Department of Sociology, The University of British Columbia, Vancouver, BC, Canada.
Soc Sci Med. 2013 Jul;89:16-24. doi: 10.1016/j.socscimed.2013.04.014. Epub 2013 Apr 24.
Informed by intersectionality theory, a tradition that theorizes intersecting power relations of racism, patriarchy, classism and heterosexism, this paper investigates the degree to which race, gender, class and sexuality manifest distinct and interconnected associations with self-reported hypertension in nationally-representative survey data from Canada. Binary logistic regression is used to model the main effects of, and interactions between, race, gender, education, household income and sexual orientation on hypertension, controlling for age, using data from the 2003 Canadian Community Health Survey (n = 90,310). From a main effects ('additive') perspective, Black respondents, respondents with less than high school and poorer respondents were significantly more likely than White respondents, university-educated Canadians and wealthier Canadians, respectively, to report hypertension. However, the interactive models indicate that the additive models were poor predictors of hypertension for wealthy Black men, wealthy South Asian women, women with less than a high school diploma and wealthy bisexual respondents, who were more likely than expected to report hypertension, and for poor Black men, poor South Asian women, poor South Asian men and women with a university degree, who were less likely than expected to report hypertension. It appears that, with regard to blood pressure at least, Canadians experience the health effects of education differently by their genders and the health effects of income differently by their identities defined at the intersection of race and gender. This study provides empirical support for the intersectional approach to cardiovascular health inequalities by demonstrating that race, gender, class and sexuality cannot be disentangled from one another as predictors of hypertension.
本研究基于交叉性理论，该理论旨在探讨种族主义、父权制、阶级主义和异性恋主义等多种权力关系的交叉影响，旨在调查在加拿大全国代表性调查数据中，种族、性别、阶级和性取向与自我报告的高血压之间存在何种程度的独特和相互关联的关联。二元逻辑回归用于对种族、性别、教育、家庭收入和性取向对高血压的主要影响以及它们之间的相互作用进行建模，控制年龄因素，使用 2003 年加拿大社区健康调查（n=90310）的数据。从主要效应（“加性”）的角度来看，黑人受访者、受教育程度较低和收入较低的受访者报告高血压的可能性分别明显高于白人受访者、受过大学教育的加拿大人和较富裕的加拿大人。然而，交互模型表明，对于富裕的黑人男性、富裕的南亚裔女性、受教育程度较低的女性和富裕的双性恋受访者，加性模型是高血压的不良预测因子，这些受访者报告高血压的可能性高于预期，而对于贫困的黑人男性、贫困的南亚裔女性、贫困的南亚裔男性和受过大学教育的女性，他们报告高血压的可能性低于预期。这表明，至少就血压而言，加拿大男性和女性在教育方面的健康影响不同，而在种族和性别交叉点定义的身份方面，收入对健康的影响也不同。本研究通过证明种族、性别、阶级和性取向作为高血压预测因素时不能相互割裂，为心血管健康不平等的交叉性方法提供了实证支持。
