Abstract
Socioeconomic disparities in health have emerged as an important area in public health, but studies from Afro-Caribbean populations are uncommon. In this study, we report on educational health disparities in cardiovascular disease (CVD) risk factors (hypertension, diabetes mellitus, hypercholesterolemia, and obesity), among Jamaican adults. We analyzed data from the Jamaica Health and Lifestyle Survey 2007-2008. Trained research staff administered questionnaires and obtained measurements of blood pressure, anthropometrics, glucose and cholesterol. CVD risk factors were defined by internationally accepted cut-points. Educational level was classified as primary or lower, junior secondary, full secondary, and post-secondary. Educational disparities were assessed using age-adjusted or age-specific prevalence ratios and prevalence differences obtained from Poisson regression models. Post-secondary education was used as the reference category for all comparisons. Analyses were weighted for complex survey design to yield nationally representative estimates. The sample included 678 men and 1,553 women with mean age of 39.4 years. The effect of education on CVD risk factors differed between men and women and by age group among women. Age-adjusted prevalence of diabetes mellitus was higher among men with less education, with prevalence differences ranging from 6.9 to 7.4 percentage points (p < 0.05 for each group). Prevalence ratios for diabetes among men ranged from 3.3 to 3.5 but were not statistically significant. Age-specific prevalence of hypertension was generally higher among the less educated women, with statistically significant prevalence differences ranging from 6.0 to 45.6 percentage points and prevalence ratios ranging from 2.5 to 4.3. Similarly, estimates for obesity and hypercholesterolemia suggested that prevalence was higher among the less educated younger women (25-39 years) and among more educated older women (40-59 and 60-74 years). There were no statistically significant associations for diabetes among women, or for hypertension, high cholesterol, or obesity among men. Educational health disparities were demonstrated for diabetes mellitus among men, and for obesity, hypertension, and hypercholesterolemia among women in Jamaica. Prevalence of diabetes was higher among less educated men, while among younger women the prevalence of hypertension, hypercholesterolemia, and obesity was higher among those with less education.
Highlights
Health disparities have become an important area of focus in public health research, practice, and policy development [1]
In the United States, the elimination of health disparities was a major goal of the Healthy People 2010 initiative, and this has been extended to Healthy People 2020 [6,7,8]
Percentages shown reflect the weighted estimates and not the simple proportion of participants based on observed numbers. n = 64 for post-secondary education, 268 for full secondary education, 200 for junior secondary education, and 146 for primary or less education. (B) Proportion of Jamaicans women 25–74 years old with individual Cardiovascular disease (CVD) risk factors various within education categories (Jamaica Health and Lifestyle Survey 2007–2008). **p < 0.01; ***p < 0.001 for difference in proportion across education categories, derived from chi-squared tests. n = 136 for post-secondary education, 734 for full secondary education, 411 for junior secondary education, and 272 for primary or less education
Summary
Health disparities have become an important area of focus in public health research, practice, and policy development [1]. Studies in the United States and the United Kingdom demonstrate significant racial/ethnic health disparities, with poorer health for black populations when compared to white populations [2, 3]. Socioeconomic health disparities are another area of concern, due to reports showing poorer health among persons in lower occupation categories and among persons with lower educational attainment [4, 5]. In addition to providing critical data for developing health and social policy, these data can improve our understanding of the mechanisms underlying these socioeconomic health disparities
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