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Original Research

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

Authors:

Carolina Nazzal,

School of Public Health, Faculty of Medicine, University of Chile, Santiago, CL
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Steven Shea,

Department of Medicine, Columbia University College of Physicians & Surgeons, New York, NY; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, US
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Cecilia Castro-Diehl,

Department of Medicine, Columbia University College of Physicians & Surgeons, New York, NY; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, US
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Tania Alfaro ,

School of Public Health, Faculty of Medicine, University of Chile, Santiago, CL
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Patricia Frenz,

School of Public Health, Faculty of Medicine, University of Chile, Santiago, CL
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Carlos J. Rodriguez

Department of Medicine (Cardiology), Wake Forest School of Medicine, Winston-Salem, NC; Department of Epidemiology & Prevention, Wake Forest School of Medicine, Winston-Salem, NC, US
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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.

Highlights

  • Regardless of educational level and context, obesity prevalence increased in women.
  • In Chile, smoking prevalence increased significantly among the most educated.
  • Population-based and high-risk strategies appear to improve blood pressure control.
How to Cite: Nazzal C, Shea S, Castro-Diehl C, Alfaro T, Frenz P, Rodriguez CJ. Educational Inequalities in Cardiovascular Risk Factor and Blood Pressure Control in the Elderly: Comparison of MESA Cohort and Chilean NHS Survey Outcome Measures. Global Heart. 2018;13(1):19–26. DOI: http://doi.org/10.1016/j.gheart.2017.09.001
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Published on 01 Mar 2018.
Peer Reviewed

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