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), 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.
Highlights
Studies have suggested that social inequalities in chronic disease outcomes differ between industrialized and developing countries, but few have directly compared these effects
For diabetes; when considering age-group and sex specific estimates adjusted for Body mass index (BMI), among men: significant associations were seen only in the 45–59 years age-group in Jackson Heart Study (JHS) with prevalence ratios (PR) 1.84 for < high school (HS) vs > HS
Significant PR comparing < HS to > HS was seen for all three age-groups for JHS, but not in Spanish Town Cohort (STC); PR were 3.95, 1.53 and 1.32 for 25–44, 45–59 and 60–74 age-groups, respectively
Summary
Studies have suggested that social inequalities in chronic disease outcomes differ between industrialized and developing countries, but few have directly compared these effects. Acknowledging that few studies have explored among African-descent individuals the prevalence of hypertension and diabetes according to levels of educational attainment the aim was to evaluate whether there are significant differences in estimates of educational health disparity for hypertension and diabetes mellitus comparing Afro-Caribbean individuals in Jamaica and African Americans in the United States. We aimed to estimate the age adjusted prevalence, prevalence ratios and prevalence differences for hypertension and diabetes mellitus by education categories for participants in the Spanish Town Cohort Study and the Jackson Heart Study and determine whether the patterns of disparity for the education differ between the two studies Such analyses should add insights into the different stages of epidemiological transition (i.e., change in the disease pattern) that African-descent individuals in both settings are tangled in, and add information to the much debated ‘thrifty gene hypothesis’ that has so many applications to cardiometabolic diseases such as hypertension and diabetes
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