Inequalities in Hypertension and Diabetes in Canada: Intersections between Racial Identity, Gender, and Income

A growing body of research from the United States informed by intersectionality theory indicates that racial identity, gender, and income are often entwined with one another as determinants of health in unexpectedly complex ways. Research of this kind from Canada is scarce, however. Using data pooled from ten cycles (2001-2013) of the Canadian Community Health Survey, we regressed hypertension (HT) and diabetes (DM) on income in subsamples of Black women (n = 3,506), White women (n = 336,341), Black men (n = 2,806) and White men (n = 271,260). An increase of one decile in income was associated with lower odds of hypertension and diabetes among White men (OR_HT = .98, 95% CI (.97, .99); OR_DM = .93, 95% CI (.92, .94)) and White women (OR_HT = .95, 95% CI (.95, .96); OR_DM = .90, 95% CI (.89, .91)). In contrast, an increase of one decile in income was not associated with either health outcome among Black men (OR_HT = .99, 95% CI (.92, 1.06); OR_DM = .99, 95% CI (.91, 1.08)) and strongly associated with both outcomes among Black women (OR_HT = .86, 95% CI (.80, .92); OR_DM = .83, 95% CI (.75, .92)). Our findings highlight the complexity of the unequal distribution of hypertension and diabetes, which includes inordinately high risks of both outcomes for poor Black women and an absence of associations between income and both outcomes for Black men in Canada. These results suggest that an intersectionality framework can contribute to uncovering health inequalities in Canada.