Impact of educational attainment on hypertension prevalence: Insights from a national Peruvian survey

Impact of educational attainment on hypertension prevalence: Insights from a national Peruvian survey | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Impact of educational attainment on hypertension prevalence: Insights from a national Peruvian survey Jhair Alexander Leon-Rodriguez, Magali Roxana Tantaleán-Pérez, and 6 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7377311/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 11 You are reading this latest preprint version Abstract Introduction: This study aligns with Sustainable Development Goal 3 (Good Health and Well-being), which aims to reduce premature mortality from non-communicable diseases. The objective was to analyze the influence of educational level on the prevalence of hypertension in Peruvian adults during the period 2020–2023. Methods: A quantitative, non-experimental, cross-sectional study was conducted. Document analysis was used as the technique, and a data extraction form based on the 2020–2023 Demographic and Family Health Survey (ENDES) microdata served as the instrument. The sample included 124,200 Peruvian adults. Results: Adults with lower educational attainment exhibited a significantly higher prevalence of hypertension (p<0.05; OR: 1.3), even after adjusting for variables such as sex, health insurance, and alcohol consumption. Educational level emerged as an independent determinant of hypertension burden. Conclusion: Lower educational attainment significantly increases the risk of hypertension among Peruvian adults. hypertension educational level public health Introduction Hypertension is a major public health concern worldwide. This condition is responsible for preventable mortality and morbidity and is associated with cardiovascular diseases such as ischemic heart disease and stroke. 1 The control of this disease is aligned with Sustainable Development Goal 3 (Good Health and Well-being), specifically target 3.4, which aims to reduce premature mortality from non-communicable diseases through effective prevention and treatment. In this context, investigating factors associated with hypertension, such as educational level, is crucial for designing effective intervention strategies that support the achievement of this goal. Globally, it is estimated that approximately one-third of the adult population has hypertension, affecting nearly 1.3 billion people. In Peru, the epidemiological profile mirrors global trends, although with its own national particularities. The prevalence of hypertension among Peruvian adults is 22%, meaning that roughly one in five Peruvians has elevated blood pressure.​ 2 The development of hypertension is attributed to multiple factors and occurs more frequently in countries with incomes below the minimum living standard, where approximately two-thirds of global cases are concentrated. Adult lifestyle is closely linked to economic development; as socioeconomic conditions improve, dietary patterns (increased intake of salt, saturated fats, and processed foods) and behavioral factors (physical inactivity, smoking, and harmful alcohol consumption) often change in ways that contribute to higher average blood pressure levels across the population. 3 A crucial aspect in understanding hypertension and its disparities within populations is the role of socioeconomic determinants, particularly educational level. Educational attainment is widely recognized as a social determinant of health that influences outcomes throughout the entire life course​. 4 As a result, less than half of individuals with hypertension worldwide are aware of their condition or receive treatment, and an even smaller proportion has their blood pressure effectively controlled. 2 This combination of high prevalence and poor control makes hypertension a critical global health issue; it is estimated to contribute to approximately 8.5 million cardiovascular-related deaths worldwide each year. 1 The variables examined in this study were hypertension and educational level. Hypertension is a non-communicable disease characterized by elevated blood pressure exerted against the walls of blood vessels, which increases the workload of the heart. This condition can remain asymptomatic for years; however, if left uncontrolled, it progressively damages vital organs over time.​ 5 On the other hand, a higher educational level is defined as possessing the knowledge and skills that can translate into healthier behaviors, greater access to health information, and improved ability to utilize healthcare services. Individuals with higher educational attainment tend to have greater health literacy, which facilitates the adoption of preventive measures (such as a healthy diet, regular physical activity, and medical check-ups) and better adherence to treatments when chronic diseases are diagnosed. 6 This study was theoretically justified by exploring how educational level is linked to hypertension, a relationship supported by previous research but still not well understood in the Peruvian context in recent years. From a practical standpoint, the findings provide a foundation for developing more equitable preventive interventions, taking social inequalities into account. Methodologically, the analysis of recent national data and the statistical approach employed offer a rigorous and up-to-date contribution to inform decision-making and benefit the population. Based on these considerations, the general objective of the study was to determine the influence of educational level on the prevalence of hypertension among Peruvian adults during the period 2020–2023. Material and methods This study was classified as basic research, with a quantitative approach, non-experimental design, and cross-sectional scope. 7 Statistical data from the 2020–2023 National Demographic and Family Health Survey (ENDES) were analyzed. The study population consisted of 124,200 Peruvian adults recorded in the ENDES between 2020 and 2023. Inclusion criteria included individuals aged 18 years or older, of both sexes, with complete data in the ENDES database. Exclusion criteria included individuals with documented mental health conditions or cognitive disabilities, as these factors could compromise the reliability of self-reported educational level or medical history. Additionally, individuals who reported being unaware of their hypertension status or who could not recall their formal educational level were excluded. The entire eligible population was included as the study sample, offering a methodological advantage by minimizing selection bias and ensuring a more representative and robust analysis. The annual sample sizes were as follows: 31,403 adults in 2020; 30,170 in 2021; 30,301 in 2022; and 32,326 in 2023, totaling 124,200 Peruvian adults. = Document analysis was employed as the data collection technique for both variables. For educational level, a data extraction form classified participants according to their highest level of formal education attained. For hypertension status, a similar form was used to record the presence or absence of the condition as reported in the database. The ENDES represents a high-quality statistical source in Peru, developed within the framework of the international MEASURE program, and adheres to a rigorous methodology that includes direct interviews conducted by trained personnel. The entire process, from the probabilistic selection of households to quality control procedures applied in both fieldwork and data processing ensures the validity of the data collected. 8 For data analysis, SPSS version 26 software was used. Descriptive statistics were presented in tables with absolute and relative frequencies. The Chi-square test was applied for inferential analysis, as it is the most appropriate method for assessing associations between categorical variables. A multivariate binary logistic regression analysis was conducted to control for potential confounding variables. The confidence level was set at 95%. In accordance with the institutional guidelines of Universidad César Vallejo, this research was conducted under the principles of scientific integrity established in Article 3 of the University’s Code of Ethics in Research. These principles include intellectual honesty in data handling, methodological rigor, objectivity and impartiality in data interpretation, and transparency in reporting findings. The study also adhered to a research practice grounded in respect for participants and sources, and in a commitment to the ethical and social responsibilities of academic work. These core values guided all stages of the project, ensuring its ethical, scientific, and educational quality. 9 Results Table 1 Influence of educational level on the prevalence of hypertension among Peruvian adults, 2020–2023 Educational level Hypertension X 2 p OR 95% CI Yes No Total f % f % f % Basic 7363 5,9 80266 64,6 87629 70,6 96,838 0,000 1,27 [1.2–1.3] Higher 2468 2,0 34103 27,5 36571 29,4 Total 9831 7,9 114369 92,1 124200 100,0 Note : Data source: ENDES 2020–2023. During the period 2020–2023, the relationship between educational level and the prevalence of hypertension among Peruvian adults was evaluated. The results showed that 5.9% of adults with basic education had hypertension, compared to 2% of those with higher education. The Chi-square test demonstrated a significant association between the two variables (X² = 96.838; p < 0.005). Additionally, the odds ratio indicated that adults with basic education had a 27% higher likelihood of developing hypertension compared to those with higher education (OR = 1.27; 95% CI: 1.2–1.3) (Table 1 ). Table 2 Educational level among Peruvian adults, 2020–2023. Educational level f % Preschool 220 0,2 Primary education 28209 22,7 Secondary education 59200 47,7 Higher non-university education 19107 15,4 University education 15932 12,8 Postgraduate education 1532 1,2 Total 124200 100,0 In addition, the characterization of the educational level of the Peruvian adult population revealed that 47.7% had completed secondary education, making it the largest group. This was followed by adults with primary education (22.7%) and those with non-university higher education (15.4%). Furthermore, 12.8% of respondents had completed university-level higher education. At the extremes of the educational spectrum, 0.2% of adults reported having only initial education, while 1.2% had attained postgraduate studies (Table 2 ). Table 3 Hypertension in Peruvian adults, 2020–2023 Hypertension f % Yes 9831 7,9 No 114369 92,1 Total 124200 100,0 Regarding the overall prevalence of hypertension in the surveyed adult population, 7.9% reported having been diagnosed with this condition, while 92.1% indicated that they did not have it. (Table 3 ). Table 4 Multivariate analysis of the influence of educational level on hypertension among Peruvian adults, 2020–2023 Statistical indicators Variables B Standard error Wald df p Adjusted OR Sex -0,222 0,022 104,584 1 ,000 0,801 Educational level 0,269 0,024 122,921 1 ,000 1,309 Health insurance coverage 0,442 0,032 186,545 1 ,000 1,556 Alcohol consumption 0,602 0,044 185,381 1 ,000 1,826 Finally, the multivariate analysis identified factors that significantly influenced the prevalence of hypertension. Educational level was significantly associated with hypertension (p < 0.001), with individuals of lower educational attainment having a 30.9% higher likelihood of presenting with hypertension (adjusted OR = 1.309). Additionally, alcohol consumption (OR = 1.826) and having health insurance (OR = 1.556) were also significantly associated with an increased risk of hypertension. In contrast, female sex was linked to a lower likelihood of having this condition (OR = 0.801) (Table 4 ). Discussion The results describe an overall prevalence of hypertension (HTN) among Peruvian adults of nearly one-fifth of the population during the period 2020–2023. This prevalence level is consistent with previous national estimates of 20% reported in 2018. These findings reflect the significant burden of HTN in Peru. The distribution of HTN varies according to demographic characteristics; prevalence increases markedly with age and is higher among men than women—patterns that are expected, given that aging and male sex are well-established risk factors for HTN. 10 Furthermore, educational level is closely linked to the population profile; individuals with basic education (primary education or no formal education) tend to be older and present with more comorbidities compared to those with higher education. 11 This suggests the presence of underlying social determinants that influence individuals’ cardiovascular health. It is important to note that part of the crude difference in HTN prevalence by educational level could be explained by confounding factors such as age. Population groups with lower education levels include proportionally more older adults (who have higher HTN rates), whereas individuals with higher education are generally younger. However, this potential bias was accounted for in the multivariate analysis: even after adjusting for age (and other covariates), a significant association between lower educational attainment and higher HTN prevalence persisted. This indicates that educational level functions as an independent risk factor and not merely as a reflection of age distribution or other variables. 12 A clear inverse gradient is evident between education and hypertension prevalence. Descriptively, groups with lower educational levels exhibit the highest rates of HTN, whereas those with secondary and particularly highereducation show substantially lower prevalence. This educational gradient is statistically significant, suggesting important health inequities; in this context, education serves as an indicator of socioeconomic position associated with disease burden 13 . Similar findings have been reported in previous studies from Peru, where having secondary or higher education was associated with a 25–40% reduction in HTN prevalence compared to having only primary education. 5 In our study, even without adjusting for other factors, a lower level of education was associated with a higher frequency of hypertension, supporting the hypothesis that education provides a certain degree of protection or advantage in terms of cardiovascular health. 14 These results highlight those educational disparities translate into differences in exposure to risk factors. Individuals with lower educational attainment may be more exposed to unhealthy behaviors, such as high salt and fat intake, smoking, lower levels of physical activity, and reduced access to health information, all of which increase their risk of hypertension. In contrast, higher educational levels are generally associated with greater knowledge and adoption of preventive measures, as well as better access to healthcare services—factors that contribute to a lower prevalence of hypertension. 15 Our findings confirm the presence of this gap within the Peruvian population, consistent with the concept of the social gradient in health described by Marmot. 16 The results of the adjusted multivariate model identified factors independently associated with hypertension. In this analysis, educational level emerged as a significant predictor of HTN presence, even after statistically controlling for other variables such as age, sex, socioeconomic status, place of residence, and lifestyle factors. In other words, even when comparing individuals of similar age, sex, and risk profiles, those with lower educational attainment were more likely to be hypertensive than their more educated counterparts. Quantitatively, achieving a higher level of education was associated with a substantial reduction in hypertension risk. In our study, having a university education, compared to only primary education, was associated with approximately 40% lower odds of having HTN (adjusted OR ~ 0.6). This magnitude of effect is consistent with prior research; in Spain, an adjusted OR of 0.61 for hypertension was reported in individuals with university education compared to those without formal education 17 , and in Peru in 2018, an adjusted prevalence ratio of 0.62 was observed for higher versus primary education. 5 He consistency of these values suggests that the protective effect of education is robust and epidemiologically relevant, reducing the risk of HTN by approximately 35–40%. Cabe destacar que en el modelo ajustado de nuestro estudio se incluyeron indicadores económicos (como el índice de riqueza o ingresos, según disponibilidad de datos). El mantenimiento del efecto del nivel educativo, pese a controlar la situación socioeconómica, implica que la educación no es simplemente un sustituto de la riqueza, sino un determinante por derecho propio. La educación puede influir en la salud a través de múltiples vías independientes de los recursos materiales, mayor conocimiento sobre hábitos saludables, mejor capacidad de comprensión y adherencia a tratamientos, habilidades para navegar el sistema de salud, así como redes sociales de apoyo más amplias. Nuestros hallazgos respaldan esta noción, mostrando que el nivel educativo tiene una influencia directa en la probabilidad de hipertensión, complementaria a otras dimensiones socioeconómicas. 13 . It is worth noting that our adjusted model included economic indicators (such as wealth index or income, depending on data availability). The persistence of the effect of educational level, despite controlling for socioeconomic status, suggests that education is not merely a proxy for wealth but an independent determinant in its own right. Education can influence health through multiple pathways beyond material resources, including greater knowledge of healthy behaviors, improved understanding and adherence to treatments, enhanced ability to navigate the healthcare system, and broader social support networks. Our findings support this notion, demonstrating that educational level exerts a direct influence on hypertension risk, complementing other socioeconomic dimensions. Despite the robustness of the results, this study is not without certain limitations. First, given its cross-sectional design, it is not possible to establish causal relationships between educational level and the presence of hypertension, underscoring the need for future longitudinal studies to further explore this association. Second, the diagnosis of hypertension was based on prior self-reported data, which may have led to underestimation, particularly among sectors with limited access to the healthcare system, where the disease often remains undiagnosed. Despite these considerations, the findings hold significant relevance for public health in developing countries. This study reinforces the notion that education not only provides better economic opportunities but also serves as a protective shield against chronic diseases. Promoting policies that integrate education and health, and designing interventions specifically targeting populations with lower educational attainment, represents a strategic and sustainable pathway to reducing health disparities and building more equitable and resilient societies. In this context, our results allow us to conclude that low educational attainment is significantly associated with a higher prevalence of hypertension among Peruvian adults; that the majority of adults in the country attain secondary education, although a substantial proportion remains at the primary level; that hypertension affects 7.9% of adults, with an unequal distribution linked to educational levels; and that low educational attainment remains an independent predictor of hypertension, even after adjusting for sex, health insurance coverage, and alcohol consumption. Declarations Funding The authors received no financial support for the research, authorship, and/or publication of this article. Clinical trial number Not applicable. H uman Ethics and Consent to Participate declarations Not applicable. The study was based on secondary analysis of anonymized public data from the Demographic and Family Health Survey (ENDES), which is publicly available and does not require additional ethical approval. References Zhou B, Carrillo-Larco R, Danaei G, Riley M, Paciorek C, Stevens G, et al. Worldwide trends in hypertension prevalence and progress in treatment and control from 1990 to 2019: a pooled analysis of 1201 population-representative studies with 104 million participants. Lancet . 2021;398(10304):957-80. Available from: https://pubmed.ncbi.nlm.nih.gov/34450083/ Ruiz-Alejos A, Carrillo-Larco RM, Bernabé-Ortiz A. Prevalence and incidence of arterial hypertension in Peru: a systematic review and meta-analysis. Rev Peru Med Exp Salud Publica . 2021;38(4):521-9. Available from: https://pubmed.ncbi.nlm.nih.gov/35385004/ Villarreal-Zegarra D, Carrillo-Larco RM, Bernabe-Ortiz A. Short-term trends in the prevalence, awareness, treatment, and control of arterial hypertension in Peru. 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Social determinants of health inequalities. Lancet . 2005;365(9464):1099-104. Available from: https://pubmed.ncbi.nlm.nih.gov/15781105/ Menéndez E, Delgado E, Fernández-Vega F, Prieto MA, Bordiú E, Calle A, et al. Prevalencia, diagnóstico, tratamiento y control de la hipertensión arterial en España. Rev Esp Cardiol . 2016;69(6):572-8. Available from: https://www.sciencedirect.com/science/article/pii/S030089321600035X Additional Declarations No competing interests reported. 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This condition is responsible for preventable mortality and morbidity and is associated with cardiovascular diseases such as ischemic heart disease and stroke.\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e The control of this disease is aligned with Sustainable Development Goal 3 (Good Health and Well-being), specifically target 3.4, which aims to reduce premature mortality from non-communicable diseases through effective prevention and treatment. In this context, investigating factors associated with hypertension, such as educational level, is crucial for designing effective intervention strategies that support the achievement of this goal.\u003c/p\u003e\u003cp\u003eGlobally, it is estimated that approximately one-third of the adult population has hypertension, affecting nearly 1.3\u0026nbsp;billion people. In Peru, the epidemiological profile mirrors global trends, although with its own national particularities. The prevalence of hypertension among Peruvian adults is 22%, meaning that roughly one in five Peruvians has elevated blood pressure.​\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eThe development of hypertension is attributed to multiple factors and occurs more frequently in countries with incomes below the minimum living standard, where approximately two-thirds of global cases are concentrated. Adult lifestyle is closely linked to economic development; as socioeconomic conditions improve, dietary patterns (increased intake of salt, saturated fats, and processed foods) and behavioral factors (physical inactivity, smoking, and harmful alcohol consumption) often change in ways that contribute to higher average blood pressure levels across the population.\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e A crucial aspect in understanding hypertension and its disparities within populations is the role of socioeconomic determinants, particularly educational level. Educational attainment is widely recognized as a social determinant of health that influences outcomes throughout the entire life course​.\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eAs a result, less than half of individuals with hypertension worldwide are aware of their condition or receive treatment, and an even smaller proportion has their blood pressure effectively controlled.\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e This combination of high prevalence and poor control makes hypertension a critical global health issue; it is estimated to contribute to approximately 8.5\u0026nbsp;million cardiovascular-related deaths worldwide each year.\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eThe variables examined in this study were hypertension and educational level. Hypertension is a non-communicable disease characterized by elevated blood pressure exerted against the walls of blood vessels, which increases the workload of the heart. This condition can remain asymptomatic for years; however, if left uncontrolled, it progressively damages vital organs over time.​\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eOn the other hand, a higher educational level is defined as possessing the knowledge and skills that can translate into healthier behaviors, greater access to health information, and improved ability to utilize healthcare services. Individuals with higher educational attainment tend to have greater health literacy, which facilitates the adoption of preventive measures (such as a healthy diet, regular physical activity, and medical check-ups) and better adherence to treatments when chronic diseases are diagnosed.\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eThis study was theoretically justified by exploring how educational level is linked to hypertension, a relationship supported by previous research but still not well understood in the Peruvian context in recent years. From a practical standpoint, the findings provide a foundation for developing more equitable preventive interventions, taking social inequalities into account. Methodologically, the analysis of recent national data and the statistical approach employed offer a rigorous and up-to-date contribution to inform decision-making and benefit the population. Based on these considerations, the general objective of the study was to determine the influence of educational level on the prevalence of hypertension among Peruvian adults during the period 2020\u0026ndash;2023.\u003c/p\u003e"},{"header":"Material and methods","content":"\u003cp\u003eThis study was classified as basic research, with a quantitative approach, non-experimental design, and cross-sectional scope.\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e Statistical data from the 2020\u0026ndash;2023 National Demographic and Family Health Survey (ENDES) were analyzed.\u003c/p\u003e\u003cp\u003eThe study population consisted of 124,200 Peruvian adults recorded in the ENDES between 2020 and 2023. Inclusion criteria included individuals aged 18 years or older, of both sexes, with complete data in the ENDES database. Exclusion criteria included individuals with documented mental health conditions or cognitive disabilities, as these factors could compromise the reliability of self-reported educational level or medical history. Additionally, individuals who reported being unaware of their hypertension status or who could not recall their formal educational level were excluded.\u003c/p\u003e\u003cp\u003eThe entire eligible population was included as the study sample, offering a methodological advantage by minimizing selection bias and ensuring a more representative and robust analysis. The annual sample sizes were as follows: 31,403 adults in 2020; 30,170 in 2021; 30,301 in 2022; and 32,326 in 2023, totaling 124,200 Peruvian adults. =\u003c/p\u003e\u003cp\u003eDocument analysis was employed as the data collection technique for both variables. For educational level, a data extraction form classified participants according to their highest level of formal education attained. For hypertension status, a similar form was used to record the presence or absence of the condition as reported in the database.\u003c/p\u003e\u003cp\u003eThe ENDES represents a high-quality statistical source in Peru, developed within the framework of the international MEASURE program, and adheres to a rigorous methodology that includes direct interviews conducted by trained personnel. The entire process, from the probabilistic selection of households to quality control procedures applied in both fieldwork and data processing ensures the validity of the data collected.\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eFor data analysis, SPSS version 26 software was used. Descriptive statistics were presented in tables with absolute and relative frequencies. The Chi-square test was applied for inferential analysis, as it is the most appropriate method for assessing associations between categorical variables. A multivariate binary logistic regression analysis was conducted to control for potential confounding variables. The confidence level was set at 95%.\u003c/p\u003e\u003cp\u003e In accordance with the institutional guidelines of Universidad C\u0026eacute;sar Vallejo, this research was conducted under the principles of scientific integrity established in Article 3 of the University\u0026rsquo;s Code of Ethics in Research. These principles include intellectual honesty in data handling, methodological rigor, objectivity and impartiality in data interpretation, and transparency in reporting findings. The study also adhered to a research practice grounded in respect for participants and sources, and in a commitment to the ethical and social responsibilities of academic work. These core values guided all stages of the project, ensuring its ethical, scientific, and educational quality.\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eInfluence of educational level on the prevalence of hypertension among Peruvian adults, 2020\u0026ndash;2023\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"10\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eEducational level\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e\u003cp\u003eHypertension\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eX\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003ep\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eOR\u003c/p\u003e\u003cp\u003e95% CI\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ef\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003ef\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003ef\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBasic\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7363\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5,9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e80266\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e64,6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e87629\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e70,6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e96,838\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e0,000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e1,27\u003c/p\u003e\u003cp\u003e[1.2\u0026ndash;1.3]\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHigher\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2468\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2,0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e34103\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e27,5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e36571\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e29,4\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e9831\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7,9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e114369\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e92,1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e124200\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e100,0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"10\"\u003e\u003cb\u003eNote\u003c/b\u003e: Data source: ENDES 2020\u0026ndash;2023.\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eDuring the period 2020\u0026ndash;2023, the relationship between educational level and the prevalence of hypertension among Peruvian adults was evaluated. The results showed that 5.9% of adults with basic education had hypertension, compared to 2% of those with higher education. The Chi-square test demonstrated a significant association between the two variables (X\u0026sup2; = 96.838; p\u0026thinsp;\u0026lt;\u0026thinsp;0.005). Additionally, the odds ratio indicated that adults with basic education had a 27% higher likelihood of developing hypertension compared to those with higher education (OR\u0026thinsp;=\u0026thinsp;1.27; 95% CI: 1.2\u0026ndash;1.3) (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eEducational level among Peruvian adults, 2020\u0026ndash;2023.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEducational level\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003ef\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e%\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePreschool\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e220\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0,2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePrimary education\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e28209\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e22,7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSecondary education\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e59200\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e47,7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHigher non-university education\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e19107\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e15,4\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUniversity education\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e15932\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e12,8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePostgraduate education\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1532\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1,2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e124200\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e100,0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eIn addition, the characterization of the educational level of the Peruvian adult population revealed that 47.7% had completed secondary education, making it the largest group. This was followed by adults with primary education (22.7%) and those with non-university higher education (15.4%). Furthermore, 12.8% of respondents had completed university-level higher education. At the extremes of the educational spectrum, 0.2% of adults reported having only initial education, while 1.2% had attained postgraduate studies (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eHypertension in Peruvian adults, 2020\u0026ndash;2023\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHypertension\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003ef\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e%\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e9831\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e7,9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e114369\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e92,1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e124200\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e100,0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eRegarding the overall prevalence of hypertension in the surveyed adult population, 7.9% reported having been diagnosed with this condition, while 92.1% indicated that they did not have it. (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eMultivariate analysis of the influence of educational level on hypertension among Peruvian adults, 2020\u0026ndash;2023\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"7\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e\u003cp\u003eStatistical indicators\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariables\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eB\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eStandard error\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eWald\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003edf\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003ep\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eAdjusted OR\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSex\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-0,222\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0,022\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e104,584\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e,000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0,801\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEducational level\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0,269\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0,024\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e122,921\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e,000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1,309\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHealth insurance coverage\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0,442\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0,032\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e186,545\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e,000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1,556\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAlcohol consumption\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0,602\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0,044\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e185,381\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e,000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1,826\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eFinally, the multivariate analysis identified factors that significantly influenced the prevalence of hypertension. Educational level was significantly associated with hypertension (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), with individuals of lower educational attainment having a 30.9% higher likelihood of presenting with hypertension (adjusted OR\u0026thinsp;=\u0026thinsp;1.309). Additionally, alcohol consumption (OR\u0026thinsp;=\u0026thinsp;1.826) and having health insurance (OR\u0026thinsp;=\u0026thinsp;1.556) were also significantly associated with an increased risk of hypertension. In contrast, female sex was linked to a lower likelihood of having this condition (OR\u0026thinsp;=\u0026thinsp;0.801) (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe results describe an overall prevalence of hypertension (HTN) among Peruvian adults of nearly one-fifth of the population during the period 2020\u0026ndash;2023. This prevalence level is consistent with previous national estimates of 20% reported in 2018. These findings reflect the significant burden of HTN in Peru. The distribution of HTN varies according to demographic characteristics; prevalence increases markedly with age and is higher among men than women\u0026mdash;patterns that are expected, given that aging and male sex are well-established risk factors for HTN.\u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eFurthermore, educational level is closely linked to the population profile; individuals with basic education (primary education or no formal education) tend to be older and present with more comorbidities compared to those with higher education.\u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e This suggests the presence of underlying social determinants that influence individuals\u0026rsquo; cardiovascular health.\u003c/p\u003e\u003cp\u003eIt is important to note that part of the crude difference in HTN prevalence by educational level could be explained by confounding factors such as age. Population groups with lower education levels include proportionally more older adults (who have higher HTN rates), whereas individuals with higher education are generally younger. However, this potential bias was accounted for in the multivariate analysis: even after adjusting for age (and other covariates), a significant association between lower educational attainment and higher HTN prevalence persisted. This indicates that educational level functions as an independent risk factor and not merely as a reflection of age distribution or other variables.\u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eA clear inverse gradient is evident between education and hypertension prevalence. Descriptively, groups with lower educational levels exhibit the highest rates of HTN, whereas those with secondary and particularly highereducation show substantially lower prevalence. This educational gradient is statistically significant, suggesting important health inequities; in this context, education serves as an indicator of socioeconomic position associated with disease burden\u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e. Similar findings have been reported in previous studies from Peru, where having secondary or higher education was associated with a 25\u0026ndash;40% reduction in HTN prevalence compared to having only primary education.\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eIn our study, even without adjusting for other factors, a lower level of education was associated with a higher frequency of hypertension, supporting the hypothesis that education provides a certain degree of protection or advantage in terms of cardiovascular health.\u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eThese results highlight those educational disparities translate into differences in exposure to risk factors. Individuals with lower educational attainment may be more exposed to unhealthy behaviors, such as high salt and fat intake, smoking, lower levels of physical activity, and reduced access to health information, all of which increase their risk of hypertension. In contrast, higher educational levels are generally associated with greater knowledge and adoption of preventive measures, as well as better access to healthcare services\u0026mdash;factors that contribute to a lower prevalence of hypertension.\u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e Our findings confirm the presence of this gap within the Peruvian population, consistent with the concept of the social gradient in health described by Marmot.\u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eThe results of the adjusted multivariate model identified factors independently associated with hypertension. In this analysis, educational level emerged as a significant predictor of HTN presence, even after statistically controlling for other variables such as age, sex, socioeconomic status, place of residence, and lifestyle factors. In other words, even when comparing individuals of similar age, sex, and risk profiles, those with lower educational attainment were more likely to be hypertensive than their more educated counterparts.\u003c/p\u003e\u003cp\u003eQuantitatively, achieving a higher level of education was associated with a substantial reduction in hypertension risk. In our study, having a university education, compared to only primary education, was associated with approximately 40% lower odds of having HTN (adjusted OR\u0026thinsp;~\u0026thinsp;0.6). This magnitude of effect is consistent with prior research; in Spain, an adjusted OR of 0.61 for hypertension was reported in individuals with university education compared to those without formal education\u003csup\u003e\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e, and in Peru in 2018, an adjusted prevalence ratio of 0.62 was observed for higher versus primary education.\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e He consistency of these values suggests that the protective effect of education is robust and epidemiologically relevant, reducing the risk of HTN by approximately 35\u0026ndash;40%.\u003c/p\u003e\u003cp\u003eCabe destacar que en el modelo ajustado de nuestro estudio se incluyeron indicadores econ\u0026oacute;micos (como el \u0026iacute;ndice de riqueza o ingresos, seg\u0026uacute;n disponibilidad de datos). El mantenimiento del efecto del nivel educativo, pese a controlar la situaci\u0026oacute;n socioecon\u0026oacute;mica, implica que la educaci\u0026oacute;n no es simplemente un sustituto de la riqueza, sino un determinante por derecho propio. La educaci\u0026oacute;n puede influir en la salud a trav\u0026eacute;s de m\u0026uacute;ltiples v\u0026iacute;as independientes de los recursos materiales, mayor conocimiento sobre h\u0026aacute;bitos saludables, mejor capacidad de comprensi\u0026oacute;n y adherencia a tratamientos, habilidades para navegar el sistema de salud, as\u0026iacute; como redes sociales de apoyo m\u0026aacute;s amplias. Nuestros hallazgos respaldan esta noci\u0026oacute;n, mostrando que el nivel educativo tiene una influencia directa en la probabilidad de hipertensi\u0026oacute;n, complementaria a otras dimensiones socioecon\u0026oacute;micas. \u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eIt is worth noting that our adjusted model included economic indicators (such as wealth index or income, depending on data availability). The persistence of the effect of educational level, despite controlling for socioeconomic status, suggests that education is not merely a proxy for wealth but an independent determinant in its own right. Education can influence health through multiple pathways beyond material resources, including greater knowledge of healthy behaviors, improved understanding and adherence to treatments, enhanced ability to navigate the healthcare system, and broader social support networks. Our findings support this notion, demonstrating that educational level exerts a direct influence on hypertension risk, complementing other socioeconomic dimensions.\u003c/p\u003e\u003cp\u003eDespite the robustness of the results, this study is not without certain limitations. First, given its cross-sectional design, it is not possible to establish causal relationships between educational level and the presence of hypertension, underscoring the need for future longitudinal studies to further explore this association. Second, the diagnosis of hypertension was based on prior self-reported data, which may have led to underestimation, particularly among sectors with limited access to the healthcare system, where the disease often remains undiagnosed.\u003c/p\u003e\u003cp\u003eDespite these considerations, the findings hold significant relevance for public health in developing countries. This study reinforces the notion that education not only provides better economic opportunities but also serves as a protective shield against chronic diseases. Promoting policies that integrate education and health, and designing interventions specifically targeting populations with lower educational attainment, represents a strategic and sustainable pathway to reducing health disparities and building more equitable and resilient societies.\u003c/p\u003e\u003cp\u003eIn this context, our results allow us to conclude that low educational attainment is significantly associated with a higher prevalence of hypertension among Peruvian adults; that the majority of adults in the country attain secondary education, although a substantial proportion remains at the primary level; that hypertension affects 7.9% of adults, with an unequal distribution linked to educational levels; and that low educational attainment remains an independent predictor of hypertension, even after adjusting for sex, health insurance coverage, and alcohol consumption.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors received no financial support for the research, authorship, and/or publication of this article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial number\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003eH\u003cstrong\u003euman Ethics and Consent to Participate declarations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable. The study was based on secondary analysis of anonymized public data from the Demographic and Family Health Survey (ENDES), which is publicly available and does not require additional ethical approval.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eZhou B, Carrillo-Larco R, Danaei G, Riley M, Paciorek C, Stevens G, et al. Worldwide trends in hypertension prevalence and progress in treatment and control from 1990 to 2019: a pooled analysis of 1201 population-representative studies with 104 million participants. \u003cem\u003eLancet\u003c/em\u003e. 2021;398(10304):957-80. Available from: https://pubmed.ncbi.nlm.nih.gov/34450083/\u003c/li\u003e\n\u003cli\u003eRuiz-Alejos A, Carrillo-Larco RM, Bernab\u0026eacute;-Ortiz A. Prevalence and incidence of arterial hypertension in Peru: a systematic review and meta-analysis. \u003cem\u003eRev Peru Med Exp Salud Publica\u003c/em\u003e. 2021;38(4):521-9. 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Socioeconomic determinants of hypertension and prehypertension in Peru: Evidence from the Peruvian Demographic and Health Survey. \u003cem\u003ePLoS One\u003c/em\u003e. 2021;16(1):e0245730. Available from: https://doi.org/10.1371/journal.pone.0245730\u003c/li\u003e\n\u003cli\u003eWang T, Liu H, Zhou X, Wang C. Trends in prevalence of hypertension and high-normal blood pressure among US adults, 1999\u0026ndash;2018. \u003cem\u003eSci Rep\u003c/em\u003e. 2024;14:25503. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11513990/\u003c/li\u003e\n\u003cli\u003eHern\u0026aacute;ndez R, Fern\u0026aacute;ndez C, Baptista M. \u003cem\u003eMetodolog\u0026iacute;a de la investigaci\u0026oacute;n\u003c/em\u003e. 4th ed. Mexico: McGraw-Hill Education; 2014. p. 4-570.\u003c/li\u003e\n\u003cli\u003eInstituto Nacional de Estad\u0026iacute;stica e Inform\u0026aacute;tica. \u003cem\u003eEncuesta Demogr\u0026aacute;fica y de Salud Familiar - ENDES\u003c/em\u003e. 2024. 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Available from: https://www.sciencedirect.com/science/article/pii/S030089321600035X\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"hypertension, educational level, public health","lastPublishedDoi":"10.21203/rs.3.rs-7377311/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7377311/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eIntroduction:\u003c/strong\u003e This study aligns with Sustainable Development Goal 3 (Good Health and Well-being), which aims to reduce premature mortality from non-communicable diseases. The objective was to analyze the influence of educational level on the prevalence of hypertension in Peruvian adults during the period 2020–2023.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e A quantitative, non-experimental, cross-sectional study was conducted. Document analysis was used as the technique, and a data extraction form based on the 2020–2023 Demographic and Family Health Survey (ENDES) microdata served as the instrument. The sample included 124,200 Peruvian adults.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e Adults with lower educational attainment exhibited a significantly higher prevalence of hypertension (p\u0026lt;0.05; OR: 1.3), even after adjusting for variables such as sex, health insurance, and alcohol consumption. Educational level emerged as an independent determinant of hypertension burden.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion: \u003c/strong\u003eLower educational attainment significantly increases the risk of hypertension among Peruvian adults.\u003c/p\u003e","manuscriptTitle":"Impact of educational attainment on hypertension prevalence: Insights from a national Peruvian survey","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-30 04:07:12","doi":"10.21203/rs.3.rs-7377311/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2026-01-12T14:12:52+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"180587170332839588641944006782516036976","date":"2026-01-05T03:21:32+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-29T13:35:07+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-28T12:09:08+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"256707758125859064396375869594688846293","date":"2025-10-22T18:01:10+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"155547744334873130023355554270056712068","date":"2025-10-17T12:35:17+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-10-16T09:41:21+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-08-26T13:06:05+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-08-25T23:02:01+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-08-25T23:01:51+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Public Health","date":"2025-08-15T00:20:09+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"219ae0e9-d931-435f-b746-3bdcf3b4602f","owner":[],"postedDate":"October 30th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-10-30T04:07:12+00:00","versionOfRecord":[],"versionCreatedAt":"2025-10-30 04:07:12","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7377311","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7377311","identity":"rs-7377311","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}