Abstract
BackgroundThe excess burden of hypertension among blacks has been a prominent feature of the heath disparities literature, and many scientists presume it to be a stable and inevitable phenomenon. The underlying causes of this disparity can only be disentangled in a setting in which the population does not experience racial stratification of socioeconomic opportunities. While such conditions of racial equality remain uncommon, they may be approximated in Cuba, a country with a persistent policy of social inclusion over the last 5 decades.MethodsWe report on a 2010–2011 stratified probability sample of those aged 15–74 years from the urban population of Cienfuegos in central Cuba. A total of 1496 adults (880 women and 616 men) were recruited and assessed for blood pressure and anthropometrics according to standardized protocols, as well as medication use, educational attainment and observed skin tone (dichotomized into “black” and “white”). Weighted tabular and regression analyses were conducted to estimate adjusted prevalences of hypertension (> 140/90 mmHg) and adjusted prevalence odds ratios for contrasts between the two skin color groups.ResultsMean pressures were higher for men than for women, but overall did not differ importantly between racial groups. About half of all diagnosed hypertensive men were on medication, a proportion that did not vary by racial group. For women, however, adjusted prevalence was somewhat higher among blacks, and treatment and control rates were also somewhat advantaged for white women.ConclusionsOverall, skin color was unrelated to mean blood pressure or hypertensive status in this population, although among women specifically some racial advantage appears evident in adjusted prevalence and control, and should be investigated further. The overall null result suggests that Cuba may exemplify the social conditions in which racial excess in hypertension, characteristic of much of the western world, is not a necessary reality.
Highlights
The excess burden of hypertension among blacks has been a prominent feature of the heath disparities literature, and many scientists presume it to be a stable and inevitable phenomenon
One line of argument regarding racial/ethnic differentials in hypertension holds that the cumulative effects of social disadvantage would explain the observed excess risk if it could be measured [7]
We previously examined racial hypertension differentials in Cuba, a country with a persistently implemented policy of social inclusion stemming from the 1959 revolution, and we found consistent evidence of a diminished prevalence gap between blacks and whites compared to the United States (US) [10,11]
Summary
The excess burden of hypertension among blacks has been a prominent feature of the heath disparities literature, and many scientists presume it to be a stable and inevitable phenomenon. The underlying causes of this disparity can only be disentangled in a setting in which the population does not experience racial stratification of socioeconomic opportunities While such conditions of racial equality remain uncommon, they may be approximated in Cuba, a country with a persistent policy of social inclusion over the last 5 decades. Epidemiological survey methods are inadequate to capture most of these exposures, especially in the psychological domain [8] In support of this argument, a social class gradient is often observed in hypertension, and clear geographic differences in hypertension burden have been well documented [9]. The “social-structural” theory, which invokes the net effect of discrimination, can only be tested under counterfactual conditions of social equality between blacks and whites. We report here findings from a new survey in Cuba confirming an absence of substantial racial differentials in blood pressure
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