Educational health disparities in hypertension and diabetes mellitus among African descent populations in the Caribbean and the USA: a comparative ... View Full Text


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Article Info

DATE

2017-02-14

AUTHORS

Aurelian Bidulescu, Trevor S. Ferguson, Ian Hambleton, Novie Younger-Coleman, Damian Francis, Nadia Bennett, Michael Griswold, Ervin Fox, Marlene MacLeish, Rainford Wilks, E. Nigel Harris, Louis W. Sullivan

ABSTRACT

BackgroundStudies have suggested that social inequalities in chronic disease outcomes differ between industrialized and developing countries, but few have directly compared these effects. We explored inequalities in hypertension and diabetes prevalence between African-descent populations with different levels of educational attainment in Jamaica and in the United States of America (USA), comparing disparities within each location, and between countries.MethodsWe analyzed baseline data from the Jackson Heart Study (JHS) in the USA and Spanish Town Cohort (STC) in Jamaica. Participants reported their highest level of educational attainment, which was categorized as ‘less than high school’ (HS). Educational disparities in the prevalence of hypertension and diabetes were examined using prevalence ratios (PR), controlling for age, sex and body mass index (BMI).ResultsAnalyses included 7248 participants, 2382 from STC and 4866 from JHS, with mean age of 47 and 54 years, respectively (p < 0.001). Prevalence for both hypertension and diabetes was significantly higher in the JHS compared to STC, 62% vs. 25% (p < 0.001) and 18% vs. 13% (p < 0.001), respectively. In bivariate analyses there were significant disparities by education level for both hypertension and diabetes in both studies; however, after accounting for confounding or interaction by age, sex and BMI these effects were attenuated. For hypertension, after adjusting for age and BMI, a significant education disparity was found only for women in JHS, with PR of 1.10 (95% CI 1.04–1.16) for < HS vs > HS and 1.07 (95% CI 1.01–1.13) for HS vs > HS. For diabetes; when considering age-group and sex specific estimates adjusted for BMI, among men: significant associations were seen only in the 45–59 years age-group in JHS with PR 1.84 (95% CI 1.16–2.91) for < HS vs > HS. Among women, significant PR comparing < HS to > HS was seen for all three age-groups for JHS, but not in STC; PR were 3.95 (95% CI 1.94–8.05), 1.53 (95% CI 1.10–2.11) and 1.32 (95% CI 1.06–1.64) for 25–44, 45–59 and 60–74 age-groups, respectively.ConclusionIn Jamaica, educational disparities were largely explained by age, sex and BMI, while in the USA these disparities were larger and persisted after accounting these variables. More... »

PAGES

33

Identifiers

URI

http://scigraph.springernature.com/pub.10.1186/s12939-017-0527-9

DOI

http://dx.doi.org/10.1186/s12939-017-0527-9

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1083833633

PUBMED

https://www.ncbi.nlm.nih.gov/pubmed/28222733


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28 schema:description BackgroundStudies have suggested that social inequalities in chronic disease outcomes differ between industrialized and developing countries, but few have directly compared these effects. We explored inequalities in hypertension and diabetes prevalence between African-descent populations with different levels of educational attainment in Jamaica and in the United States of America (USA), comparing disparities within each location, and between countries.MethodsWe analyzed baseline data from the Jackson Heart Study (JHS) in the USA and Spanish Town Cohort (STC) in Jamaica. Participants reported their highest level of educational attainment, which was categorized as ‘less than high school’ (<HS), high school (HS) and ‘more than high school’ (>HS). Educational disparities in the prevalence of hypertension and diabetes were examined using prevalence ratios (PR), controlling for age, sex and body mass index (BMI).ResultsAnalyses included 7248 participants, 2382 from STC and 4866 from JHS, with mean age of 47 and 54 years, respectively (p < 0.001). Prevalence for both hypertension and diabetes was significantly higher in the JHS compared to STC, 62% vs. 25% (p < 0.001) and 18% vs. 13% (p < 0.001), respectively. In bivariate analyses there were significant disparities by education level for both hypertension and diabetes in both studies; however, after accounting for confounding or interaction by age, sex and BMI these effects were attenuated. For hypertension, after adjusting for age and BMI, a significant education disparity was found only for women in JHS, with PR of 1.10 (95% CI 1.04–1.16) for < HS vs > HS and 1.07 (95% CI 1.01–1.13) for HS vs > HS. For diabetes; when considering age-group and sex specific estimates adjusted for BMI, among men: significant associations were seen only in the 45–59 years age-group in JHS with PR 1.84 (95% CI 1.16–2.91) for < HS vs > HS. Among women, significant PR comparing < HS to > HS was seen for all three age-groups for JHS, but not in STC; PR were 3.95 (95% CI 1.94–8.05), 1.53 (95% CI 1.10–2.11) and 1.32 (95% CI 1.06–1.64) for 25–44, 45–59 and 60–74 age-groups, respectively.ConclusionIn Jamaica, educational disparities were largely explained by age, sex and BMI, while in the USA these disparities were larger and persisted after accounting these variables.
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35 schema:keywords African descent populations
36 America
37 BackgroundStudies
38 Caribbean
39 Heart Study
40 Jackson Heart Study
41 Jamaica
42 MethodsWe
43 ResultsAnalyses
44 USA
45 United States
46 Vs
47 age
48 analysis
49 association
50 attainment
51 baseline data
52 bivariate analysis
53 body mass index
54 chronic disease outcomes
55 cohort
56 comparative analysis
57 confounding
58 countries
59 data
60 descent populations
61 diabetes
62 diabetes mellitus
63 diabetes prevalence
64 different levels
65 disease outcome
66 disparities
67 education disparities
68 education level
69 educational attainment
70 educational disparities
71 educational health disparities
72 effect
73 estimates
74 health disparities
75 high levels
76 high school
77 hypertension
78 index
79 inequality
80 interaction
81 levels
82 location
83 mass index
84 mean age
85 mellitus
86 men
87 outcomes
88 participants
89 population
90 prevalence
91 prevalence of hypertension
92 prevalence ratios
93 ratio
94 schools
95 sex
96 sex-specific estimates
97 significant association
98 significant disparities
99 significant prevalence ratios
100 social inequalities
101 specific estimates
102 state
103 study
104 variables
105 women
106 years
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