Bidulescu Aurelian, Ferguson Trevor S, Hambleton Ian, Younger-Coleman Novie, Francis Damian, Bennett Nadia, Griswold Michael, Fox Ervin, MacLeish Marlene, Wilks Rainford, Harris E Nigel, Sullivan Louis W
Department of Epidemiology and Biostatistics, Indiana University School of Public Health - Bloomington, Bloomington, IN, USA.
Epidemiology Research Unit, Tropical Medicine Research Institute, The University of the West Indies, Kingston, West Indies, Jamaica.
Int J Equity Health. 2017 Feb 14;16(1):33. doi: 10.1186/s12939-017-0527-9.
Studies 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.
We 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).
Analyses 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.
In 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.
研究表明，慢性病结局方面的社会不平等在工业化国家和发展中国家有所不同，但很少有研究直接比较这些影响。我们探讨了牙买加和美利坚合众国（美国）不同教育程度的非裔人群中高血压和糖尿病患病率的不平等情况，比较了每个地区内部以及国家之间的差异。
我们分析了美国杰克逊心脏研究（JHS）和牙买加西班牙镇队列（STC）的基线数据。参与者报告了他们的最高教育程度，分为“高中以下”（<HS）、高中（HS）和“高中以上”（>HS）。使用患病率比（PR）研究高血压和糖尿病患病率的教育差异，并对年龄、性别和体重指数（BMI）进行控制。
分析纳入了7248名参与者，其中2382名来自STC，4866名来自JHS，平均年龄分别为47岁和54岁（p < 0.001）。与STC相比，JHS中高血压和糖尿病的患病率均显著更高，分别为62%对25%（p < 0.001）和18%对13%（p < 0.001）。在双变量分析中，两项研究中高血压和糖尿病的患病率在教育程度上均存在显著差异；然而，在考虑年龄、性别和BMI的混杂或相互作用后，这些影响减弱。对于高血压，在调整年龄和BMI后，仅在JHS的女性中发现了显著的教育差异，<HS与>HS相比的PR为1.10（95%CI 1.04 - 1.16），HS与>HS相比的PR为1.07（95%CI 1.01 - 1.13）。对于糖尿病；在考虑按年龄组和性别调整BMI后的估计值时，在男性中：仅在JHS的45 - 59岁年龄组中发现显著关联，<HS与>HS相比的PR为1.84（95%CI 1.16 - 2.91）。在女性中，JHS的所有三个年龄组中<HS与>HS相比均有显著的PR，但STC中没有；25 - 44岁、45 - 59岁和60 - 74岁年龄组的PR分别为3.95（95%CI 1.94 - 8.05）、1.53（95%CI 1.10 - 2.11）和1.32（95%CI 1.06 - 1.64）。
在牙买加，教育差异在很大程度上由年龄、性别和BMI解释，而在美国，这些差异更大，在考虑这些变量后仍然存在。
