Lifestyle and Environmental Stress as Determinants of Hypertension Development in Rural Indonesia: A Multinomial Logistic Regression Analysis
Lia Mulyati, Linda Rosalia

Universitas Bhakti Husada Indonesia

Abstract

Global evidence links lifestyle and environmental stress to hypertension, but studies on their combined effect in rural Indonesia remain scarce. This study aimed to examine the independent and interactive effects of lifestyle and environmental stress on hypertension severity using multinomial logistic regression.
We conducted a cross-sectional study of 373 hypertensive patients (>45 years old) in three rural villages of Kuningan Regency. Lifestyle and environmental stress were measured using validated questionnaires (Cronbach^s > 0.70). Blood pressure was classified into Stage 1, 2, or 3 based on the 2020 International Society of Hypertension guidelines. Multinomial logistic regression, adjusted for age, gender, BMI, and hypertension duration, examined main and interaction effects.
The model showed strong predictive power (Chi-square = 158.84, p < 0.001- Pearson Chi-square = 24.76, p = 0.001). A healthy lifestyle increased the odds of Stage 1 (OR = 30.04) and Stage 2 (OR = 11.45) over Stage 3. Mild stress raised the odds of Stage 1 (OR = 7.03) and Stage 2 (OR = 8.07), while moderate stress remained protective (p < 0.01). Notably, a healthy lifestyle moderated the negative impact of severe stress, preserving a high probability of Stage 1 hypertension.
Both lifestyle and environmental stress independently and interactively predict hypertension severity in rural Indonesia. Findings reinforce Roy^s Adaptation Model and Pender^s Health Promotion Model, highlighting the need for integrating lifestyle improvement and stress management into community health programs to support Sustainable Development Goal 3.

Keywords: Hypertension, lifestyle, environmental stress, multinomial logistic regression, probability prediction

Topic: Public Health Sciences