Iniquidades raciais e de gênero na incidência e controle da hipertensão arterial no ELSA-Brasil: uma abordagem interseccional

Abstract

Racial and gender inequities in the incidence and control of hypertension (HTN) are well documented. However, few empirical investigations looked into these associations, considering the synergies and heterogeneous experiences of intersectional gender and race/skin colour groups. This study investigated the association of intersectional categories defined by gender and race/skin colour with HTN incidence and inadequate blood pressure control. We used data from the Longitudinal Study of Adult Health (ELSA-Brasil), a multicentric and multiracial cohort of Brazilian civil servants to estimated the incidence of HTN between visits 1 (2008- 2010) and 2 (2012-2014) in 8528 individuals without HTN or cardiovascular diseases at visit 1 by intersectional category. The prevalence of inadequate blood pressure control was estimated at 4571 individuals with HTN on medication at visit 2. Six categories of gender-race/skin colour intersection were defined: White woman, Brown woman, Black woman, White man, Brown man and Black man. Generalized linear models with Poisson distribution and logarithmic linkage function were used to examine the magnitude of associations. The incidence of HTN was 43.4/1000 person-years, ranging from 30.5/1000 in White women to 59.4/1000 in Black men. After adjusting for age and family history of HTN, the incidence rate ratio (IRR) was higher in Black men (2.25; 95%CI: 1.65-3.08), Brown (Pardo) men (1.89; 95%CI :1.59-2.25), Black women (1.85; 95%CI:1.50-2.30), Whites men (1.76; 95%CI: 1.49-2.08), and Brown (Parda) women (1.47; CI%:1.31-1.67), compared with White women. These associations were maintained even after considering socioeconomic, behavioural and health mediators in the model (article 1). The age-standarlized prevalence of inadequate blood pressure control ranged from 19.8% in White women to 30.2% in Black women and from 27.3% in White men to 38.0% in Black men. After adjusting for sociodemographic, behavioral and health characteristics, and number of classes of antihypertensive drugs used, Black men (PR: 1.51 95%CI: 1.28-1.77), Brown (Pardo) men (PR: 1.45 95%CI: 1.17-1.79), White men (PR: 1.34 95% CI: 1.09-1.65) and Black women (PR: 1.33 95% CI: 1.09-1.60) showed worse blood pressure control compared with White women (article 2). By using an intersectional approach, we showed the complex relationships between race/skin color and gender inequities in the incidence and control of HTN. Disclosing not only the higher risk of developing HTN and worse blood pressure control in Black men compared to White women, but also that Black women have a higher risk of HTN than White men and a prevalence of inadequated blood pressure control similar to White men compared to White women.