Gender differences in the association of individual and contextual socioeconomic status with hypertension in 230 Latin American cities from the SALURBAL study: a multilevel analysis
Abstract Background Despite global interest in gender disparities and social determinants of hypertension, research in urban areas and regions with a high prevalence of hypertension, such as Latin America, is very limited. The objective of this study was to examine associations of individual- and ar...
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| Format: | Article |
| Language: | English |
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BMC
2023-08-01
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| Series: | BMC Public Health |
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| Online Access: | https://doi.org/10.1186/s12889-023-16480-3 |
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| author | Débora Moraes Coelho Amanda Cristina de Souza Andrade Uriel Moreira Silva Mariana Lazo S. Claire Slesinski Alex Quistberg Ana V. Diez-Roux Amélia Augusta de Lima Friche Waleska Teixeira Caiaffa |
| author_facet | Débora Moraes Coelho Amanda Cristina de Souza Andrade Uriel Moreira Silva Mariana Lazo S. Claire Slesinski Alex Quistberg Ana V. Diez-Roux Amélia Augusta de Lima Friche Waleska Teixeira Caiaffa |
| author_sort | Débora Moraes Coelho |
| collection | DOAJ |
| description | Abstract Background Despite global interest in gender disparities and social determinants of hypertension, research in urban areas and regions with a high prevalence of hypertension, such as Latin America, is very limited. The objective of this study was to examine associations of individual- and area-level socioeconomic status with hypertension in adults living in 230 cities in eight Latin America countries. Methods In this cross-sectional study, we used harmonized data from 109,184 adults (aged 18–97 years) from the SALURBAL (Salud Urbana en America Latina/Urban Health in Latin America) project. Hypertension was assessed by self-report. Individual-, sub-city- and city-level education were used as proxies of socioeconomic status. All models were stratified by gender. Results Higher individual-level education was associated with lower odds of hypertension among women (university education or higher versus lower than primary: odds ratio [OR] = 0.67, 95% confidence interval [CI] = 0.61–0.74) but higher odds among men (OR = 1.65; 95%CI 1.47–1.86), although in men an inverse association emerged when measured blood pressure was used (OR = 0.86; 95%CI 0.76–0.97). For both genders, living in sub-city areas with higher educational achievement was associated with higher odds of hypertension (OR per standard deviation [SD] = 1.07, 95%CI = 1.02–1.12; OR = 1.11 per SD, 95%CI = 1.05–1.18, for women and men, respectively). The association of city-level education with hypertension varied across countries. In Peru, there was an inverse association (higher city level education was associated with lower odds of hypertension) in women and men, but in other countries no association was observed. In addition, the inverse association of individual-level education with hypertension became stronger (in women) or emerged (in men) as city or sub-city education increased. Conclusion The social patterning of hypertension differs by gender and by the level of analysis highlighting the importance of context- and gender-sensitive approaches and policies to reduce the prevalence of hypertension in Latin America. |
| first_indexed | 2024-03-10T16:53:51Z |
| format | Article |
| id | doaj.art-531f6f5c89ab4b06b5674251222b9765 |
| institution | Directory Open Access Journal |
| issn | 1471-2458 |
| language | English |
| last_indexed | 2024-03-10T16:53:51Z |
| publishDate | 2023-08-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Public Health |
| spelling | doaj.art-531f6f5c89ab4b06b5674251222b97652023-11-20T11:12:37ZengBMCBMC Public Health1471-24582023-08-0123111110.1186/s12889-023-16480-3Gender differences in the association of individual and contextual socioeconomic status with hypertension in 230 Latin American cities from the SALURBAL study: a multilevel analysisDébora Moraes Coelho0Amanda Cristina de Souza Andrade1Uriel Moreira Silva2Mariana Lazo3S. Claire Slesinski4Alex Quistberg5Ana V. Diez-Roux6Amélia Augusta de Lima Friche7Waleska Teixeira Caiaffa8Faculty of Medicine, Federal University of Minas GeraisBelo Horizonte Observatory for Urban HealthFaculty of Medicine, Federal University of Minas GeraisDornsife School of Public Health, Drexel UniversityDornsife School of Public Health, Drexel UniversityDornsife School of Public Health, Drexel UniversityDornsife School of Public Health, Drexel UniversityFaculty of Medicine, Federal University of Minas GeraisFaculty of Medicine, Federal University of Minas GeraisAbstract Background Despite global interest in gender disparities and social determinants of hypertension, research in urban areas and regions with a high prevalence of hypertension, such as Latin America, is very limited. The objective of this study was to examine associations of individual- and area-level socioeconomic status with hypertension in adults living in 230 cities in eight Latin America countries. Methods In this cross-sectional study, we used harmonized data from 109,184 adults (aged 18–97 years) from the SALURBAL (Salud Urbana en America Latina/Urban Health in Latin America) project. Hypertension was assessed by self-report. Individual-, sub-city- and city-level education were used as proxies of socioeconomic status. All models were stratified by gender. Results Higher individual-level education was associated with lower odds of hypertension among women (university education or higher versus lower than primary: odds ratio [OR] = 0.67, 95% confidence interval [CI] = 0.61–0.74) but higher odds among men (OR = 1.65; 95%CI 1.47–1.86), although in men an inverse association emerged when measured blood pressure was used (OR = 0.86; 95%CI 0.76–0.97). For both genders, living in sub-city areas with higher educational achievement was associated with higher odds of hypertension (OR per standard deviation [SD] = 1.07, 95%CI = 1.02–1.12; OR = 1.11 per SD, 95%CI = 1.05–1.18, for women and men, respectively). The association of city-level education with hypertension varied across countries. In Peru, there was an inverse association (higher city level education was associated with lower odds of hypertension) in women and men, but in other countries no association was observed. In addition, the inverse association of individual-level education with hypertension became stronger (in women) or emerged (in men) as city or sub-city education increased. Conclusion The social patterning of hypertension differs by gender and by the level of analysis highlighting the importance of context- and gender-sensitive approaches and policies to reduce the prevalence of hypertension in Latin America.https://doi.org/10.1186/s12889-023-16480-3Urban healthHypertensionEducationSocioeconomic statusLatin AmericaMultilevel analysis |
| spellingShingle | Débora Moraes Coelho Amanda Cristina de Souza Andrade Uriel Moreira Silva Mariana Lazo S. Claire Slesinski Alex Quistberg Ana V. Diez-Roux Amélia Augusta de Lima Friche Waleska Teixeira Caiaffa Gender differences in the association of individual and contextual socioeconomic status with hypertension in 230 Latin American cities from the SALURBAL study: a multilevel analysis BMC Public Health Urban health Hypertension Education Socioeconomic status Latin America Multilevel analysis |
| title | Gender differences in the association of individual and contextual socioeconomic status with hypertension in 230 Latin American cities from the SALURBAL study: a multilevel analysis |
| title_full | Gender differences in the association of individual and contextual socioeconomic status with hypertension in 230 Latin American cities from the SALURBAL study: a multilevel analysis |
| title_fullStr | Gender differences in the association of individual and contextual socioeconomic status with hypertension in 230 Latin American cities from the SALURBAL study: a multilevel analysis |
| title_full_unstemmed | Gender differences in the association of individual and contextual socioeconomic status with hypertension in 230 Latin American cities from the SALURBAL study: a multilevel analysis |
| title_short | Gender differences in the association of individual and contextual socioeconomic status with hypertension in 230 Latin American cities from the SALURBAL study: a multilevel analysis |
| title_sort | gender differences in the association of individual and contextual socioeconomic status with hypertension in 230 latin american cities from the salurbal study a multilevel analysis |
| topic | Urban health Hypertension Education Socioeconomic status Latin America Multilevel analysis |
| url | https://doi.org/10.1186/s12889-023-16480-3 |
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