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Racial and gender inequities in the control of arterial hypertension in ELSA-Brasil: An intersectional approach
Etna Kaliane Pereira Da Silva1, Sandhi Maria Barreto2, Lidyane do Valle Camelo2
1Center of Biological and Health Sciences, Universidade Federal do Oeste da Bahia, Rua Professor José Seabra de Lemos 316, Recanto dos Passaros. CEP 47808-021, Barreiras, BA, Brazil.
Insights
Black and Brown men experience higher rates of inadequate blood pressure control. This study highlights the need for targeted hypertension management strategies for socially marginalized groups, including Black women.
Area of Science:
- Public Health
- Epidemiology
- Social Determinants of Health
Background:
- Hypertension management remains a global health challenge.
- Intersectional disparities in health outcomes are increasingly recognized.
- Understanding the impact of combined gender and race/color on hypertension control is crucial for equitable care.
Purpose of the Study:
- To investigate the association between intersectional categories of gender and race/color with inadequate blood pressure control.
- To identify specific socially marginalized groups disproportionately affected by poor hypertension management.
- To inform the development of equitable public health strategies for blood pressure control.
Main Methods:
- Cross-sectional analysis of 4448 adults with hypertension from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil).
- Participants were undergoing pharmacological treatment for hypertension.
- Generalized linear models with Poisson distribution were used to estimate prevalence ratios (PR) and 95% confidence intervals (95% CI), adjusting for covariates.
Main Results:
- The age-standardized prevalence of inadequate blood pressure control ranged from 18.9% in White women to 35.6% in Black men.
- Compared to White women, Black men (PR: 1.49), Brown men (PR: 1.42), Black women (PR: 1.36), and White men (PR: 1.32) exhibited poorer blood pressure control after adjustments.
- Black and Brown men showed a higher prevalence of inadequate blood pressure control. Black women also had a higher prevalence compared to White men.
Conclusions:
- Intersectional analysis reveals significant disparities in blood pressure control based on combined gender and race/color.
- Socially marginalized groups, particularly Black men and women, face a greater burden of inadequate hypertension management.
- Equitable blood pressure control strategies must address the specific needs of intersectional, marginalized populations.
Abstract:
This study investigated the association of the intersectional categories of gender-race/color with inadequate blood pressure (BP) control in Brazilian adults using antihypertensive drugs to treat hypertension. This is a cross-sectional analysis conducted with 4448 participants living with hypertension from visit 2 (2012-2014) of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) undergoing pharmacological treatment. The association of the intersectional categories - White woman, Brown woman, Black woman, White man, Brown man, Black man - with inadequate BP control (systolic BP levels ≥140 mmHg and/or diastolic BP levels ≥90mmH) was estimated by the prevalence ratio (PR) and 95% confidence interval (95% CI) obtained by generalized linear models with Poisson distribution, adjusted covariates. The age-standardized prevalence of inadequate BP control ranged from 18.9% (White women) to 35.6% (Black men). After adjusting for sociodemographic characteristics, health-related behavior, health conditions, and the class number of antihypertensive medications, compared to White women, Black men (PR: 1.49 95% CI: 1.26-1.75), Brown men (PR: 1.42 95% CI: 1.18-1.72), Black women (PR: 1.36 95% CI: 1.12-1.65), and White men (PR: 1.32 95% CI: 1.09-1.60) showed poorer BP control. Results corroborate a higher prevalence of inadequate BP control in Black and Brown men. Furthermore, this intersectional approach evidenced that the prevalence of inadequate BP control in Black women is higher than that in White men, when compared to White women. Findings highlight that, for the development of more equitable BP control strategies, one must consider the specificities of socially marginalized intersectional groups, especially Black men and women.
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