Upstream Factors: The Association Between County Intergenerational Deprivation, State Income Inequality, State Minimum Wage and Hypertension among Young Adults

While hypertension is largely preventable, its rates have been increasing in young adults. Hypertension is associated with substantial costs to the US health care system and therefore a public health burden. In recent times, there has been a shift in focus toward the role of upstream factors and how they influence the risk of hypertension. The primary objective of this dissertation was to evaluate whether upstream social factors, namely, county intergenerational deprivation, state income inequality and state minimum wage are associated with hypertension in young adults. The secondary objective was to assess whether race-ethnicity and geographical region were effect modifiers of these associations. To address these two objectives, three separate studies were done. Paper 1 examined the association between county intergenerational deprivation and hypertension among young adults, 18-39 years, using the 2009 and 2011 Behavioral Risk Factor Surveillance System (BRFSS), 1996-2012 Opportunity Insights database, 2008-2012 American Community Survey (ACS), and 2010 County Health Rankings and Roadmaps (CHR&R) data. Paper 2 examined the associations between state income inequality and hypertension in young adults, 18-39 years, using the 2019 BRFSS and 2015-2019 ACS data. Last, paper 3 assessed the association between state minimum wage and hypertension among young adults 18-39 years with a high school education or less. Taken together, findings indicated that within the young adult hypertension literature, county intergenerational deprivation may be a more salient upstream factor than state income inequality and state minimum wage. Also, findings suggested that race-ethnicity and geographical region were effect modifiers of the exposure-disease associations. Additional population-based studies are necessary to confirm findings.