Differences in Blood Pressure Levels Among Children by Sociodemographic Status

Melissa Goulding, MS; Robert Goldberg, PhD; Stephenie C. Lemon, PhD


Prev Chronic Dis. 2021;18(9):e88 

In This Article


Characteristics of US Children. Among children aged 8 to 17 years in NHANES 2011–2018, nearly a third (31.1%) were aged 13 to 15 years (Table 1). About half were female (49.7%). More than half (55.4%) were non-Latino White. The next largest racial/ethnic group was Mexican American (14.1%). Over one-third (37.6%) had an unhealthy body weight index (BMI) (≥85 percentile).

Prevalence of Elevated and Hypertensive BP. In the most recent NHANES cycle, 2017–2018, the prevalence of elevated BP was 6.2% (95% CI, 4.2%–9.3%) (Table 2) and the prevalence of hypertensive BP was 3.9% (95% CI, 2.9%–5.3%). Prevalence of hypertensive BP overall from 2011–2018 was 3.8% (95% CI, 3.3%–4.5%).

Elevated and Hypertensive BP by Child's Weight Status. Both elevated and hypertensive BP were more prevalent in children categorized as overweight or as having obesity compared with children of healthy weight. For elevated BP among overweight children, the prevalence difference was +4.3% (95% CI, 1.8%–6.8%). For children with obesity, the prevalence difference for elevated BP was +7.8% (95% CI, 5.7%–9.9%). For hypertensive BP, the prevalence difference for overweight children was +1.9% (95% CI, 0.3%–3.5%), and for children with obesity, the prevalence difference was +6.4% (95% CI, 4.3%– 8.6%) (Table 3). Children with BMIs within the range indicating obesity had a prevalence of hypertensive BP almost 4 times greater than those with healthy weight (8.6%; 95% CI, 6.9%–10.9%) versus 2.2% (95% CI, 1.7%–2.8%).

Sociodemographic Differences in Elevated BP Prevalence. Prevalence of elevated BP differed across sociodemographic groups. Prevalence was higher among males (9.6%; 95% CI, 8.1%–11.2%) than among females (4.9%; 95% CI, 3.9%–6.1%), and the difference remained significant after adjustment for body weight status (adjusted prevalence difference, +4.6%; 95% CI, 2.8%–6.5%) (Table 3). Prevalence was also greater among older children (16–17 y vs 8–9 y) before adjustment (crude prevalence difference +6.9%; 95% CI, 3.7%–10.2%) and after adjustment (adjusted prevalence difference, +6.3%; 95% CI, 3.2%–9.4%). Children of non-Latino Asian descent had the lowest crude prevalence of elevated BP (4.6%; 95% CI, 2.9%–7.4%), followed by non-Latino White children (6.3%; 95% CI, 5.1%–7.9%), whereas non-Latino Black children had significantly greater prevalence (10.4%; 95% CI, 8.8%–12.1%), with the crude prevalence difference +4.0% (95% CI, 2.1%–5.9%) (Table 3). After adjustment for weight status, these prevalence differences remained: +4.0 (95% CI, 2.2%–5.8%) among non-Latino Black children compared with non-Latino White children. Elevated BP also appeared to have an inverse relationship with socioeconomic status: the highest prevalence estimates were observed among children of low-income families (8.4%; 95% CI, 7.3%–9.6%) or from a household with parent/guardian educational attainment of less than a high school diploma (8.0%; 95% CI, 6.5%–9.9%) in unadjusted estimates. These socioeconomic differences were attenuated, and significance remained only when comparing those with the lowest parent/guardian education (<high school diploma) to those with the highest (college graduate or above) after adjustment for weight status (adjusted prevalence difference, +2.1%; 95% CI, 0%–4.3%).

Sociodemographic Differences in Prevalence of Hypertensive BP. Prevalence of hypertensive BP also differed by sociodemographic groups as did crude and adjusted prevalence differences. Although the unadjusted prevalence estimates were higher among children in all racial/ethnic groups compared with non-Latino White children (unadjusted prevalence difference from +0.7% [95% CI, −1.2% to 2.6%] to +2.3 [95% CI −0.4% to 5.1%]), these differences were not significant (Table 3). The unadjusted prevalence of hypertensive BP was higher among male children (prevalence, +1.7%; 95% CI, 0.2%–3.2%) than female children, but this difference was no longer significant after adjustment for the differential distribution of weight status. The prevalence of hypertensive BP was lower among children aged 13 to 15 years compared with those aged 8 to 9 years (unadjusted prevalence difference, −4.1%; 95% CI, −5.9% to −2.3%), and these differences remained significant after adjustment for weight status (adjusted prevalence difference, −3.8%; 95% CI, −5.6% to −2.0%). No differences in hypertensive BP prevalence were seen across PIR levels or parent/guardian education levels.