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Select behavioral and social risk factors were correlated with early onset of hypertension and diabetes, a prospective cohort study found.

At 3.5 years of follow-up, among the patients without diabetes at baseline, 4% developed diabetes, while 6.4% of the cohort without baseline hypertension developed hypertension, reported Matthew Pantell, MD, MS, of the University of California, San Francisco, and colleagues.

As shown in their study in , the results also noted a dose-response association for the likelihood of the onset of diabetes and hypertension and several behavioral and social risk factors. The following were found to be significantly linked with early onset of diabetes:

• Smoking (HR 1.53; 95% CI 1.27-1.86)

• Concentrated neighborhood poverty (HR 1.31; 95% CI 1.07-1.60)

• Depressive symptoms (HR 1.28; 95% CI 1.10-1.50)

• Intimate partner violence (HR 1.68; 95% CI 1.14-2.48)

• High stress (HR 1.28; 95% CI 1.09-1.51)

• Financial concern (HR 1.29; 95% CI 1.13-1.46)

• Being separated or single (HR 1.24; 95% CI 1.08-1.42)

• Having less than a high school diploma (HR 1.58; 95% CI 1.26-1.97)

These factors were found to be associated with early onset of hypertension:

• Infrequent exercise (HR 1.22; 95% CI 1.08-1.38)

• Smoking (HR 1.35; 95% CI 1.10-1.67)

• Concentrated neighborhood poverty (HR 1.26; 95% CI 1.00-1.59)

• Being widowed (HR 1.38; 95% CI 1.11-1.71)

• Having less than a high school diploma (HR 1.84; 95% CI 1.40-2.43)

The National Academy of Medicine has suggested adding information on behavioral and social factors linked with health, like exercise and educational level, into electronic health records, but there are still questions regarding the clinical significance of this approach, Pantell and co-authors noted. Despite the potential logistical difficulties, "the current study underscores the potential importance of knowing social and behavioral information in both clinical and healthcare system settings and advocates for exploring the utility of routine collection of this information," the team wrote.

The results "advocate for collecting this information in clinical settings to help with targeting interventions and the population health management," Pantell told MedPage Today.

The team evaluated a total of 35,788 patients without baseline diabetes, mean age of 56.2; 56.4% of the total were female, and 68.0% were white. The researchers also assessed 18,133 individuals without baseline hypertension (mean age of 48.1, 60.7% of whom were female and 63.4% of whom were white).

Excluded from the study were patients with missing information about race/ethnicity, body-mass index (BMI), sex, behavioral or social information, or for whom there were no emergency department or outpatient visits over the course of the study and those who were not continuously enrolled in Kaiser Permanente Northern California (KPNC) during the follow-up period.

Participants filled out the KPNC adult member health survey from 2005 through 2016, and completed additional questionnaires every 3 years. The investigators collected information and linked survey results to information in the members' electronic health records to determine new onsets of hypertension and diabetes, and used Cox proportional hazards regression analysis and Kaplan-Meier survival tables to approximate the onset of diabetes and hypertension among patients with no indication for the conditions at baseline.

After the researchers controlled for sex, ethnicity, race, survey year, BMI, and age and compared the patients who had more than three risk factors with patients who had none, the hazard ratios were 1.53 (95% CI 1.29-1.82) for developing diabetes and 1.41 (95% CI 1.17-1.71) for developing hypertension.

The team said that notably, black race was not linked with diabetes onset when using logistic regression, and Hispanic and Asian race/ethnicity were not significantly linked with hypertension onset.

Study limitations, Pantell said, included that it lacked long-term follow-up and may not be generalizable.