Among 3,842 overweight and obese Ethiopian adults drawn from 612 clusters in the nationally representative 2024–25 Ethiopia Demographic and Health Survey, the weighted prevalence of hypertension reached 24.8%. Multilevel logistic regression identified advancing age, male sex, higher education, and upper wealth quintiles as individual-level risk factors, while residing in urban clusters and communities with concentrated wealth independently elevated hypertension odds — even after accounting for individual characteristics. Substantial intraclass correlation in the null model confirmed meaningful geographic clustering of risk.
This preprint — not yet peer-reviewed and subject to revision — adds important granularity to Sub-Saharan Africa's accelerating non-communicable disease burden. The community-level findings are the most novel: they suggest that urbanization itself, beyond individual socioeconomic status, shapes cardiovascular risk through structural pathways such as sedentary built environments, processed-food availability, and chronic stress. This mirrors patterns documented in urban health penalty literature from South Asia and Latin America, but robust nationally representative Ethiopian data at this scale are rare. Limitations include the cross-sectional design, which precludes causal inference, and self-reported medication use as a hypertension proxy. The relatively modest sample of overweight adults (3,842) also limits subgroup power. Practically, the finding that community-level wealth concentration independently elevates risk argues for urban planning interventions — walkable infrastructure, green space — rather than clinical screening alone. Incremental in method, but contextually significant for Ethiopian health policy.
