Educational Inequalities in Cardiovascular Risk Factor and Blood Pressure Control in the Elderly: Comparison of MESA Cohort and Chilean NHS Survey Outcome Measures

Carolina Nazzal, Steven Shea, Cecilia Castro-Diehl, Tania Alfaro, Patricia Frenz, Carlos J. Rodriguez

Research output: Contribution to journalArticle

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Abstract

Background: Social determinants differ between countries, which is not always considered when adapting health policies and interventions to face inequalities in noncommunicable diseases and their risk factors. Objectives: The study sought to analyze educational inequalities in controlled blood pressure (CBP), obesity, and smoking in study populations from Chile and the United States in 2 periods, both countries with large social inequalities. Methods: The study used data from the first and fifth waves of the MESA (Multiethnic Study of Atherosclerosis) cohort, and the 2003 and 2009 to 2010 Chilean National Health Survey (CNHS) survey outcome measures. The study compared cardiovascular risk factors prevalence as well as relative index of inequality (RII) and slope index of inequality (SII) between the 2 samples. Results: In the CNHS 67.9% and 52.6% of participants had below primary education in 2003 and 2009 to 2010, respectively, compared with 12.3% and 8.1% in the first and fifth waves of the MESA study, respectively. Smoking prevalence was higher and increased in the CNHS compared with the MESA study, concentrated in better-educated women in both years (RII: 0.34; 95% confidence interval [CI]: 0.17 to 0.68; and RII: 0.55; 95% CI: 0.34 to 0.89, respectively). In contrast, smoking decreased over time in the MESA study in all socioeconomic strata, although relative inequalities increased in both sexes (for women, RII: 2.32; 95% CI 1.36 to 3.97; for men, RII: 3.34; 95% CI 2.04 to 5.47). CBP prevalence in both periods was higher in the first and fifth waves of the MESA study (69.7% and 80.2%) compared with the 2003 and 2009 to 2010 CNHS samples (34.2% and 52.3%), but only for the MESA study RII, favoring the better educated, was it significant in both periods and sexes. Obesity inequalities for Chilean women decreased slightly between 2003 and 2009 as prevalence grew in the most educated (RII: 2.21 to 1.68; SII: 0.29 to 0.22, respectively); conversely, they increased for both sexes in the MESA study. Conclusions: The study findings confirm that patterns and trends in prevalence, and absolute and relative inequalities vary by country, suggesting that context and cultural issues matters.

Original languageEnglish (US)
Pages (from-to)19-26
Number of pages8
JournalGlobal Heart
Volume13
Issue number1
DOIs
StatePublished - Mar 2018
Externally publishedYes

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Atherosclerosis
Cohort Studies
Outcome Assessment (Health Care)
Blood Pressure
Health Surveys
Confidence Intervals
Smoking
Surveys and Questionnaires
Obesity
Chile
Health Policy
Education

ASJC Scopus subject areas

  • Epidemiology
  • Community and Home Care
  • Cardiology and Cardiovascular Medicine

Cite this

Educational Inequalities in Cardiovascular Risk Factor and Blood Pressure Control in the Elderly : Comparison of MESA Cohort and Chilean NHS Survey Outcome Measures. / Nazzal, Carolina; Shea, Steven; Castro-Diehl, Cecilia; Alfaro, Tania; Frenz, Patricia; Rodriguez, Carlos J.

In: Global Heart, Vol. 13, No. 1, 03.2018, p. 19-26.

Research output: Contribution to journalArticle

Nazzal, Carolina ; Shea, Steven ; Castro-Diehl, Cecilia ; Alfaro, Tania ; Frenz, Patricia ; Rodriguez, Carlos J. / Educational Inequalities in Cardiovascular Risk Factor and Blood Pressure Control in the Elderly : Comparison of MESA Cohort and Chilean NHS Survey Outcome Measures. In: Global Heart. 2018 ; Vol. 13, No. 1. pp. 19-26.
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abstract = "Background: Social determinants differ between countries, which is not always considered when adapting health policies and interventions to face inequalities in noncommunicable diseases and their risk factors. Objectives: The study sought to analyze educational inequalities in controlled blood pressure (CBP), obesity, and smoking in study populations from Chile and the United States in 2 periods, both countries with large social inequalities. Methods: The study used data from the first and fifth waves of the MESA (Multiethnic Study of Atherosclerosis) cohort, and the 2003 and 2009 to 2010 Chilean National Health Survey (CNHS) survey outcome measures. The study compared cardiovascular risk factors prevalence as well as relative index of inequality (RII) and slope index of inequality (SII) between the 2 samples. Results: In the CNHS 67.9{\%} and 52.6{\%} of participants had below primary education in 2003 and 2009 to 2010, respectively, compared with 12.3{\%} and 8.1{\%} in the first and fifth waves of the MESA study, respectively. Smoking prevalence was higher and increased in the CNHS compared with the MESA study, concentrated in better-educated women in both years (RII: 0.34; 95{\%} confidence interval [CI]: 0.17 to 0.68; and RII: 0.55; 95{\%} CI: 0.34 to 0.89, respectively). In contrast, smoking decreased over time in the MESA study in all socioeconomic strata, although relative inequalities increased in both sexes (for women, RII: 2.32; 95{\%} CI 1.36 to 3.97; for men, RII: 3.34; 95{\%} CI 2.04 to 5.47). CBP prevalence in both periods was higher in the first and fifth waves of the MESA study (69.7{\%} and 80.2{\%}) compared with the 2003 and 2009 to 2010 CNHS samples (34.2{\%} and 52.3{\%}), but only for the MESA study RII, favoring the better educated, was it significant in both periods and sexes. Obesity inequalities for Chilean women decreased slightly between 2003 and 2009 as prevalence grew in the most educated (RII: 2.21 to 1.68; SII: 0.29 to 0.22, respectively); conversely, they increased for both sexes in the MESA study. Conclusions: The study findings confirm that patterns and trends in prevalence, and absolute and relative inequalities vary by country, suggesting that context and cultural issues matters.",
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AU - Rodriguez, Carlos J.

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N2 - Background: Social determinants differ between countries, which is not always considered when adapting health policies and interventions to face inequalities in noncommunicable diseases and their risk factors. Objectives: The study sought to analyze educational inequalities in controlled blood pressure (CBP), obesity, and smoking in study populations from Chile and the United States in 2 periods, both countries with large social inequalities. Methods: The study used data from the first and fifth waves of the MESA (Multiethnic Study of Atherosclerosis) cohort, and the 2003 and 2009 to 2010 Chilean National Health Survey (CNHS) survey outcome measures. The study compared cardiovascular risk factors prevalence as well as relative index of inequality (RII) and slope index of inequality (SII) between the 2 samples. Results: In the CNHS 67.9% and 52.6% of participants had below primary education in 2003 and 2009 to 2010, respectively, compared with 12.3% and 8.1% in the first and fifth waves of the MESA study, respectively. Smoking prevalence was higher and increased in the CNHS compared with the MESA study, concentrated in better-educated women in both years (RII: 0.34; 95% confidence interval [CI]: 0.17 to 0.68; and RII: 0.55; 95% CI: 0.34 to 0.89, respectively). In contrast, smoking decreased over time in the MESA study in all socioeconomic strata, although relative inequalities increased in both sexes (for women, RII: 2.32; 95% CI 1.36 to 3.97; for men, RII: 3.34; 95% CI 2.04 to 5.47). CBP prevalence in both periods was higher in the first and fifth waves of the MESA study (69.7% and 80.2%) compared with the 2003 and 2009 to 2010 CNHS samples (34.2% and 52.3%), but only for the MESA study RII, favoring the better educated, was it significant in both periods and sexes. Obesity inequalities for Chilean women decreased slightly between 2003 and 2009 as prevalence grew in the most educated (RII: 2.21 to 1.68; SII: 0.29 to 0.22, respectively); conversely, they increased for both sexes in the MESA study. Conclusions: The study findings confirm that patterns and trends in prevalence, and absolute and relative inequalities vary by country, suggesting that context and cultural issues matters.

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