Prevalence, awareness, treatment and control of hypertension among ethnoracial minorities in France: results from the CONSTANCES cohort.

Abstract

Race/ethnicity, combined with sex, is an important determinant of hypertension prevalence and management in high-income countries, but data for France are lacking. This study aims to explore hypertension prevalence and each stage of the cascade of care (<i>i.e.</i>, awareness, treatment, and control), at the intersection of sex and race/ethnicity in a French cohort. We used data from the population-based CONSTANCES cohort, linked with the French National Health Data System. 180 459 individuals were included, aged 18-69 (mean age 47, SD: 13), among which 53% (n=95 395) women and 81% (n=145 983) of the majority group, and 4.9% (n=8 775) of North African, 1.2% (n=2 220) of sub-Saharan African (SSA), 1.2% (n=2 204) of Asian, 1.4% (n=4 462) of Overseas France <i>départements</i> and regions (DROMs) and 10% of European and other descents. Among these 180 459 individuals, 54 009 (29.9%) had hypertension. Migration status was used as a proxy for race/ethnicity. Age-standardized hypertension rates were estimated by sex and race/ethnicity. Multinomial logistic regressions, adjusted for age, were used to compare ethnoracial differences in the cascade of care. Individuals from SSA or DROMs had higher prevalence rates than the majority group, especially among women (37.6% and 26.8% <i>vs</i> 20.8%, respectively). These groups also had higher odds of entering a hypertension care path, although women from SSA tended to remain treated, instead of achieving control (OR 1.39 (0.99 to 1.96)). Women of Europe and others (OR 1.46 (1.14 to 1.87)) and men originating from Asia (OR 1.85 (1.03 to 3.33)) were more likely to remain at the awareness step. Race/ethnicity impacts hypertension prevalence and management in France, with variations by sex. Our findings underscore the necessity to consider these results when designing intervention strategies to reduce the burden of uncontrolled hypertension.