-51,0) 558 42,69 (40,0-45,3) 627 48,42 (45,7-51,1) 990 46,52 (44,4-48,6)
Very insufficient 178 17,28 (15,0- 19,7) 197 15,07 (13,2-17,1) 198 15,29 (13,4-17,3) 310 14,57 (13,1-16,1)
Intermediary
Determinants
p= p=
How many full meals do you One meal 21 2,04 (1,3-3,1) 15 1,15 (0,6-1,8) 11 0,85 (0,4-1,5) 44 2,07 (1,5-2,7)
0,029 0,001
eat per day?
Two meals 239 23,20 (20,7-25,8) 310 23,72 821,4-26,1) 261 20,15 (18,0-22,4) 492 23,12 (21,3-24,9)
Three or more meals 602 58,45 (55,4-61,4) 718 54,93 (52,2-57,6) 827 63,86 (61,2-66,4) 1245 58,51 (56,3-60,5)
p= p=
Do you live alone? No 908 88,16 (86,0-89,9) 1206 92,27 (90,6-93,6) 1152 88,96 (87,1-90,5) 1971 92,62 (91,4-93,6)
0,001 0,000
Yes 122 11,84 (10,0-9,3) 101 7,73 (6,3-9,3) 143 11,04 (9,4-12,8) 157 7,38 (6,3-8,5)
Have you been displaced by
P= p=
armed conflict or violence, Yes 185 17,96 (15,7-20,4) 177 13,54 (11,7-15,5) 216 16,68 (14,7-18,8) 264 12,41 (11,0-13,8)
0,002 0,000
sometime in your life?
No 845 82,04 (79,5-84,2) 1130 86,46 (84,4-88,2) 1078 83,24 (81,1-85,1) 1864 87,59 (86,1-88,9)
Don't know / didn't answer - - - - 1 0,08 (0,0-0,5) - -
How old were you when you
p= p=
were first displaced? (n., 182 46 (±20) 172 41 (±21) 215 42 (±19) 257 40 (±20)
0,050 0,321
average ± S,D)
p= p=
Are you satisfied with your Yes 807 93,51 (91,6-94,9) 1001 95,88 (94,4-96,9) 1056 96,00 (94,6-97,0) 1684 94,50 (93,3-95,4)
0,021 0,067
life?
No 56 6,49 (5,0-8,3) 43 4,12 (3,0-5,5) 44 4,00 (2,9-5,3) 98 5,50 (4,5-6,6)
If you compare your current

health with that one a year
p= p=
ago. Would you say that you Better 104 10,10 (8,3-12,0) 206 15,76 (13,8-17,8) 164 12,66 (10,9-14,5) 337 15,84 (14,3-17,4)
0,000 0,000
are now better, equal or
worse?
Same 519 50,39 (47,3-53,4) 552 42,23 (39,5-44,9) 668 51,58 (48,8-54,2) 904 42,48 (40,3-44,5)
Page 46 of 59
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Worse 238 23,11 (20,6-25,7) 285 21,81 (19,6-24,1) 264 20,39 (18,2-22,6) 533 25,05 (23,2-26,9)
In comparison with other
people of your age. Would p= p=
Better 414 40,19 (37,2-43,2) 541 41,39 (38,7-44,0) 543 41,93 (39,2-44,6) 979 46,01 (43,8-48,1)
you say your health is 0,024 0,001
better, equal or worse?
Same 329 31,94 (29,1-34,8) 353 27,01 (24,6-29,4) 417 32,20 (29,7-34,7) 543 25,52 (23,7-27,4)
Worse 83 8,06 (6,5-9,8) 101 7,73 (6,3-9,3) 93 7,18 (5,8-8,7) 174 8,18 (7,0-9,4)
Don't know / didn't answer 204 19,81 (17,4-22,3) 312 23,87 (21,6-26,2 242 18,69 (16,6-20,9) 432 20,30 (18,622,0)
In the last year, have you p= p=

Yes 83 8,06 (6,5-9,8) 75 5,74 (4,5-7,1) 84 6,49 (5,2-7,9) 133 6,25 (5,2-7,3)
been insulted or mistreated 0,007 0,644
by a stranger?
No 780 75,73 (73,0-78,2) 967 73,99 (71,5-76,2) 1014 78,30 (75,9-80,4) 1,646 77,35 (75,5-79,0)
Behavioral factors
Do you have any restriction ¿Do you have any limitation to walk 5
to do physical activity? blocks (400 mts)?
p= p=
None 725 70,3 (67,5-73,0) 738 56,4 (53,7-59,1) 930 71,81 (69,3-74,1) 1259 59,16 (57,0-61,2)
0,000 0,016
A little restrIction 152 14,7 (12,7-17,0) 250 19,1 (17,0-21,3) 150 11,58 (9,9-13,4) 376 17,67 (16,1-19,3)
Some restriction 62 6,0 (4,7-7,6) 123 9,4 (7,9-11,1) 90 6,95 (5,6-8,4) 208 9,77 (5,6-8,4)
High restriction 72 6,9 (5,5-8,7) 157 12,0 (10,3-13,8) 87 6,72 (5,4-8,2) 215 10,10 (8,8-11,4)
Complete restriction 19 1,8 (1,1-2,8) 37 2,8 (2,0-3,8) 38 2,93 (2,1-4,0) 67 3,15 (2,4-3,9)
Don't know / didn't answer - - 2 0,1 (0,0 - 0,6) - - 3 0,14 (0,0-0,4)
¿Do you need any special help (walking
stick, ,walker,) to wak 5 blocks (400
mts)?
p= p=
Yes 139 13,5(11,5-15,7) 242 18,52 (16,5-20,7) 192 14,83 (12,9-16,8) 309 14,52 (13,0-16,0)
0,001 0,044
No 888 86,21 (83,9-88,1) 1 81,41 (79,2-83,4) 1090 84,17 (82,0-86,0) 1812 85,15 (83,5-86,5)
Don't know / didn't answer 3 0,29 (0,0-0,8) 1 0,08 (0,0-0,5) 13 1 (0,5,1,7) 7 0,33 (0,1-0,6)
Page 47 of 59
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Physical activity week, between 9 and 20 blocks (1,6
Km) without stopping?
p= p=
Yes 210 20,39 (18,0-22,9) 170 13,01 (11,2-14,9) 350 27,03 (24,6-29,5) 383 18 (16,4-19,6)
0,000 0,000
No 820 79,61 (77,0-81,9) 1 86,99 (85,0-88,7) 945 72,97 (70,4-75,3) 1745 82 (80,3-83,5)
week less than 8 blocks (0,5 Km)
without stopping?
p= p=
Yes 627 60,87 (57,8-63,8) 494 37,80 (35,2-40,4) 789 60,93 (58,2-63,5) 847 39,80 (37,7-41,9)
0,000 0,000
No 403 39,13 (36,1-42,1) 811 62,05 (59,3-64,6) 503 38,84 (37,7-41,9) 1278 60,06 (57,9-62,1)
Don't know / didn't answer - - 2 0,15 (0,0-0,6) 3 0,23 (0,0-0,7) 3 0,14 (0,0-0,4)
p= p=
Smoking Never smoked 318 30,87 (28,1-33,7) 848 64,88 (62,2-67,4) 339 26,18 (23,8-28,6) 1384 65,04 (62,9-67,0)
0,000 0,000
Current smoker 148 14,37 (12,3-16,6) 91 6,96 (5,7-8,4) 189 14,59 (12,7-16,6) 152 7,14 (6,1-8,3)
Ex-smoker 564 54,76 (51,7-57,7) 368 28,16 (25,7-30,6) 767 59,23 (56,5-61,8) 592 27,82 (25,9-29,7)
p= p=
Alcohol consumption No 819 79,51 (76,9-81,8) 1247 95,41 (94,1-96,4) 994 76,76 (74,3-78,9) 2019 94,88 (93,8-95,7)
0,000 0,000
Yes 211 20,49 (18,1-23,0)) 60 4,59 (3,5-5,8) 301 23,24 (21,0-25,6) 109 5,12 (4,2-6,1)
Serving of fruits and
p= p=
vegetables at least twice per No 499 48,45 (45,4-51,5) 578 44,22 (41,5-46,9) 577 44,56 (41,8-47,2) 857 40,27 (38,2-42,3)
0,023 0,014
day
Yes 531 51,55 (48,4,54,5) 729 55,78 (53,0-58,4) 718 55,44 (52,7-58,1) 1271 59,73 (57,6-61,7)
Biological factors
p= p=
Age group 60-65 276 26,8 (24,1-29,5) 337 25,7 (23,4-28,2) 424 32,74 (30,2-35,3) 791 37,17 (35,1-39,2)
0,524 0,049
66-70 226 21,9 (19,5-24,5) 271 20,7 (18,6-23,0) 326 25,17 (22,8-27,6) 503 23,64 (21,8-25,4)
71-75 198 19,2 (16,9-21,7) 282 21,5 (19,4-23,8) 223 17,22 (15,2-19,3) 322 15,13 (13,6-16,7)
76-80 157 15,2 (13,1-17,5) 214 16,3 (14,4-18,4) 151 11,66 (10,0-13,5) 265 12,45 (11,1-13,9)
80+ 173 16,8 (14,6-19,2) 203 15,5 (13,6-17,5) 171 13,20 (11,4-15,1) 247 11,61 (10,3-13,0)
2 p= p=
BMI (Kg/m ) Underweight (<18,5) 17 1,80 (1,1-2,8) 30 2,66 (1,8-3,7) 41 3,55 (2,6-4,7) 50 2,69 (2,0-3,5)
0,000 0,000
Normal (18,5-24,9) 405 42,95 (39,8-46,1) 320 28,39 (25,8-31,1) 491 42,51 (39,6-45,3) 520 27,94 (25,9-30,0)
Overweight (≥25,0-29,9) 379 40,19 (37,1-43,3)) 442 39,22 (36,4-42,1) 477 41,30 (38,4-44,1) 737 39,60(37,4-41,8)
Obese (≥30,0) 142 15,06 (12,9-17,4) 335 29,72 (27,1,32,4) 146 12,64 (10,8-14,6) 554 29,77 (27,7-31,8)
p= p=
Waist circumference (in cm) Normal 359 36,04 (33,1-39,0) 162 13,46 (11,6-15,5) 465 38,4 (35,6-41,1) 273 13,94 (12,4-15,5)
0,000 0,000
High (>90 cm for men y >80 cm for
637 63,96 (60,9-66,8) 1 86,54 (84,4-88,3) 746 61,6 (58,8-64,3) 1685 86,06 (84,4-87,5)
women)
P= p=
Comorbilities ≤2 781 75,83 (73,1-78,3) 822 62,89 (60,2-65,4) 975 75,29 (72,8-77,5) 1284 60,34 (58,2-62,3)
0,000 0,000
3+ 249 24,17 (21,6-26,8) 485 37,11 (34,5-39,7) 320 24,71 (22,4-27,1) 844 39,66 (37,6-41,7)
Page 48 of 59
[HP431] [23502]
Health System
p= p=
Health Insurance Contributive 389 37,77 (34,8-40,7) 499 38,18 (35,5-40,8) 572 44,17 (41,4-46,8) 987 46,38 (44,2-48,5)
0,053 0,286
Subsidized 593 57,57 (54,5-60,5) 765 58,53 (55,8-61,1) 660 50,97 (48,2-53,6) 1069 50,23 (48,1-52,3)
Exception 2 0,19 (0,0-0,7) 6 0,46 (0,2-1,0) 9 0,69 (0,3-1,3) 10 0,47 (0,2-0,8)
Special 7 0,68 (0,3-1,4) 13 0,99 (0,5-1,7) 18 1,39 (0,8-2,1) 23 1,08 (0,7-1,6)
None 38 3,69 (2,6-5,0) 23 1,76 (1,1-2,6) 35 2,7 (1,9-3,7) 38 1,79 (1,3-2,4)
No 1 0,1 (0,0-0,5) 1 0,08 (0,0-0,5) 1 0,08 (0,0-0,5) 1 0,05 (0,0-0,3)
Did you receive the
requested care from your
p= p=
health service for the health Yes 206 20,00 (17,6-22,5) 331 25,33 (23,0-27,7) 286 22,08 (19,9-24,4) 583 27,40 (25,5-29,3)
0,002 0,000
problems that you have
presented?
No 824 80,00 (77,4-82,3) 976 74,67 (72,2-76,9) 1009 77,92 (75,5-80,0) 1545 72,60 (70,6-74,4)
Page 49 of 59
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APPENDIX 2: Awareness of Hypertension

Variable Categories Awareness of hypertension Non Awareness of Hypertension
Men Women Men Women
n = 1134 n = 2129 n = 1191 n = 1306
Non Awareness Non Awareness

Awareness of HTA Awareness of HTA p- p-
n n n of HTA % n of HTA %
% (IC95%) % (IC95%) value value
(IC95%) (IC95%)
Total 1134 2129 1191 1306
p= P=
Age group 60-65 258 23,7 (21,2-26,5) 567 26,63 (26,9-31,2) 442 37,11 (35,8-41,7) 561 42,96 (42,9-48,8)
0,021 0,018
66-70 276 25,3 (22,7-28,1) 469 22,03 (21,6-25,6) 276 23,17 (21,2-26,3) 305 23,35 (21,9-26,9)
71-75 222 20,1 (17,7-22,7) 417 19,59 (17,9-21,7) 199 16,71 (14,8-19,3) 187 14,32 (12-16,1)
76-80 162 14,2 (12,1-16,5) 337 15,83 (13,5-16,9) 146 12,26 (10,6-14,6) 142 10,87 (8,3-11,8)
80+ 216 16,7 (14,5-19,2) 339 15,92 (11,2-14,3) 128 10,75 (6,7-10) 111 8,5 (4,8-7,7)
p= p=
Ethnicity Indigenous 123 10,9 (9,1-13) 128 6,01 (4,9-7,1) 158 13,27 (11,5-15,6) 111 8,5 (6,9-10,1)
0,000 0,019
Gypsy / ROM 1 0,1 (0-1,7) 4 0,19 (0,1-0,6) 5 0,42 (0,1-1) 5 0,38 (0,1-1)
Root of the archipelago of San
9 0,8 (0,4-1,6) 11 0,52 (0,3-1) 8 0,67 (0,3-1,4) 9 0,69 (0,3-1,3)
Andres y Providencia
Palenquero de San Basilio 110 10,2 (8,5-12,3) 152 7,14 (6,6-9,2) 3 0,25 (0,1-0,9) 1 0,08 (0-0,6)
627 58 (54,8-61) 1,28 60,12 (60,8-65,4) 94 7,89 (6,8-10,1) 94 7,2 (6,4-9,6)
Colombian
None of the above 264 20,1 (17,7-22,7) 554 26,02 (20,5-24,4) 698 58,61 (57,4-63,2) 812 62,17 (60,6-66,3)
Don't know / didn't answer - - - - 225 18,89 (14,5-19) 274 20,98 (16,9-21,6)
p= p=
Geographic region Atlantic 166 14,3 (12,2-16,6) 299 14,04 (11,7-14,9) 238 19,98 (17,5-22,2) 202 15,47 (13,5-17,8)
0,983 0,018
Eastern 146 12,9 (10,9-15,1) 266 12,49 (10,6-13,6) 172 14,44 (13-17,3) 196 15,01 (13-17,2)
Orinoquia y Amazonia 7 0,6 (0,3-1,3) 12 0,56 (0,4-1,1) 12 1,01 (0,6-2) 8 0,61 (0,4-1,4)
Bogota 224 19,9 (17,5-22,5) 414 19,45 (17,9-21,6) 216 18,14 (16,5-21,2) 241 18,45 (16,2-20,8)
Central 351 30,9 (28,1-33,9) 683 32,08 (31-35,4) 312 26,2 (22,9-28,2) 369 28,25 (26,1-31,4)
Pacific 240 21,5 (19-24,2) 455 21,37 (19,4-23,3) 241 20,24 (17,6-22,4) 290 22,21 (19,4-24,2)
p= p=
Residence Urban 900 78,7 (76,1-81,2) 1766 82,95 (80,8-84,3) 838 70,36 (68,3-73,7) 1018 77,95 (76,1-80,9)
0,012 0,000
Rural 234 21,3 (18,8-23,9) 363 17,05 (15,7-19,2) 353 29,64 (26,3-31,7) 288 22,05 (19,1-23,9)
I 362 32,1 (29,3-35,1) 645 30,3 (28,4-32,7) 495 41,56 (38,8-44,7) 455 34,84 (31,7-37,3)
(Strata) 0,176 0,000
II 494 43,7 (40,6-46,8) 918 43,12 (40,8-45,4) 463 38,87 (35,9-41,8) 517 39,59 (36,6-42,4)
III 246 21,8 (19,3-24,5) 473 22,22 (20,1-24) 204 17,13 (15-19,6) 276 21,13 (19,3-24,1)
Page 50 of 59
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IV 27 2,1 (1,4-3,2) 70 3,29 (2,5-4,2) 21 1,76 (1-2,6) 45 3,45 (2,7-4,9)

V – VI 5 0,3 (0,1-0,9) 23 1,08 (0,7-1,8) 8 0,67 (0,3-1,4) 13 1 (0,4-1,6)
Education
p= p=
Years spent in school ≤6 years 919 80,6 (78,1-83) 1827 85,81 (83,8-87,1) 987 82,87 (79,5-84,2) 1060 81,16 (77,6-82,3)
0,001 0,405
7 to 12 years 153 13,4 (11,4-15,6) 233 10,94 (9,8-12,8) 153 12,85 (11,9-16) 192 14,7 (13,4-17,7)
>12 years 62 6 (4,7-7,6) 69 3,24 (2,5-4,2) 51 4,28 (3,2-5,6) 54 4,13 (3,5-5,9)
p= p=
Educational level None 174 14,6 (12,5-16,9) 426 20,01 (16,5-20,1) 219 18,39 (15,4-20) 216 16,54 (14-18,4)
0,016 0,496
Primary 666 58,8 (55,7-61,8) 1281 60,17 (59-63,6) 699 58,69 (55,9-61,9) 753 57,66 (53,8-59,6)
Secundary 189 16,8 (14,6-19,3) 309 14,51 (13,5-16,9) 191 16,04 (14,4-18,9) 239 18,3 (17,1-21,8)
Technical 35 3,3 (2,4-4,7) 59 2,77 (2,2-3,8) 37 3,11 (2,4-4,5) 51 3,91 (3,1-5,5)
University 46 4,4 (3,2-5,8) 32 1,5 (1-2,1) 34 2,85 (2,1-4,2) 34 2,6 (1,9-3,9)
Postgraduate 16 1,6 (1-2,6) 12 0,56 (0,3-1,1) 8 0,67 (0,3-1,2) 7 0,54 (0,3-1,3)
Don't know / didn't answer 8 0,5 (0,2-1,2) 10 0,47 (0,2-0,8) 3 0,25 (0-0,7) 6 0,46 (0,1-1)
Income
What is the range in which
you receive your monthly Less than one CLMW (- p= p=
547 47,9 (44,8-51) 1196 56,18 (53,8-58,5) 657 55,16 (52,4-58,3) 729 55,82 (52,1-58)
income? (Current Legal 644,350) 0,016 0,019
Minimum Wage -CLMW)
One CLMW (644,350) 194 17 (14,8-19,5) 304 14,28 (12,6-15,9) 191 16,04 (14,4-18,9) 193 14,78 (13,6-17,9)
More than 1 CLMW and 2
163 14,9 (12,8-17,3) 145 6,81 (5,9-8,3) 148 12,43 (10,8-14,8) 91 6,97 (5,4-8,4)
CLMW (644.351 a 1.288.700)
54 5,1 (3,9-6,6) 38 1,78 (1,4-2,7) 46 3,86 (2,9-5,3) 24 1,84 (1,4-3,1)
CLMW (1.288.701 a 1.933.050)
20 1,9 (1,2-3) 17 0,8 (0,4-1,3) 11 0,92 (0,6-1,9) 10 0,77 (0,4-1,6)
CLMW (1.933.051 a 2.577.400)
More than 4 CLMW (2.577.401) 25 2,1 (1,4-3,2) 12 0,56 (0,2-0,9) 12 1,01 (0,5-1,7) 5 0,38 (0,2-1,1)
Don't know / didn't answer 131 11 (9,2-13,2) 417 19,59 (17,8-21,5) 126 10,58 (7,9-11,4) 254 19,45 (17-21,7)
How many people depend p= p=

None 401 33,3 (30,5-36,3) 1382 65,04 (60,9-65,4) 383 32,27 (27,8-33,4) 834 64,01 (60,4-66,1)
totally or partially of your 0,016 0,017
income?
1 316 27,9 (25,2-30,7) 335 15,76 (15-18,5) 338 28,48 (26,3-31,7) 228 17,5 (15-19,4)
2 166 15,5 (13,3-17,9) 174 8,19 (7,5-10,2) 172 14,49 (13-17,3) 95 7,29 (6,2-9,3)
3 102 9,5 (7,8-11,5) 94 4,42 (3,8-5,8) 123 10,36 (9,1-12,8) 62 4,76 (3,8-6,3)
4 78 7,1 (5,6-8,9) 63 2,96 (2,6-4,3) 73 6,15 (5-7,9) 42 3,22 (2,4-4,6)
5 34 3,3 (2,4-4,7) 35 1,65 (1-2,1) 44 3,71 (2,8-5,2) 19 1,46 (1,1-2,7)
6 14 1,1 (0,6-2) 15 0,71 (0,4-1,2) 28 2,36 (1,6-3,5) 10 0,77 (0,4-1,6)
7 8 0,8 (0,4-1,6) 7 0,33 (0,2-0,8) 11 0,93 (0,6-1,9) 7 0,54 (0,3-1,3)
8 9 0,9 (0,5-1,7) 8 0,38 (0,2-0,8) 5 0,42 (0,1-1) 4 0,31 (0,1-1)
9 5 0,5 (0,2-1,2) 5 0,24 (0,1-0,5) 4 0,34 (0,1-1) 1 0,08 (0-0,6)
10 - - 6 0,28 (0,1-0,7) 5 0,42 (0,1-0,9) 1 0,08 (0-0,6)
11 - - 1 0,05 (0-0,4) 1 0,08 (0-0,7) - -
p= p=
income is enough to meet More than enough 19 1,6 (1-2,6) 36 1,69 (1,1-2,3) 16 1,34 (0,7-2,1) 20 1,53 (0,8-2,1)
0,355 0,118
your needs?
Page 51 of 59
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Enough 210 20 (17,6-22,6) 433 20,34 (19,5-23,4) 210 17,63 (15,6-20,2) 260 19,91 (18,2-23)
Not enough 522 47,3 (44,2-50,4) 904 42,46 (42,6-47,3) 599 50,29 (49,6-55,6) 644 49,31 (48,3-54,2)
Very insufficient 172 15,9 (13,8-18,3) 325 15,27 (14,1-17,5) 204 17,13 (15,1-19,7) 182 13,94 (11,8-15,9)
Intermediary
Determinants
p= p
How many full meals do One meal 15 1,32 (0,7-2,1) 34 1,60 (1,1-2,2) 17 1,43 (0,8-2,2) 25 1,91 (1,2-2,8)
0,095 =0,426
you make per day?
Two meals 234 20,63 (18,3-23,0) 493 23,16 (21,4-24,9) 266 22,33 (20,0-24,7) 309 23,66 (21,4-26,0)
Psychosocial
circumstances
p= p=
Do you live alone? No 1012 89,4 (87,3-91,1) 1966 92,34 (90,9-93,5) 1048 87,99 (86,3-90,1) 1211 92,73 (90,4-93,6)
0,003 0,000
Yes 122 10,6 (8,9-12,7) 163 7,66 (6,5-9,1) 143 12,01 (9,9-13,7) 95 7,27 (6,4-9,6)
Have you been displaced
by armed conflict or p= p=
Yes 184 17 (14,8-19,5) 278 13,06 (11,8-15) 217 18,22 (15,8-20,5) 163 12,48 (11,3-15,3)
violence, sometime in your 0,014 0,000
life?
No 950 83 (80,5-85,2) 1851 86,94 (85-88,2) 973 81,7 (79,4-84,1) 1143 87,52 (84,7-88,7)
Don't know / didn't answer - - - - 1 0,08 (0-0,7) - -
How old were you when
p= p=
you were first displaced? 182 43 (±20) 270 40 (±21) 215 44 (±19) 159 41 (±20)
0,120 0,170
(n., average ± S,D)
p= p=
Are you satisfied with your Yes 874 93,88 (92,1-95,2) 1618 94,62 (93,4-95,5) 989 95,83 (94,4-96,8) 1067 95,61 (94,2-96,6)
0,432 0,798
life?
No 57 6,12 (4,7-7,8) 92 5,38 (4,4-6,5) 43 4,17 (3,1-5,5) 49 4,39 (3,3-5,7)
If you compare your
current health with that one
p= p=
a year ago. Would you say Better 141 12,43 (10,6-14,4) 331 15,55 (14,0-17,1) 127 10,66 (9,0-12,5) 212 16,23 (14,3-18,3)
0,015 0,000
that you are now better,
equal or worse?
Same 505 44,53 (41,6-47,4) 846 39,74 (37,6-41,8) 682 57,26 (54,4-60,0) 610 46,71 (44,0-49,4)
Worse 282 24,87 (22,4-27,4) 526 24,71 (22,9-26,5) 220 18,47 (16,3-20,7) 292 22,36 (20,1-24,7)
In comparison with other
people of your age. Would p= p=
Better 460 40,56 (37,7-43,4) 899 42,23 (40,1-44,3) 497 41,73 (38,9-44,5) 621 47,55 (44,8-50,2)
you say your health is 0,124 0,000
better, equal or worse?
Same 330 29,10 (26,5-31,8) 551 25,88 (24,0-27,7) 416 34,9 (32,2-37,6) 345 26,42 (24,0-28,8)
Worse 102 8,99 (7,4-10,8) 174 8,17 (7,0-9,4) 74 6,21 (4,9-7,7) 101 7,73 (6,4-9,3)
In the last year, have you
p= p=
been insulted or mistreated Yes 77 6,79 (5,4-8,4) 127 5,97 (5,0-7,0) 90 7,56 (6,1-9,2) 81 6,20 (5,0-7,6)
0,320 0,317
by a stranger?
Page 52 of 59
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No 853 75,22 (72,6-77,6) 1579 74,17 (72,2-75,9) 941 79,01 (76,6-81,2) 1034 79,17 (76,8-81,2)
Behavioral factors
Do you have any
¿Do you have any limitation to
restriction to do physical
walk 5 blocks (400 mts)?
activity?
p= p=
None 729 67,4 (64,4-70,2) 1108 52,04 (53,9-58,6) 926 77,75 (78,2-82,9) 889 68,07 (69-74,3)
0,016 0,000
A little restruction 174 15,6 (13,5-18) 428 20,1 (18,6-22,4) 128 10,75 (8,9-12,6) 198 15,16 (13-17,2)
Some restriction 94 8,4 (6,8-10,3) 232 10,9 (9,7-12,6) 58 4,87 (3,6-6,1) 99 7,58 (5,5-8,5)
High restriction 97 7,4 (5,9-9,2) 283 13,29 (9,5-12,4) 62 5,21 (2,4-4,7) 89 6,81 (4,6-7,4)
Complete restriction 40 1,2 (0,7-2,1) 76 3,57 (0,9-2,1) 17 1,43 (0,3-1,4) 28 2,14 (0,2-1,2)
Don't know / didn't answer - - 2 0,09 (0-0,4) - - 3 0,23 (0-0,7)
¿Do you need any special help
(walking stick, ,walker,) to wak 5
blocks (400 mts)?
p= p=
Yes 206 13,8 (11,8-16,1) 400 18,79 (13-19,3) 125 10,5 (6,3-9,6) 151 11,56 (7,9-11,4)
0,004 0,685
No 916 85,4 (83,1-87,5) 1725 81,02 (83,7-87) 1062 89,17 (90-93,3) 1151 88,13 (88,4-91,9)
Don't know / didn't answer 12 0,8 (0,4-1,6) 4 0,19 (0-0,4) 4 0,34 (0,1-1) 4 0,31 (0-0,7)
¿Do you walk, at least three
times per week, between 9 and
Physical activity
20 blocks (1,6 Km) without
stopping?
p= p=
Yes 273 25,8 (23,2-28,7) 336 15,78 (15,3-18,9) 287 24,1 (22,3-27,5) 217 16,62 (16,1-20,6)
0,000 0,000
No 861 74,2 (71,3-76,8) 1793 84,22 (81,1-84,7) 904 75,9 (72,5-77,7) 1089 83,38 (79,4-83,9)
times per week less than 8
blocks (0,5 Km) without
stopping?
p= p=
Yes 625 59 (55,9-62) 755 35,46 (35,8-40,3) 791 66,41 (66,7-72,2) 586 44,87 (44,1-50)
0,000 0,000
No 507 40,9 (37,9-44) 1370 64,35 (59,5-64,1) 399 33,5 (27,7-33,2) 719 55,05 (49,9-55,8)
Don't know / didn't answer 2 0,1 (0-0,7) 4 0,19 (0,1-0,5) 1 0,08 (0-0,7) 1 0,08 (0-0,6)
p p=
Smoking Never smoked 343 29,2 (26,4-32,1) 1387 65,15 (62,7-67,2) 314 26,36 (23,8-29) 845 64,7 (61,6-67,3)
=0,000 0,000
Current smoker 110 9,8 (8,1-11,8) 113 5,31 (4,3-6,4) 227 19,06 (17-21,7) 130 9,95 (8,1-11,6)
Ex-smoker 681 61 (57,9-64) 629 29,54 (27,6-31,9) 650 54,58 (51,4-57,4) 331 25,34 (23,3-28,4)
p= p=
Alcohol consumption No 913 79,2 (76,6-81,6) 2041 95,87 (94,5-96,4) 900 75,57 (71,8-77,1) 1225 93,8 (91,7-94,7)
0,000 0,000
Yes 221 20,8 (18,4-23,4) 88 4,13 (3,6-5,5) 291 24,43 (22,9-28,2) 81 6,2 (5,3-8,3)
p= p=
vegetables at least twice No 533 44,9 (41,8-48) 921 43,26 (38-42,6) 543 45,59 (40,8-46,8) 514 39,36 (35,8-41,6)
0,041 0,002
per day
Yes 601 55,1 (52-58,2) 1208 56,74 (57,4-62) 648 54,41 (53,2-59,2) 792 60,64 (58,4-64,2)
Biological factors
p= p=
BMI (Kg/m2) Underweight (<18,5) 21 1,8 (1,2-2,9) 33 1,82 (1,1-2,3) 37 3,4 (2,3-4,4) 47 4,01 (1,4-3,1)
0,000 0,000
Normal (18,5-24,9) 368 36,5 (33,5-39,5) 438 24,13 (22,3-26,3) 528 48,48 (45,7-51,7) 402 34,27 (31,6-37,2)
Page 53 of 59
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Overweight (≥25,0-29,9) 444 44,8 (41,7-47,9) 725 39,94 (38,2-42,8) 412 37,83 (35,2-41) 454 38,7 (37,1-42,9)
Obese (≥30,0) 176 16,9 (14,7-19,4) 619 34,1 (31,5-36) 112 10,28 (8,4-12) 270 23,02 (21,2-26,2)
Waist circumference (in p= p=
Normal 308 28,9 (26,1-31,8) 228 11,59 (9,8-12,8) 516 44,99 (41,4-47,4) 207 17,32 (14,8-19,2)
cm) 0,000 0,000
High (>90 cm for men y >80 cm
752 71,1 (68,2-73,9) 1739 88,41 (87,2-90,2) 631 55,01 (52,6-58,6) 988 82,68 (80,8-85,2)
for women)
p= p=
Comorbilities ≤2 705 61,7 (58,6-64,7) 1116 52,42 (50,3-55) 1051 88,25 (86,3-90,1) 990 75,8 (72-77,2)
0,000 0,000
3+ 429 38,3 (35,3-41,4) 1013 47,58 (45-49,7) 140 11,75 (9,9-13,7) 316 24,2 (22,8-28)
Health System
p= p=
Health Insurance Contributive 517 45,9 (42,8-49) 958 45 (43-47,7) 444 37,28 (34,8-40,6) 528 40,43 (38,8-44,6)
0,102 0,043
Subsidized 566 49,4 (46,3-52,6) 1110 52,14 (49,5-54,2) 687 57,68 (54,1-60) 724 55,44 (51-56,9)
Exception 8 0,7 (0,3-1,5) 10 0,47 (0,2-0,9) 3 0,25 (0,1-0,9) 6 0,46 (0,2-1,2)
Special 18 1,6 (1-2,6) 23 1,08 (0,7-1,7) 7 0,59 (0,3-1,4) 13 1 (0,5-1,7)
None 23 2,1 (1,4-3,2) 28 1,32 (0,8-1,9) 50 4,2 (3,3-5,7) 33 2,53 (1,9-3,9)
Don't know / didn't answer 2 0,2 (0,1-0,8) - - - - 2 0,15 (0-0,7)
Did you receive the
requested care from your
p= p=
health service for the Yes 280 24,1 (21,5-26,9) 595 27,95 (26,3-30,6) 212 17,8 (15-19,5) 319 24,43 (22-27,1)
0,045 0,000
health problems that you
have presented?
No 854 75,9 (73,1-78,5) 1534 72,05 (69,4-73,7) 979 82,2 (80,5-85) 987 75,57 (72,9-78)
Page 54 of 59
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APPENDIX 3: Control of Hypertension

Variable Categories Controlled Hypertension Non-Controlled Hypertension
Men Women Men Women
n = 1038 n = 1610 n = 563 n = 913
Controlled Controlled
p- Non-Controlled Non-Controlled p-
n Hypertension % n Hypertension % n n
value Hypertension % (IC95%) Hypertension % (IC95%) value
(IC95%) (IC95%)
Total 1038 1610 563 913
p= p=
Age group 60-65 306 29,48 (28,1-34,1) 488 30,3 (30,6-35,7) 114 20,3 (17,2-24,3) 208 22,8
0,858 0,144
66-70 240 23,12 (20,8-26,3) 386 24 (23,1-27,7) 131 23,3 (20,9-28,5) 177 19,4
71-75 182 17,53 (15,1-20,1) 277 17,2 (15,1-19,2) 119 21,1 (18,9-26,2) 211 23,1
76-80 145 13,97 (12,3-16,8) 227 14,1 (11,3-14,9) 87 15,5 (12,4-18,8) 162 17,7
80+ 165 15,9 (11,6-16,1) 232 14,4 (10-15,4) 112 19,9 (14,3-20,9) 155 17,0
Structural
determinants
p= p=
Ethnicity Indigenous 111 10,69 (9-13,1) 106 6,6 (5,4-8,1) 70 12,4 (10,1-16) 60 6,6
0,000 0,001
Gypsy / ROM 4 0,39 (0,1-1) 3 0,2 (0,1-0,7) 6 1,1 (0,5-2,6) 2 0,2
Root of the archipelago of San
6 0,58 (0,2-1,2) 10 0,6 (0,3-1,2) 53 9,4 (7,3-12,5) 6 0,7
Andres y Providencia
Palenquero de San Basilio 2 0,19 (0,1-0,9) 115 7,1 (5,9-8,5) 304 54 (51,6-60,3) 66 7,2
98 9,44 (8,1-12) 989 61,4 (59,0-63,7) 130 23,1 (17,2-24,3) 527 57,7
Colombian
None of the above 588 56,65 (56,3-62,7) 387 24 (22,0-26,1) - - 252 27,6
Don't know / don't answer 229 22,06 (16,3-21,3) - - - - - -
p= p=
Geographic region Atlantic 173 16,67 (13,9-18,7) 231 14,4 (11,8-15,4) 92 16,3 (12,8-19,2) 134 14,7
0,457 0,0874
Eastern 138 13,29 (11,4-15,9) 212 13,2 (10,9-14,5) 68 12,1 (9,7-15,5) 101 11,1
Orinoquia y Amazonia 9 0,87 (0,4-1,7) 10 0,6 (0,4-1,3) 2 0,4 (0,1-1,6) 5 0,6
Bogota 191 18,4 (16,3-21,3) 289 18 (16,1-20,3) 130 23,1 (19,8-27,2) 206 22,6
Central 312 30,06 (27,3-33,3) 532 33 (31,8-36,9) 143 25,4 (21,7-29,3) 245 26,8
Pacific 215 20,71 (18-23,3) 336 20,9 (18,8-23,1) 128 22,7 (19,4-26,8) 222 24,3
p= p=
Residence Urban 778 74,95 (71,7-77,3) 1336 83 (80,7-84,8) 427 75,8 (72-79,4) 714 78,2
0,000 0,294
Rural 260 25,05 (22,7-28,3) 274 17 (15,2-19,3) 136 24,2 (20,6-28) 199 21,8
I 367 35,36 (32,7-38,9) 488 30,3 (28,1-33,1) 202 35,9 (31,6-40) 323 35,4
(Strata) 0,012 0,636
II 427 41,14 (38,1-44,4) 685 42,6 (39,9-45,2) 253 44,9 (41,1-49,8) 384 42,1
III 215 20,71 (18,2-23,4) 362 22,5 (20,2-24,7) 94 16,7 (13,7-20,3) 177 19,4
IV 25 2,41 (1,2-3,1) 57 3,5 (2,5-4,5) 10 1,8 (0,9-3,4) 21 2,3
V - VI 4 0,39 (0,2-1,2) 18 1,1 (0,7-2) 4 0,7 (0,1-1,6) 8 0,9
Page 55 of 59
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Education
p= p=
Years spent in school ≤6 years 845 81,41 (78,2-83,3) 1367 84,9 (82,5-86,4) 465 82,6 (78,9-85,6) 806 88,3
0,047 0,003
7 to 12 years 140 13,49 (11,6-16,1) 184 11,4 (10,1-13,5) 70 12,4 (9,7-15,5) 86 9,4
>12 years 53 5,11 (4,1-7,1) 59 3,7 (2,9-4,9) 28 5 (3,5-7,5) 21 2,3
p= p=
Educational level None 175 16,86 (14,2-19) 295 18,3 (15-19,1) 104 18,5 (14,1-20,7) 215 23,6
0,018 0,025
Primary 605 58,29 (54,8-61,2) 973 60,4 (58,5-63,7) 320 56,8 (53,6-62,2) 546 59,8
Secundary 175 16,86 (14,8-19,7) 240 14,9 (13,7-17,6) 87 15,5 (12,4-18,8) 119 13,0
Technical 34 3,28 (2,5-4,9) 53 3,3 (2,5-4,4) 18 3,2 (2,1-5,4) 17 1,9
University 31 2,99 (2,2-4,5) 30 1,9 (1,3-2,9) 25 4,4 (3,1-6,8) 7 0,8
Postgraduate 13 1,25 (0,8-2,3) 9 0,6 (0,3-1,2) 5 0,9 (0,4-2,4) 5 0,6
Don't know / didn't answer 5 0,48 (0,1-1) 10 0,6 (0,3-1,1) 4 0,7 (0,2-1,8) 4 0,4
Income
What is the range in
which you receive your
Less than one CLMW (- p= p=
monthly income? 532 51,25 (48,1-54,6) 885 55 (51,3-56,7) 288 51,2 (46,8-55,6) 549 60,1
644,350) 0,018 0,024
(Current Legal Minimum
Wage -CLMW)
One CLMW (644,350) 191 18,4 (16,3-21,3) 237 14,7 (13,2-17) 83 14,7 (11,9-18,1) 119 13,0
142 13,68 (11,6-16,1) 114 7,1 (6-8,8) 67 11,9 (9,6-15,3) 58 6,4
CLMW (644.351 - 1.288.700)
34 3,28 (2,5-4,9) 31 1,9 (1,5-3,1) 32 5,7 (4,2-8,4) 14 1,5
CLMW (1.288.701 - 1.933.050)
12 1,16 (0,7-2,2) 13 0,8 (0,4-1,4) 10 1,8 (1,1-3,7) 5 0,6
CLMW (1.933.051 - 2.577.400)
More than 4 SMLV (2.577.401) 16 1,54 (0,8-2,4) 12 0,8 (0,4-1,4) 10 1,8 (0,8-3,2) 2 0,2
Don't know / didn't answer 111 10,69 (8,3-12,2) 318 19,8 (18-22,3) 73 13 (9,7-15,5) 166 18,2
How many people

p= p
depend totally or None 349 33,79 (28,6-34,6) 1046 65,1 (61,1-66,2) 202 35,9 (30,6-38,9) 592 65,0
0,017 =0,023
partially of your
income?
1 295 28,56 (26,3-32,2) 261 16,2 (14,7-18,7) 158 28,1 (24,3-32,2) 147 16,1
2 148 14,33 (12,6-17,2) 139 8,6 (7,8-11) 86 15,3 (13,2-19,6) 65 7,1
3 94 9,1 (8-11,9) 72 4,5 (3,7-6) 48 8,5 (6,4-11,4) 41 4,5
4 68 6,58 (5,5-8,9) 39 2,4 (2-3,7) 41 7,3 (5-9,6) 32 3,5
5 37 3,58 (2,8-5,3) 23 1,4 (0,9-2,1) 14 2,5 (1,7-4,7) 16 1,8
6 21 2,03 (1,1-2,9) 10 0,6 (0,3-1,2) 5 0,9 (0,4-2,4) 7 0,8
7 6 0,58 (0,3-1,5) 4 0,3 (0,1-0,8) 5 0,9 (0,4-2,4) 4 0,4
8 7 0,68 (0,4-1,6) 5 0,3 (0,1-0,7) 3 0,5 (0,2-1,8) 4 0,4
9 6 0,58 (0,3-1,5) 3 0,2 (0-0,6) 1 0,2 (0-1,4) 2 0,2
10 2 0,19 (0-0,8) 5 0,3 (0,1-0,8) - - 1 0,1
11 - - 1 0,1 (0-0,5) - - - -
p= p=
income is enough to More than enough 17 1,64 (1-2,7) 21 1,3 (0,9-2,1) 11 2 (0,9-3,4) 19 2,1
0,119 0,209
meet your needs?
Enough 185 17,82 (16,3-21,3) 341 21,2 (20-24,5) 97 17,2 (15,4-22,2) 176 19,3
Page 56 of 59
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Not enough 490 47,21 (45,6-52) 710 44,1 (43,4-48,7) 263 46,7 (44,1-52,8) 376 41,2
Very insufficient 168 16,18 (14,8-19,7) 236 14,7 (13,4-17,3) 91 16,2 (13,2-19,6) 143 15,7
Don't know / didn't answer 178 17,15 (11,6-16,1) 302 18,8 (13,4-17,3) 101 17,9 (12,3-18,6) 199 21,8
Intermediary
Determinants
p= p=
How many full meals do One meal 12 1,16 (0,6-2,0) 25 1,55 81,0-2,2) 12 2,13 (1,2-3,7) 12 1,31 (0,7-2,3)
0,347 0,130
you make per day?
Two meals 227 21,87 (19,4-24,4) 375 23,29 (21,2-25,4) 123 21,85 (18,6-25,4) 214 23,44 (20,8-26,3)
Psychosocial
circumstances
p= p=
Do you live alone? No 924 89,02 (87,5-91,5) 1478 91,8 (89,9-92,9) 498 88,5 (85,3-91) 847 92,8
0,017 0,005
Yes 114 10,98 (8,5-12,5) 132 8,2 (7,1-10,1) 65 11,6 (9-14,7) 66 7,2
Have you been
displaced by armed p= p
Yes 171 16,47 (15-20) 203 12,6 (11-14,6) 99 17,6 (14,6-21,3) 126 13,8
conflict or violence, 0,006 =0,051
sometime in your life?
No 867 83,53 (80-85) 1047 87,4 (85,4-89) 464 82,4 (78,7-85,4) 787 86,2
Don't know / didn't answer - - - - - - - -
How old were you when
you were first p= p=
168 43 (±20) 196 40 (±22) 98 45 (±20) 123 41 (±20)
displaced? (n., average 0,243 0,077
± S,D)
p= p=
Are you satisfied with Yes 833 96,19 (94,6-97,2) 1243 94,45 (93,0-95,5) 424 91,38 (88,4-93,6) 688 95,69 (93,9-96,9)
0,061 0,003
your life?
No 33 3,81 (2,7-5,3) 73 5,55 (4,4-6,9) 40 8,62 (6,3-11,5) 31 4,31 (3,0-6,0)
If you compare your
current health with that
one a year ago. Would p= p=
Better 129 12,43 (10,5-14,5) 263 16,34 814,6-18,2) 58 10,30 (8,0-13,0) 137 15,01 812,8-17,4)
you say that you are 0,000 0,008
now better, equal or
worse?
Same 518 49,90 (46,8-52,9) 672 41,74 (39,3-44,1) 253 44,94 (40,8-49,0) 363 39,76 (36,6-42,9)
Worse 216 20,81 (18,4-23,3) 375 23,29 (21,2-25,4) 152 27,00 (23,4-30,8) 218 23,88 (21,2-26,7)
In comparison with
other people of your
p= p=
age. Would you say Better 408 39,31 (36,3-42,3) 736 45,71 (43,2-48,1) 233 41,39 (37,3-45,5) 352 38,55 (35,4-41,7)
0,000 0,264
your health is better,
equal or worse?
Same 331 31,89 (29,1-34,7) 394 24,47 (22,4-26,6) 164 29,13 (25,5-33,0) 255 27,93 (25,1-30,9)
Worse 85 8,19 (6,6-10,2) 121 7,52 (6,3-8,9) 50 8,88 (6,7-11,5) 77 8,43 (6,7-10,4)
In the last year, have p= p=
Yes 66 6,36 (5,0-8,0) 94 5,84 (4,7-7,0) 47 8,35 (6,3-10,9) 54 5,91 84,5-7,6)
you been insulted or 0,482 0,057
Page 57 of 59
[HP431] [23502]
mistreated by a
stranger?
No 799 76,97 (74,3-79,4) 1220 75,78 (73,6-77,8) 417 74,07 (70,2-77,5) 663 72,62 (69,675,4)
Behavioral factors
Do you have any
¿Do you have any limitation to
restriction to do physical
walk 5 blocks (400 mts)?
activity?
p= p=
None 730 70,33 (70,8-76,5) 882 54,8 (55,7-61) 362 64,3 (61,9-70,1) 482 52,8
0,018 0,001
A little restruction 138 13,29 (11,4-15,9) 314 19,5 (18,2-22,5) 94 16,7 (13,5-20) 182 19,9
Some restriction 74 7,13 (5,2-8,4) 163 10,1 (8,7-11,9) 41 7,3 (5,9-10,7) 96 10,5
High restriction 67 6,45 (3,8-6,7) 192 11,9 (8,2-11,4) 51 9,1 (6,4-11,4) 124 13,6
Complete restriction 29 2,79 (0,6-2) 57 3,5 (0,9-2,2) 15 2,7 (0,3-2,1) 28 3,1
Don't know / didn't answer - - 2 0,1 (0,0-0,4) - - 1 0,1
¿Do you need any special help
(walking stick, ,walker,) to wak 5
blocks (400 mts)?
p= p=
Yes 157 15,13 (9,4-16,5) 264 16,4 (11,2-17,8) 94 16,7 (10,3-17,2) 189 20,7
0,008 0,081
No 870 83,82 (85,6-89,9) 1343 83,4 (85,1-88,7) 467 83 (83,4-89,4) 723 79,2
Don't know / didn't answer 11 1,06 (0,4-1,6) 3 0,2 (0-0,5) 2 0,4 (0,1-1,6) 1 0,1
times per week, between 9 and
Physical activity
20 blocks (1,6 Km) without
stopping?
p= p=
Yes 239 23,03 (21,5-27,1) 248 15,4 (15,2-19,2) 122 21,7 (19,8-27,2) 129 14,1
0,000 0,000
No 799 76,97 (72,9-78,5) 1362 84,6 (80,8-84,8) 441 78,3 (72,8-80,2) 784 85,9
times per week less than 8
blocks (0,5 Km) without
stopping?
p= p=
Yes 618 59,54 (60,1-66,4) 625 38,8 (38,5-43,8) 317 56,3 (54,8-63,4) 312 34,2
0,000 0,000
No 418 40,27 (33,5-39,8) 983 61,1 (56,1-61,4) 246 43,7 (36,6-45,2) 599 65,6
Don't know / don't answer 2 0,19 (0-0,8) 2 0,1 (0-0,5) - - 2 0,2
p= p=
Smoking Never smoked 297 28,61 (25-30,8) 1025 63,7 (61,4-66,5) 182 32,3 (27,6-35,7) 605 66,3
0,000 0,000
Current smoker 150 14,45 (12,5-17,1) 114 7,1 (5,8-8,5) 54 9,6 (7,6-12,9) 45 4,9
Ex-smoker 591 56,94 (54,3-60,8) 471 29,3 (26,6-31,5) 327 58,1 (54,2-62,8) 263 28,8
p= p
Alcohol consumption No 810 78,03 (74,1-79,5) 1536 95,4 (93,7-96,1) 461 81,9 (77,2-84,1) 876 96,0
0,000 =0,000
Yes 228 21,97 (20,5-25,9) 74 4,6 (3,9-6,3) 102 18,1 (15,9-22,8) 37 4,1
p= p=
vegetables at least No 492 47,4 (42,2-48,6) 667 41,4 (36,9-42,1) 270 48 (41,7-50,4) 416 45,6
0,003 0,371
twice per day
Yes 52,6 (51,4-57,8) 943 58,6 (57,9-63,1) 293 52 (49,6-58,3) 497 54,4
546
Page 58 of 59
[HP431] [23502]
Biological factors
p= p
BMI (Kg/m2) Underweight (<18,5) 24 2,57 (1,4-3,4) 33 2,4 (1-2,4) 7 1,4 (0,5-2,6) 15 1,9
0,000 =0,000
Normal (18,5-24,9) 369 39,51 (36,5-42,9) 364 26,1 (23,8-28,5) 202 39,7 (35,1-43,6) 197 25,5
Overweight (≥25,0-29,9) 409 43,79 (41,4-47,9) 545 39 (37,1-42,4) 207 40,7 (37-45,6) 311 40,2
Obese (≥30,0) 132 14,13 (11,4-15,9) 454 32,5 (30,2-35,2) 93 18,3 (15,2-22) 250 32,3
Waist circumference (in p= p=
Normal 325 33,1 (29,9-36) 190 12,8 (10,6-14,2) 171 31,8 (27,7-35,9) 100 11,8
cm) 0,000 0,000
High (>90 cm for men y >80 cm
657 66,9 (64-70,1) 1291 87,2 (85,8-89,4) 366 68,2 (64,1-72,3) 745 88,2
for women)
p= p=
Comorbilities ≤2 768 73,99 (71,1-76,8) 930 57,8 (54,7-60,1) 359 63,8 (59,6-68) 504 55,2
0,000 0,001
3+ 270 26,01 (23,2-28,9) 680 42,2 (39,9-45,3) 204 36,2 (32-40,4) 409 44,8
Health System
p= p=
Health Insurance Contributive 424 40,85 (37,8-44,2) 723 44,9 (42,9-48,3) 241 42,8 (38,6-47,2) 367 40,2
0,028 0,338
Subsidized 561 54,05 (50,4-56,8) 839 52,1 (48,8-54,2) 299 53,1 (48,6-57,3) 518 56,7
Exception 6 0,58 (0,2-1,3) 6 0,4 (0,2-0,9) 2 0,4 (0,1-1,6) 5 0,6
Special 15 1,45 (0,8-2,4) 18 1,1 (0,7-1,9) 5 0,9 (0,4-2,4) 9 1,0
None 31 2,99 (2,3-4,7) 23 1,4 (0,9-2,1) 15 2,7 (1,5-4,4) 14 1,5
Don't know / didn't answer 1 0,1 (0-0,8) 1 0,1 (0-0,5) 1 0,2 (0-1,4) - -
Did you receive the
requested care from
p= p=
your health service for Yes 206 19,85 (16,5-21,6) 434 27 (25,2-30,1) 140 24,9 (20,9-28,5) 246 26,9
0,000 0,377
the health problems that
you have presented?
No 832 80,15 (78,4-83,5) 1176 73 (69,9-74,8) 423 75,1 (71,5-79,1) 667 73,1
Page 59 of 59

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[HP431] [23502]

DISSERTATION SUBMISSION TEMPLATE 2018/19

DISSERTATION TITLE: Determinants of socio-economic

MSc HEALTH POLICY PLANNING AND FINANCE

Due date: 28th August 2019 at 12.00pm

during difficult times that life often presents.

economic studies at LSE and LSHTM.

and control of hypertension in the elderly population of Colombia.

elderly population of Colombia.

hypertension among elderly Colombian people.

socioeconomic conditions; as well as the upgrading of intermediary determinants such as

chronic disease among older Colombian people.

1.1 The relevance of tackling socioeconomic disparities 7

1.2 Social inequity in Latin-American countries 8

1.3 Research gap and aim 9

2.1 The concepts of equality and equity 10

2.2 Social justice and health Equity 11

2.3 Theories explaining relationship between social inequities and health 12

2.4 The CDSH Conceptual framework 13

3.1 Dataset and sample 16

3.2 Relevant outcomes for the analysis 16

3.3 Statistical analysis 19

3.4 Multivariate Logistic Regression Model 19

3.5 Ethical approval 22

4.1 Descriptive statistics 23

4.2 Results of the Multivariate Logistic Regression 29

6. CONCLUSIONS AND POLICY IMPLICATIONS 38

7. STRENGTHS AND LIMITATION 40

Table 1: Description of the structural and intermediary determinants 25

Table 2: Results of the Multivariate Logistic Regression 32

Figure 1: The CDSH Conceptual Framework 15

Figure 2: Geographic regions of Colombia 18

Appendix 1: Prevalence of Hypertension 44

Appendix 2: Awareness of Hypertension 50

Appendix 3: Control of Hypertension 55

1.1 The relevance of tackling socioeconomic disparities

cardiovascular disease (CVD) has been shown to be strongly influenced by socioeconomic

inequity and health at the individual level (2).

decisions (the concept of healthy ageing) (5).

1.2 Social Inequity in Latin-American countries

(Colombian National Department of Statistics) in 2019 estimated a population of approximately

information…” (8) was recorded in 2018 at 7.2% (8).

1.3 Research gap and aim

and the presence of hypertension among the elderly population.

elderly people in Colombia.

2.1 The concepts of equality and equity

remediable differences in health among population groups defined socially, economically,

2.2 Social justice and health equity

It is important to mention afforded concept as emphasized by Professor Michael Marmot in the

developing hypertension. (1).

2.4 The CDSH Conceptual Framework

most influential of these is the socioecomic position (5):

Intermediary Determinants of Health:

 Material circumstances: Including factors such as housing, consumption potential and

 Psychosocial circumstances: Including psychosocial stressors, stressful living

circumstances, and social support.

when a patient is sick.

Figure 1: The CDSH Conceptual Framework

Source: Conceptual Framework for action on the social determinants of Health

WHO, Geneva 2010

intermediary determinants of health (7).

3.1 Dataset and sample

analysis of physical determinants (incorporating measurement of blood pressure, weight, size,