Gender Differences in Social Determinants of Hypertension Among Older Brazilian Adults Residing in Urban Areas: A Multilevel Approach from the ELSI-Urbe.
Débora Moraes Coelho, Amanda Cristina de Souza Andrade, Bruno de Souza Moreira, Luciana de Souza Braga, Maria Fernanda Lima-Costa, Waleska Teixeira Caiaffa
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引用次数: 0
Abstract
Despite growing interest in the social determinants of hypertension, nationally representative studies examining intra-urban effects of individual and contextual socioeconomic conditions within unequal urban areas, such as those in Latin America, remain scarce. This study describes gender disparities in the association of individual and contextual socioeconomic conditions with hypertension among older adults residing in urban areas of Brazil. We analyzed data from 6,767 participants from the baseline (2015-2016) of the Brazilian Longitudinal Study of Aging (ELSI-Brazil), a nationally representative cohort of community-dwelling adults aged ≥ 50years. Analyses were conducted as part of the ELSI-Urbe project, which integrates individual-level ELSI-Brazil data with contextual urban information. Hypertension was self-reported. The measure of socioeconomic condition was education, and the contextual measure was the Brazilian Deprivation Index (IBP; acronym in Portuguese) of the census tract of the participant's residence. Multilevel logistic regression models (individuals and census tracts), adjusted for age and stratified by gender, were used. The prevalence of hypertension by education and the IBP differed between men and women. In women, higher education (≥9 years versus ≤4 years of schooling) was associated with a lower chance of hypertension (odds ratio [OR] = 0.62; 95% confidence interval [CI] = 0.52-0.74), and residing in census tracts with higher deprivation was associated with a higher chance of hypertension (OR per standard deviation [SD] = 1.04; 95%CI = 1.01-1.09). In men, there was no significant association between education or IBP and hypertension. Our findings suggest that public policies in middle- and low-income countries, such as Brazil, should be gender-sensitive context-specific to effectively address the burden of this disease.
期刊介绍:
The Journal of Urban Health is the premier and authoritative source of rigorous analyses to advance the health and well-being of people in cities. The Journal provides a platform for interdisciplinary exploration of the evidence base for the broader determinants of health and health inequities needed to strengthen policies, programs, and governance for urban health.
The Journal publishes original data, case studies, commentaries, book reviews, executive summaries of selected reports, and proceedings from important global meetings. It welcomes submissions presenting new analytic methods, including systems science approaches to urban problem solving. Finally, the Journal provides a forum linking scholars, practitioners, civil society, and policy makers from the multiple sectors that can influence the health of urban populations.