Indicators of Environmental Health Disparities: Age-adjusted Hypertension
About the Indicators of Environmental Health Disparities
EPA’s indicators of environmental health disparities aim to illustrate disparities in key environmental and public health conditions, as well as the relationship between these health outcomes and the work of EPA programs. This project was created in direct response to EPA’s 2022-2026 Strategic Plan. These indicators are intended solely as an informational tool and are not intended to be the basis for agency decision making. EPA does not, consistent with applicable laws, distribute governmental benefits or burdens based on race, color, national origin, or sex.
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Age-adjusted Hypertension: Overview
Hypertension is a condition in which pressure in blood vessels is consistently elevated. There are a wide range of risk factors associated with hypertension, some of which EPA has some influence over, including air quality and lead exposure. Disparities in rate of age-adjusted hypertension exist across a range of demographic factors. Through actions under its statutory authorities, grantmaking, and partnerships, EPA engages in a range of activities aimed at improving air quality and reducing lead exposure.
Background
Hypertension is a type of cardiovascular disease (CVD) that is characterized by a prolonged increase in blood pressure, and is a major risk factor for other CVD conditions like coronary heart disease, coronary (ischemic) heart attack, and stroke. Major risk factors for hypertension include obesity, physical inactivity, and high sodium consumption.1
There are also known environmental exposures that can impact CVD and hypertension. There is consistent evidence to show that lead exposure increases hypertension and cardiovascular mortality,2 and air pollution exposure has also been found to contribute to the development of hypertension and exacerbate other existing CVD conditions.3 Evidence is particularly strong for exposure to fine particulate matter with a diameter of less than 2.5 micrometers (also known as PM2.5).4 Additionally, the effects of greenhouse gas emissions and climate change can worsen air quality by impacting ozone and particular matter concentrations, wildfires, and allergens,5 and people with conditions such as hypertension are particularly vulnerable to these effects.6
Certain populations remain at a disproportionate risk for exposure and negative health outcomes related to air quality. Those at increased risk of exposure to air pollution include non-white and low-income populations, as well as those who live or work in urban and industrial areas.7 Exposure to ambient airborne particulate matter also may be associated with increased hospitalizations and mortality among older individuals, largely due to cardiopulmonary and cardiovascular disease.8 To learn more about age-adjusted hypertension, read the Age-adjusted Hypertension Disparities Report (pdf) .
Data and Interpretation
Figure 1. Age-adjusted Percent of Adults (18+) with Hypertension by Race/Ethnicity
Figure 2. Age-adjusted Percent of Adults (18+) with Hypertension by Race/Ethnicity, Disparities Highlighted
Figure 3. Age-adjusted Percent of Adults (18+) with Hypertension by Poverty Level
What these charts show
These charts show the age-adjusted rates of hypertension in adults in the U.S. from 2002 to 2018, broken down by race/ethnicity and socio-economic status. In 2018, across race/ethnicity, people identifying as Non-Hispanic Black or African American have the highest rates of hypertension, at 32.8%, compared to an overall average of 24.8%. Since 2002, adults in households below the poverty level have consistently had the highest rates of hypertension (30.5% in 2018), followed by adults in households between 1 and 2 times the poverty level (29.2% in 2018), followed by adults in households over 2 times the poverty level (23.3% in 2018).
To learn more about this data, read the Age-adjusted Hypertension Disparities Report (pdf) or the Indicator Technical Documentation: Age-adjusted Hypertension (pdf) .
What these charts do not show
While analyzing the number of cases by socioeconomic and racial and ethnic groups is useful for determining those who may be most vulnerable and impacted by hypertension, these graphs do not suggest that socioeconomic level or race and ethnicity cause hypertension. Instead, there are many factors that may influence the number of cases of hypertension in a specific population, some of which may be related to systemic inequities, including underlying health issues, proximity to industrial sources of air pollution, poor nutrition due to limited access to healthy food, and stress. These are known to be higher in lower income communities as well as for certain racial and ethnic groups.9 Further exacerbating these disparities, some racial/ethnic and socioeconomic groups have been found to be more vulnerable to the health impacts of climate change than others.10
Relevant EPA Activities
The EPA conducts a variety of research, funding, and regulatory actions to mitigate the risk of CVD and hypertension due to environmental exposure. While regulatory actions by federal and state agencies have broadly improved air quality, an important focus has been placed on improving the risk of CVD and hypertension in areas with higher levels of pollution. These activities include:
- Regulating criteria air pollutants
- Reducing lead exposure
- Providing resources to communities to improve air quality
- Developing public education tools
- Understanding and addressing climate change
For more information on each of these activities, see the Age-adjusted Hypertension Disparities Report (pdf) .
References
1 U.S. EPA. Report on the environment: Cardiovascular disease prevalence and mortality. U.S. EPA. Published February 6, 2015. Accessed June 6, 2024. https://cfpub.epa.gov/roe/indicator.cfm?i=74.
2 U.S. EPA. Integrated Science Assessment (ISA) for Lead (Final Report). U.S. Environmental Protection Agency, Washington, DC, EPA/600/R‑23/375, 2024.
3 U.S. EPA. Particle pollution and cardiovascular effects. U.S. EPA. Published September 15, 2014. Accessed June 6, 2024. https://www.epa.gov/pmcourse/particle-pollution-and-cardiovascular-effects.
4 U.S. EPA. Integrated Science Assessment (ISA) for Particulate Matter (Final Report, Dec 2019). U.S. Environmental Protection Agency, Washington, DC, EPA/600/R-19/188, 2019.
5 US EPA. Climate Change Impact on Health. US EPA. Last Updated May 15, 2024. https://www.epa.gov/climateimpacts/climate-change-impacts-health.
6 US EPA. Climate Change and the Health of People with Chronic Medical Conditions. US EPA. Last Updated December 27, 2023. Accessed July 19, 2024. https://www.epa.gov/climateimpacts/climate-change-and-health-people-chronic-medical-conditions.
7 U.S. EPA. Air pollution and cardiovascular disease basics. U.S. EPA. Published September 17, 2021. Accessed June 6, 2024. https://www.epa.gov/air-research/air-pollution-and-cardiovascular-disease-basics.
8 U.S. EPA. Integrated Science Assessment (ISA) for Particulate Matter (Final Report, Dec 2019). U.S. Environmental Protection Agency, Washington, DC, EPA/600/R-19/188, 2019.
9 US EPA. Research on Health Effects from Air Pollution. US EPA. Published October 28, 2020. Accessed June 6, 2024. https://www.epa.gov/air-research/research-health-effects-air-pollution.
10 U.S. EPA. Climate Change and the Health of Socially Vulnerable People. U.S. EPA. Last Updated July 16, 2014. Accessed July 19, 2024. https://www.epa.gov/climateimpacts/climate-change-and-health-socially-vulnerable-people.