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Gender differences in hypertension-free life expectancy in Bangladesh

uncontrolled HTN is higher among women than men, and it is higher among older than
younger individuals. As HTN is a risk factor for developing coronary heart disease,
stroke, and kidney disease, early detection and preventive behavior for HTN can
reduce the risk of developing those non-communicable diseases. The high prevalence
of unawareness of HTN and uncontrolled HTN in the current study suggests that
a substantial number of cardiovascular events could be prevented in Bangladesh if
proper steps were taken. This study thus suggests that women and older individuals,
in particular, and all Bangladeshi individuals, in general, take appropriate measures to
prevent and control HTN.
Second, compared with men, women have longer LE but they could expect shorter
HFLE at all ages in terms of both number and proportion of years. As with women
elsewhere around the world, Bangladeshi women can expect to live longer than men
(Barford, Dorling, Smith et al., 2006; Tareque, Begum, and Saito, 2013; Tareque,
Saito, and Kawahara, 2015). While various methods and measures have been used to
measure health expectancy, none have computed HFLE, which makes it difficult to
compare our findings with others. Studies on health expectancy in terms of disability
in several countries have shown that women expect longer life than men with and
without disability (Camargos, Machado, and do Nascimento Rodrigues, 2007;
Jitapunkul, Kunanusont, Phoolcharoen et al., 2003), but women expect a greater
proportion of their later years with a disability than do men (Camargos, Machado, and
do Nascimento Rodrigues, 2007; Crimmins and Saito, 2001; Jitapunkul, Kunanusont,
Phoolcharoen et al., 2003; Reyes-Beaman, Jagger, Garcia-Peña et al., 2005). However,
a study on health expectancy in terms of disability for Bangladesh (Tareque, Begum,
and Saito, 2013) used similar methods to our study and reported an exception. Despite
having longer LE, elderly women could expect shorter disability-free life expectancy
at all ages in both number and proportion of years compared with elderly men. This is
in line with our findings. A different LE method than that used in our study was applied
to calculate LE for normotensive and hypertensive Japanese people and found that the
LE difference between normotensive and hypertensive individuals was 2.2 years for
men and 2.9 years for women. The LE of 40-year-old Japanese men and women was
41.7 years and 48.7 years, respectively, in normotensive participants and 39.5 and 45.8
years, respectively, in hypertensive participants (Turin, Murakami, Miura et al., 2012).
For both men and women, the proportion of life with HTN increases as age increases.
Compared with men, women could expect much longer proportion of LE with HTN as
well as LE with all types of HTN at each age. The proportion of LE with HTN as well
as LE with all types of HTN increases as age increases for both men and women, and
the proportion of LE with HTN as well as LE with all types of HTN for men at age 65
is lower than the respective proportion for women at age 35. The higher prevalence of
HTN as well as all types of HTN for women and older individuals in Bangladesh is
the reason behind the higher proportion of LE with HTN as well as LE with all types
of HTN for women and older individuals in Bangladesh. The possibility of women
developing HTN increases as they grow older, and in turn, more women become
hypertensive compared to men. A significant amount of HTN in women is attributable
to obesity (Chiang, Perlman, and Epstein, 1969), oral contraceptive use (American
Heart Association, 2017; August and Oparil, 1999), preeclampsia and menopause
(American Heart Association, 2017). Gender differences in functional status, HTN and
health problems could be due to gender inequalities in nutritional status, marital status
and education (Onadja, Atchessi, Soura et al., 2013), greater female longevity, and
exposures to domestic violence (Guedes, Vafaei, Alvarado et al., 2016; Islam, Tareque,
Tiedt et al., 2014). Higher prevalence of HTN among women could also be due to less
than adequate care and services for pregnant/delivering mothers, and the impact of
gender-related life conditions. Mothers encounter some long lasting health problems
during the reproductive period, and the problems remain undisclosed due to cultural
reasons. These health problems can cause women to fall sick with greater frequency
during reproductive years as well as in later life (Tareque, Begum, and Saito, 2014).
Patriarchy is also thought to limit women’s advancement, rights, and a cause of lower

116 International Journal of Population Studies 2017, Volume 3, Issue 1