0006/2022 - Social inequalities between neighborhoods and cardiovascular disease: a multilevel analysis in a Latin American city Desigualdades sociais entre vizinhanças e doenças cardiovasculares: análise multinível em uma cidade Latino-americana.
Os estudos que analisam as relações entre doenças cardiovasculares (DCVs) e aspectos ambientais em cidades latino-americanas são relativamente recentes e limitados. A maioria é realizada em países de alta renda analisando a mortalidade em grandes áreas. Esta investigação faz foco na população de adultos residentes em áreas carenciadas em acompanhamento clínico por diabetes e/ou hipertensão. No nível individual foram avaliados fatores sócio demográficos e de risco cardiovascular a partir dos prontuários médicos; e a partir de dados censitários as condições socioeconômicas no nível da vizinhança. Mais mulheres do que homens estavam sob acompanhamento clínico, mas os homens apresentaram maior frequência, maior chance e menor tempo para o diagnóstico de DCV. A análise multinível mostrou que residir em bairros com piores condições socioeconômicas leva a maiores chances de DCV, mesmo após o controle de variáveis individuais. As OR (IC95%) de DCV foram: Q2 OR 3,9 (1,2-12,1); Q3 OR 4,0 (1,3-12,3); Q4 OR 2,3 (0,7-8,0) (referencia: quartil de maior nível socioeconômico). Entre os indivíduos que vivem em contextos desiguais, encontramos diferenças nas DCV, mostrando desigualdades dentro das desigualdades. Diferenças entre homens e mulheres devem abordar-se com uma perspectiva de gênero.
Palavras-chave:
Doenças cardiovasculares, Desigualdades, Análise Multinível, Saúde Urbana
Abstract:
Studies analyzing relations between cardiovascular diseases (CVDs) and environmental aspects in Latin American cities are relatively recent and limited, since most of them are conducted in high-income countries, analyzing mortality outcomes, and comprising large areas. This research focuses on adults with diabetes and/or hypertension under clinical follow-up who live in deprived areas. At the individual level we evaluated sociodemographic and cardiovascular risk factors from patient´s records, and at the neighborhood level, socioeconomic conditions from census data. A multilevel analysis was carried out to study CVD. More women than men were under clinical follow-up, but men had higher frequency, higher odds, and shorter time to CVD diagnosis. Multilevel analysis showed that residing in neighborhoods with worst socioeconomic conditions leads to higher odds of CVDs, even after controlling for individual variables: OR (CI95%) of CVD in quartile 2 (Q2) 3.9 (1.2-12.1); Q3 4.0 (1.3-12.3); Q4 2.3 (0.7-8.0) (vs. highest socioeconomic level quartile). Among individuals living in unequal contexts, we found differences in CVD, which makes visible inequalities within inequalities. Differences between women and men should be considered through a gender perspective.
Keywords:
Cardiovascular diseases, Inequalities, Multilevel Analysis, Urban Health
Desigualdades sociais entre vizinhanças e doenças cardiovasculares: análise multinível em uma cidade Latino-americana.
Resumo (abstract):
Studies analyzing relations between cardiovascular diseases (CVDs) and environmental aspects in Latin American cities are relatively recent and limited, since most of them are conducted in high-income countries, analyzing mortality outcomes, and comprising large areas. This research focuses on adults with diabetes and/or hypertension under clinical follow-up who live in deprived areas. At the individual level we evaluated sociodemographic and cardiovascular risk factors from patient´s records, and at the neighborhood level, socioeconomic conditions from census data. A multilevel analysis was carried out to study CVD. More women than men were under clinical follow-up, but men had higher frequency, higher odds, and shorter time to CVD diagnosis. Multilevel analysis showed that residing in neighborhoods with worst socioeconomic conditions leads to higher odds of CVDs, even after controlling for individual variables: OR (CI95%) of CVD in quartile 2 (Q2) 3.9 (1.2-12.1); Q3 4.0 (1.3-12.3); Q4 2.3 (0.7-8.0) (vs. highest socioeconomic level quartile). Among individuals living in unequal contexts, we found differences in CVD, which makes visible inequalities within inequalities. Differences between women and men should be considered through a gender perspective.
Palavras-chave (keywords):
Cardiovascular diseases, Inequalities, Multilevel Analysis, Urban Health
Perner, M. S., Alazraqui, M., Amorim, L.D.A.F. Social inequalities between neighborhoods and cardiovascular disease: a multilevel analysis in a Latin American city. Cien Saude Colet [periódico na internet] (2022/jan). [Citado em 23/12/2024].
Está disponível em: http://cienciaesaudecoletiva.com.br/artigos/social-inequalities-between-neighborhoods-and-cardiovascular-disease-a-multilevel-analysis-in-a-latin-american-city/18262?id=18262
