Abstract
BackgroundTo throw light on the under-researched association between socioeconomic position (SEP) and health in Cuba, this study examined SEP gradients in health and their underlying mechanisms among urban Cuban adults aged 18–65.MethodsBy applying linear regressions to data from the 2010 National Survey on Risk Factors and Chronic Diseases, the analysis explored the SEP-health gradient along three SEP dimensions − education, occupation, and skin colour − using ten health measures: self-reported health (SRH), general and abdominal obesity, hypertension, high glucose, high cholesterol, high triglycerides, low high-density lipoprotein cholesterol, metabolic syndrome, and cumulative risk factors. Regressions also included behaviours and health-related risk perceptions (tobacco and alcohol consumption, diet, physical activity, and risk-related behaviours). It thus investigated the SEP-health gradient and its underlying mechanisms via both behaviours and health-related risk perceptions.ResultsOnce controlling for gender, age, marital status, region and provincial dummies, the analysis detected educational gradients in SRH (estimated coefficient [95% CI]: middle-level education = 3.535 [1.329, 5.741], p < 0.01; high-level education = 5.249 [3.050, 7.448], p < 0.01) that are partially explainable by both health-affecting behaviours (tobacco and alcohol consumption, diet, physical and sedentary activity) and risk perceptions. Using objective measures of health, however, it found no SEP-health gradients other than hypertension among people identified as having Black skin color (adjusted for demographic variables, 0.060 [0.018, 0.101], p < 0.01) and high cholesterol among those identified as having Mulatto or Mestizo skin color (adjusted for demographic variables, − 0.066 [− 0.098, − 0.033], p < 0.01).ConclusionsIn terms of objective health measures, the study provides minimal evidence for an SEP-health gradient in Cuba, results primarily attributable to the country’s universal healthcare system − which offers full coverage and access and affordable medications − and its highly developed education system.
Highlights
To throw light on the under-researched association between socioeconomic position (SEP) and health in Cuba, this study examined SEP gradients in health and their underlying mechanisms among urban Cuban adults aged 18–65
The samples were weighted to ensure nationally representative estimates. Study population characteristics This analytic sample was restricted to adults aged 18–65 (SRH, n = 4124; general obesity, n = 3741; abdominal obesity, n = 3764; hypertension: 3757; high glucose, n = 1009; high total cholesterol, n = 1018, high triglycerides, n = 1008; low high-density lipoprotein cholesterol, n = 246; metabolic syndrome, n = 244 and cardiovascular disease (CVD) risk factor, n = 234) for which complete demographic, SEP, health-related behaviour, and biomarker information was available
Especially noncommunicable chronic diseases (NCDs) are on the rise in Cuba, the general picture one gets from these set of indicators is that the Cuban population is healthier than the American
Summary
To throw light on the under-researched association between socioeconomic position (SEP) and health in Cuba, this study examined SEP gradients in health and their underlying mechanisms among urban Cuban adults aged 18–65. The social and medical sciences have largely established a positive relation (i.e., gradient) between socioeconomic position (SEP) and health in Europe [1,2,3], the US [4,5,6,7,8], and other high-income countries [9,10,11,12], the evidence in low and middleincome countries (LMICs) is less clear, with some studies identifying positive SEP-health gradients [13,14,15] whilst some showing none [16,17,18,19]. Cuba offers a interesting case for assessing the SEP-health gradient because despite stable economic growth and an egalitarian healthcare system, it has a rapidly ageing population and a substantial burden of noncommunicable chronic diseases (NCDs). The nation is ageing so rapidly that by 2020, 25% of its total population is likely to be 60 and older [24]
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