Cardiometabolic diseases have substantially increased in China in the past 20
years and blood pressure is a primary modifiable risk factor. Using data from
the China Health and Nutrition Survey, we examine blood pressure trends in
China from 1991 to 2009, with a concentration on age cohorts and urbanicity.
Very large values of blood pressure are of interest, so we model the
conditional quantile functions of systolic and diastolic blood pressure. This
allows the covariate effects in the middle of the distribution to vary from
those in the upper tail, the focal point of our analysis. We join the
distributions of systolic and diastolic blood pressure using a copula, which
permits the relationships between the covariates and the two responses to share
information and enables probabilistic statements about systolic and diastolic
blood pressure jointly. Our copula maintains the marginal distributions of the
group quantile effects while accounting for within-subject dependence, enabling
inference at the population and subject levels. Our population-level regression
effects change across quantile level, year and blood pressure type, providing a
rich environment for inference. To our knowledge, this is the first quantile
function model to explicitly model within-subject autocorrelation and is the
first quantile function approach that simultaneously models multivariate
conditional response. We find that the association between high blood pressure
and living in an urban area has evolved from positive to negative, with the
strongest changes occurring in the upper tail. The increase in urbanization
over the last twenty years coupled with the transition from the positive
association between urbanization and blood pressure in earlier years to a more
uniform association with urbanization suggests increasing blood pressure over
time throughout China, even in less urbanized areas. Our methods are available
in the R package BSquare.Comment: Published at http://dx.doi.org/10.1214/15-AOAS841 in the Annals of
Applied Statistics (http://www.imstat.org/aoas/) by the Institute of
Mathematical Statistics (http://www.imstat.org
