recently , in addition to the high prevalence of infectious diseases , the incidence of noncommunicable disease is alarmingly increasing in the developing countries . although there are some more recent studies indicating the decline of cvd in africa , ncds are generally showing rapid rise in these countries .
one of the explanations for the increase is the economic and social transformation taking place in these countries , and the lifestyle changes resulted from such transformation .
hypertension is one of the noncommunicable diseases that is advancing at fast pace in african countries .
the trend is unexpected given the socioeconomic status of people in these countries , as the disease is believed to be disease of the rich and developed nations . besides being a major cause of death
, hypertension is a major risk factor for many chronic diseases like coronary heart disease , stroke , heart failure , kidney disease , and others .
it is responsible for about 6% ( 9 million ) of deaths worldwide and affects about one billion people globally .
its global prevalence among older adults aged 25 and over is around 40% in 2008 .
the highest of this effect falls on the people in middle and low income countries .
low income countries like sub - saharan africa are experiencing unexpected rise in the incidence of hypertension .
the few studies conducted in ethiopia are also showing high prevalence of the disease in the country . according to one study
another more recent study conducted in the capital shows that approximately 30% of adults in addis ababa have hypertension . added to the silent nature of the disease and the poor health seeking behavior of the people , as the country is going through a rapid economic development , and social and behavioral change , the figure is estimated to be higher .
income , education , and occupation are the most commonly used indicators or measures of the socioeconomic status of an individual .
although its measurement is difficult in the developing countries , household income has shown consistent association to the general measures of health .
educational status is also widely used as a measure of socioeconomic status and is related to many health outcomes .
educational attainment reflects a household 's ability to avoid risky behaviors and practice good health .
it reflects health risks and protection factors related to the occupation and provision of source of income to practice good health behavior .
there are significant evidences indicating an inverse association between socioeconomic status and hypertension in the developed countries [ 1214 ] .
this is because in the developed countries individuals with high socioeconomic status may be the early adopters of healthy lifestyles that help to lower the risk of hypertension .
but , in the developing countries , these groups are early adopters of harmful lifestyles characterized by smoking , diets with high energy and fats , and sedentary lifestyles .
the inverse association of socioeconomic status with hypertension is not evident in the developing countries .
the results from the few studies conducted in the developing countries have shown inconsistent results .
for instance a study from nigeria among adults aged 3060 years found an inverse association between socioeconomic status and hypertension .
in contrary to this finding , a study on civil servants in the same nation found that those at higher occupational levels had higher hypertension when compared with those at lower occupational levels . another cross sectional home to home study conducted in urban population in dar es salaam , tanzania , aged 25 to 64 came up with a result similar to that of the developed countries .
however , the use of different measurement of socioeconomic status and the stages of their economic development in these countries have made comparisons across other literatures difficult .
the results from many middle income countries are also showing positive association between socioeconomic status and hypertension .
a study in rural indian adults shows the highest socioeconomic group had almost double the prevalence of hypertension as those from the lowest socioeconomic group .
another study within the same country has also showed a significantly positive relationship between socioeconomic status and hypertension . in study undertaken among jamaican women ,
there are significant study results indicating the high prevalence of hypertension among the bank workers [ 19 , 20 ] .
in contrast some studies undertaken in africa are showing the prevalence of hypertension being higher among teachers compared to the bankers . in ethiopia little
therefore the current study aims to examine the association between socioeconomic status and hypertension among the bankers and teachers in the capital , addis ababa .
this study is based on a cross sectional study conducted for the purpose of assessing the prevalence of noncommunicable diseases among working adults in addis ababa , ethiopia .
the study was conducted by addis continental institute of public health in collaboration with university of washington multidisciplinary international research training program .
study populations are permanent employees of the commercial bank of ethiopia and teachers in government schools in addis ababa .
first two study sites , the commercial bank of ethiopia and public schools , were purposefully selected based on their work force stability . then probability proportional to size sampling procedures
was used to select both commercial bank of ethiopia branch offices and government schools . from each of the selected locations ,
all employees were invited to participate . more details of the methodology are described elsewhere [ 21 , 22 ] .
the study was conducted in accordance with the who 's step wise approach for noncommunicable disease surveillance in the developing countries [ 21 , 23 ] .
it is often measured as a combination of education , income , and occupation [ 10 , 12 ] . 

the responses were grouped into two wider categories : diploma and below and degree and above .  

three income categories are identified based on the 50% median income classification and used for analysis [ 24 , 25 ]
it was measured using a digital measuring device ( microlife bp a50 , microlife ag , switzerland ) with the participant sitting after resting for at least 5 minutes .
blood pressure was measured 3 times , with at least 3 minutes between consecutive measurements . in accordance with the who recommendation the mean systolic and diastolic blood pressure from the second and third measurements
were considered for analysis . for the purpose of this study people with systolic blood pressure greater than or equal to 140  mmhg , or diastolic pressure greater than or equal to 90  mmhg , or people with normal blood pressure who are taking antihypertensive drug therapy were classified as hypertensive .
classification of hypertension was determined according to joint national committee on prevention , detection , evaluation and treatment of high blood pressure   ( see table 1 ) . 
 weight and height .
participants were weighed using a solar - powered scale with an accuracy of 100 grams .
their height was measured using an adjustable wooden measuring board , specifically designed to provide accurate measurements [ 22 , 23 ] .  

body mass index ( bmi ) was calculated as weight in kilograms divided by the square of height in meters .
bmi < 18.5 represents underweight , 18.5 to < 25 stands for normal weight , 25 to < 30 refers to overweight , and obesity is decided when bmi  30 .
data completeness and consistency were checked by running frequency on each variable . after excluding participants with missing bp measurement data and pregnant women ( n = 339 ) from the original study sample ,
frequencies and percentages were used for descriptive statistics to see the distribution of the different variables .
bivariate and multivariate logistic regressions were conducted to see the association between the measures of socioeconomic status and hypertension . adjusted odds ratios ( aor ) with 95% confidence interval were reported .
as the study has collected data on all the variables related to ncds , for this study participants with no bp measurement data ( n = 318 ) and pregnant women ( n = 21 ) were excluded from the original study sample .
accordingly a total of 1866 study subjects ( 1124 men and 742 women ) with complete data on all the variables were included in the study .
as table 2 indicates , the majority , 1,124 ( 60.2% ) , of the participants were male and 742 ( 39.8% ) were female with the male to female sex ratio of 1.5  :  1 .
the mean age of the participants was 36.03 with a standard deviation of 11.91 years .
majority of the respondents ( 54.1% ) were in the middle income category earning between 15,000 and 48,000 ethiopian birr per year .
slightly more than half ( 51.9% ) of the participants had first degree and above and the other half ( 48.1% ) are diploma and below , making educational status normally distributed ( table 3 ) .
as table 3 indicates , the majority ( 55.3% ) of the participants had a normal bmi , while 26.3% were overweight .
83 ( 4.4 ) of the participants are current smokers and 9.1% were previous smokers .
the prevalence of hypertension in the study is 21% ( 95% ci = 19.15 , 22.85 ) .
127 ( 6.8% ) of the hypertensive participants are currently receiving bp treatment . only 278 ( 14.9% ) of the participants are aware of their hypertension status before the interview .
the results from the bivariate logistic regression indicate that males tend to be more hypertensive than females ( or : 1.43 , 95% ci : 1.131.81 ) ( figure 1 ) .
the odds of hypertension increases with increase in age : 3544 ( or : 3.11 , 95% ci : 1.944.99 ) , 4455 ( or : 7.786 , 95% ci : 5.02112.075 ) , and above 50 ( or : 14.23 , 95% ci : 8.7223.23 ) .
a higher prevalence of hypertension was observed among middle income groups ( or : 2.26 , 95% ci : 1.663.07 ) ; a statistically significant prevalence is also observed among the higher income groups ( or : 1.75 , 95% ci : 1.212.52 ) .
however , as table 4 shows , there was no statically significant difference in prevalence of hypertension among the educational categories ( p value = 0.536 ) and occupation of the participants ( p value = 0.197 ) .
this study identified hypertension as a significant health problem among bankers and teachers in addis ababa .
these figures are higher compared with the 10.5% prevalence among the general population of ethiopia   and lower than the 30% prevalence among adults in addis ababa in previous studies .
the prevalence of hypertension in this study is consistent with 19.3% reported in nigeria   and 21.8% for uganda .
all the significant factors which have proven to be related with the incidence of hypertension were entered into the multivariate regression model .
in addition checks were conducted and no multicollinearity was found among the variables used for measuring socioeconomic status . from the socioeconomic status measures used ,
even after adjustment is made educational status and occupation have shown no significant association with the prevalence of hypertension .
the association of income with hypertension in this study is consistent with the findings from many low and middle income countries [ 1 , 12 , 31 ] .
this finding indicates that in the context of the developing country having a higher income is not necessarily protective of health as it is in the developed world .
this is probably due to the lifestyle of this group of people in these countries .
these groups may use this income to provide more resources that may be used mostly for purchasing calorie - dense foods and excessive drinking , and in some instances it is a cause of sedentary lifestyles which are the underlying risk factors of hypertension . among this study population no significant association between education and hypertension was found .
the absence of the association in this study may be due to the nature of the study population . in this study
however , studies done in the developing countries like tanzania , nigeria , and ghana found out that education is inversely associated with the odds of developing hypertension [ 16 , 31 ] .
although there is a lack of studies that compared the two population groups , in studies conducted independently , the odds of developing hypertension is higher among the bank workers [ 19 , 20 ] . in those studies
it is explained that bankers ' job is more stressful and sedentary ( table 5 ) . to the best of our knowledge
this is the first study that assessed the association between socioeconomic status and hypertension in ethiopia .
even though the study has come up with important findings , there are certain limitations worth mentioning here .
first of all , the fact that our study participants are all working professionals who are urban residents and fairly well educated makes the generalizing of the result to the larger population difficult .
secondly as the study is based on secondary data the problem of social desirability bias is mentioned in the original study .
participants may withhold information regarding their life - style habits that may not be generally acceptable for working adults ( smoking , drinking , etc . ) which may result in an underestimation of these behaviors .
this study highlights the high prevalence of hypertension in the study population . as in many other developing countries hypertension
is becoming a serious public health concern among working adults like teachers and bankers in ethiopia .
like many developing and middle income countries , in this study better income is positively associated with higher odds of having hypertension . however , no association between hypertension and measures of socioeconomic status like education and occupation was found in this study .
as hypertension is becoming a serious public health concern in ethiopia , it has to be given due concern in the health agenda of the country as one of top priority .
it rather influences the practice of risky behavioral factors that are responsible for hypertension . therefore promoting healthy lifestyles and interventions in lifestyle modifications related to the behavioral risk factors
awareness creation and promotion of healthy behaviors have to be widely conducted , especially in the better income groups so that they will make rational decision in choosing their behaviors . particularly , the long term consequences that arise from these lifestyles have to be stressed to the society in general and these groups in particular .
future studies are also highly recommended to confirm these findings in general population with varying measures of socioeconomic status .
 
 background . 
 the social and economic changes taking place in developing countries are influencing the pace at which hypertension and its risk factors are expanding . 
 as opposed to the already established inverse association in developed nations , the association between socioeconomic status and hypertension in developing countries is poor and inconsistent . 
 this study aims to determine the association between socioeconomic status and hypertension among teachers and bankers in addis ababa , ethiopia 
 . methods . 
 this study is based on a cross - sectional study conducted to assess the prevalence of ncds in addis ababa , ethiopia . 
 the study was undertaken among workers of the commercial bank of ethiopia and teachers of public schools in 2010 . 
 results . 
 majority of participants were teachers ( 70.3% ) . 
 most of the respondents ( 54.1% ) earn an annual income between 15,000 etb and 48,000 etb , and 51.9% of them have educational status of first degree and above . among the socioeconomic factors income was strongly associated with the odds of having hypertension ( aor : 2.17 with 95% ci : 1.582.98 ) . conclusions . 
 higher burden of hypertension is observed among teachers and bankers in addis ababa , ethiopia . 
 promotion of healthy behaviors and interventions that target higher income groups needs to be put in place . 
1. Introduction
2. Materials and Methods
3. Results
4. Discussion
5. Conclusions
6. Recommendation