Key result
Higher individual education linked to ~33% lower hypertension odds in women but higher in men.
Why the study?
Research on gender disparities and social determinants of hypertension in urban areas of high-prevalence regions, such as Latin America, is very limited.
How does individual and contextual socioeconomic status associate with hypertension prevalence by gender in Latin American cities?
Cross-Sectional (n=109,184)
Yes
How does individual and contextual socioeconomic status associate with hypertension prevalence by gender in Latin American cities?
Odds Ratio: 0.67 (95% CI 0.61–0.74)
The association between socioeconomic status and hypertension in Latin America varies significantly by gender and level of analysis, highlighting the need for context-specific public health approaches.
Hypothesis-generating for gender-specific education effects on hypertension; requires prospective studies before guiding urban public health strategies.
BACKGROUND: Despite global interest in gender disparities and social determinants of hypertension, research in urban areas and regions with a high prevalence of hypertension, such as Latin America, is very limited. The objective of this study was to examine associations of individual- and area-level socioeconomic status with hypertension in adults living in 230 cities in eight Latin America countries. METHODS: In this cross-sectional study, we used harmonized data from 109,184 adults (aged 18-97 years) from the SALURBAL (Salud Urbana en America Latina/Urban Health in Latin America) project. Hypertension was assessed by self-report. Individual-, sub-city- and city-level education were used as proxies of socioeconomic status. All models were stratified by gender. RESULTS: Higher individual-level education was associated with lower odds of hypertension among women (university education or higher versus lower than primary: odds ratio [OR] = 0.67, 95% confidence interval [CI] = 0.61-0.74) but higher odds among men (OR = 1.65; 95%CI 1.47-1.86), although in men an inverse association emerged when measured blood pressure was used (OR = 0.86; 95%CI 0.76-0.97). For both genders, living in sub-city areas with higher educational achievement was associated with higher odds of hypertension (OR per standard deviation [SD] = 1.07, 95%CI = 1.02-1.12; OR = 1.11 per SD, 95%CI = 1.05-1.18, for women and men, respectively). The association of city-level education with hypertension varied across countries. In Peru, there was an inverse association (higher city level education was associated with lower odds of hypertension) in women and men, but in other countries no association was observed. In addition, the inverse association of individual-level education with hypertension became stronger (in women) or emerged (in men) as city or sub-city education increased. CONCLUSION: The social patterning of hypertension differs by gender and by the level of analysis highlighting the importance of context- and gender-sensitive approaches and policies to reduce the prevalence of hypertension in Latin America.
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Coelho et al. (2023) conducted a cross-sectional in Hypertension (n=109,184). Higher individual-level education (university or higher) vs. Lower than primary education was evaluated on Self-reported hypertension (OR 0.67, 95% CI 0.61-0.74). Higher individual-level education was associated with lower odds of hypertension among women (OR 0.67) but higher odds among men (OR 1.65), while higher sub-city-level education was associated with higher odds for both genders.
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