Gender Differences in Social Determinants of Hypertension Among Older Brazilian Adults Residing in Urban Areas: A Multilevel Approach from the ELSI-Urbe.

IF 4.1 2区 医学 Q1 MEDICINE, GENERAL & INTERNAL
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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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.

居住在城市地区的巴西老年人高血压社会决定因素的性别差异:来自ELSI-Urbe的多层次方法。
尽管人们对高血压的社会决定因素越来越感兴趣,但在拉丁美洲等不平等的城市地区,调查个人和背景社会经济条件对城市内部影响的具有全国代表性的研究仍然很少。本研究描述了居住在巴西城市地区的老年人中个体和背景社会经济条件与高血压之间的性别差异。我们分析了来自巴西老龄化纵向研究(ELSI-Brazil)基线(2015-2016)的6767名参与者的数据,ELSI-Brazil是一个具有全国代表性的≥50岁的社区居住成年人队列。作为elsi - urban项目的一部分进行了分析,该项目将个人层面的ELSI-Brazil数据与城市背景信息相结合。高血压是自我报告的。社会经济条件的测量是教育,背景测量是参与者居住地人口普查区的巴西剥夺指数(IBP;葡萄牙语首字母缩写)。采用多水平逻辑回归模型(个人和人口普查区),调整年龄并按性别分层。受教育程度和IBP导致的高血压患病率在男性和女性之间存在差异。在女性中,高等教育(≥9年vs≤4年)与较低的高血压发病率相关(优势比[OR] = 0.62; 95%可信区间[CI] = 0.52-0.74),居住在贫困程度较高的人口普查区与较高的高血压发病率相关(per standard deviation [OR] = 1.04; 95%CI = 1.01-1.09)。在男性中,受教育程度或IBP与高血压之间没有显著关联。我们的研究结果表明,巴西等中低收入国家的公共政策应该根据具体情况对性别问题敏感,以有效解决这种疾病的负担。
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来源期刊
Journal of Urban Health-Bulletin of the New York Academy of Medicine
Journal of Urban Health-Bulletin of the New York Academy of Medicine 医学-公共卫生、环境卫生与职业卫生
CiteScore
9.10
自引率
3.00%
发文量
105
审稿时长
6-12 weeks
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.
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