1
|
Guimarães JMN, Jackson JW, Barber S, Griep RH, da Fonseca MDJM, Camelo LV, Barreto SM, Schmidt MI, Duncan BB, Cardoso LDO, Pereira AC, Chor D. Racial Inequities in the Control of Hypertension and the Explanatory Role of Residential Segregation: a Decomposition Analysis in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). J Racial Ethn Health Disparities 2024; 11:1024-1032. [PMID: 37052798 DOI: 10.1007/s40615-023-01582-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 01/04/2023] [Accepted: 03/31/2023] [Indexed: 04/14/2023]
Abstract
The mechanisms underlying racial inequities in uncontrolled hypertension have been limited to individual factors. We investigated racial inequities in uncontrolled hypertension and the explanatory role of economic segregation in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). All 3897 baseline participants with hypertension (2008-2010) were included. Uncontrolled hypertension (SBP ≥ 140 mmHg or DBP ≥ 90 mmHg), self-reported race (White/Brown/Black people), and neighborhood economic segregation (low/medium/high) were analyzed cross-sectionally. We used decomposition analysis, which describes how much a disparity would change (disparity reduction; explained portion) and remain (disparity residual; unexplained portion) upon removing racial differences in economic segregation (i.e., if Black people had the distribution of segregation of White people, how much we would expect uncontrolled hypertension to decrease among Black people). Age- and gender-adjusted prevalence of uncontrolled hypertension (39.0%, 52.6%, and 54.2% for White, Brown, and Black participants, respectively) remained higher for Black and Brown vs White participants, regardless of economic segregation. Uncontrolled hypertension showed a dose-response pattern with increasing segregation levels for White but not for Black and Brown participants. After adjusting for age, gender, education, and study center, unexplained portion (disparity residual) of race on uncontrolled hypertension was 18.2% (95% CI 13.4%; 22.9%) for Black vs White participants and 12.6% (8.2%; 17.1%) for Brown vs White participants. However, explained portion (disparity reduction) through economic segregation was - 2.1% (- 5.1%; 1.3%) for Black vs White and 0.5% (- 1.7%; 2.8%) for Brown vs White participants. Although uncontrolled hypertension was greater for Black and Brown vs White people, racial inequities in uncontrolled hypertension were not explained by economic segregation.
Collapse
Affiliation(s)
- Joanna M N Guimarães
- National School of Public Health, Oswaldo Cruz Foundation, R Leopoldo Bulhões 1480, Manguinhos, Rio de Janeiro, RJ, Cep 21041-210, Brazil.
| | - John W Jackson
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Sharrelle Barber
- Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, PA, USA
| | - Rosane H Griep
- Laboratory of Health and Environment Education, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil
| | - Maria de J M da Fonseca
- National School of Public Health, Oswaldo Cruz Foundation, R Leopoldo Bulhões 1480, Manguinhos, Rio de Janeiro, RJ, Cep 21041-210, Brazil
| | - Lidyane V Camelo
- Department of Preventive and Social Medicine, Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | - Sandhi M Barreto
- Department of Preventive and Social Medicine, Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | - Maria Inês Schmidt
- Postgraduate Program in Epidemiology, Hospital das Clínicas de Porto Alegre, Federal University of Rio Grande Do Sul, Porto Alegre, RS, Brazil
| | - Bruce B Duncan
- Postgraduate Program in Epidemiology, Hospital das Clínicas de Porto Alegre, Federal University of Rio Grande Do Sul, Porto Alegre, RS, Brazil
| | - Leticia de O Cardoso
- National School of Public Health, Oswaldo Cruz Foundation, R Leopoldo Bulhões 1480, Manguinhos, Rio de Janeiro, RJ, Cep 21041-210, Brazil
| | - Alexandre C Pereira
- Laboratory of Genetics and Molecular Cardiology, Heart Institute, University of São Paulo, São Paulo, SP, Brazil
| | - Dora Chor
- National School of Public Health, Oswaldo Cruz Foundation, R Leopoldo Bulhões 1480, Manguinhos, Rio de Janeiro, RJ, Cep 21041-210, Brazil
| |
Collapse
|
2
|
da Silva EKP, Barreto SM, Brant LCC, Camelo LV, Araújo EMD, Griep RH, Fonseca MDJMD, Pereira ADC, Giatti L. Gender, race/skin colour and incidence of hypertension in ELSA-Brasil: an intersectional approach. ETHNICITY & HEALTH 2023; 28:469-487. [PMID: 35968763 DOI: 10.1080/13557858.2022.2108377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
OBJECTIVE Race and gender inequities in the incidence 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 identities defined by gender and race/skin colour with HTN incidence, and verified whether they are affected by educational level in adulthood. DESIGN We used the Longitudinal Study of Adult Health (ELSA-Brasil) data to estimate the incidence of HTN between visits 1 (2008-2010) and 2 (2012-2014), in 8528 participants without hypertension at visit 1. HTN was defined as systolic blood pressure ≥140 mmHg, or diastolic blood pressure ≥90 mmHg, or use of antihypertensive drugs. Generalized linear models with Poisson distribution and log link function were used to assess the associations. RESULTS 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 by 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), Brown (Parda) women (1.47; 95%CI: 1.31-1.67) and White men (1.76; 95%CI: 1.49-2.08), compared to White women. These associations were maintained even after considering socioeconomic, behavioural and health mediators in the model. No interaction was found between education level and intersectional identities in the IRRs observed. CONCLUSION By using an intersectional approach, we showed the complex relations between race/skin colour and gender inequities in the incidence of HTN, pointing not only that Black men have the highest risk of developing HTN, but also that the risk of HTN is greater in Black women than in White men, when compared to White women.
Collapse
Affiliation(s)
| | - Sandhi Maria Barreto
- Faculty of Medicine & Clinical Hospital/EBSERH, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | - Lidyane V Camelo
- Faculty of Medicine & Clinical Hospital/EBSERH, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Edna Maria de Araújo
- Department of Health, Universidade Estadual de Feira de Santana, Feira de Santana, Brazil
| | - Rosane Harter Griep
- Laboratory of Health and Environment Education, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | | | - Alexandre da Costa Pereira
- Laboratory of Genetics and Molecular Cardiology, Heart Institute (InCor), Universidade de São Paulo, São Paulo, Brazil
| | - Luana Giatti
- Faculty of Medicine & Clinical Hospital/EBSERH, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| |
Collapse
|
3
|
Pereira NP, Bastos JL, Lisboa CSDM. Intersectional Discrimination Index: Initial stages of cross-cultural adaptation to Brazilian Portuguese. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2022; 25:e220028. [PMID: 36259888 DOI: 10.1590/1980-549720220028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 08/19/2022] [Indexed: 06/16/2023] Open
Abstract
OBJECTIVE To perform the cross-cultural adaptation of Intersectional Discrimination Index (InDI) into Brazilian Portuguese. InDI assesses the health impacts of intersectional experiences with anticipated (InDI-A), day-to-day (InDI-D), and major (InDI-M) discrimination. METHODS The following steps were taken: (1) independent translations; (2) synthesis of translations; (3) evaluation by an expert committee; (4) analysis by members of the target population; (5) back translation; and (6) pre-test. Based on the evaluation by the expert committee, the content validity coefficient (CVC) was calculated for each item and for the entire instrument. CVC helped identify which items needed adjustments according to the criteria of language clarity, theoretical relevance, and practical relevance. RESULTS Of the 31 items, 24 were considered adequate and seven required further language adjustments. CVC values were satisfactory for clarity (CVCt=0.86), practical relevance (CVCt=0.87), and theoretical pertinence (CVCt=0.87); a good level of understanding was reported by the target population (mean=4.44; standard deviation=1.36). The average response time was 15.5 minutes, and no additional difficulties in interpreting the items were reported. The back-translated InDI was approved by the original authors of the instrument. CONCLUSION The initial stages of the cross-cultural adaptation process showed that the use of InDI looks promising in Brazil. Further studies still need to examine the psychometric properties of the instrument to confirm the positive results of our work, as well as its usefulness for assessing the health impacts of intersectional experiences with discrimination.
Collapse
Affiliation(s)
| | - João Luiz Bastos
- Universidade Federal de Santa Catarina - Florianópolis (SC), Brazil
| | | |
Collapse
|
4
|
Oliveira FEG, Griep RH, Chor D, Giatti L, Machado LAC, Barreto SM, da Costa Pereira A, Fonseca MDJMD, Bastos LS. Racial inequalities in multimorbidity: baseline of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). BMC Public Health 2022; 22:1319. [PMID: 35810284 PMCID: PMC9270815 DOI: 10.1186/s12889-022-13715-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 06/29/2022] [Indexed: 11/12/2022] Open
Abstract
Background Evidence of multimorbidity has come mainly from high-income regions, while disparities among racial groups have been less explored. This study examined racial differences in multimorbidity in the multiracial cohort of the Longitudinal Study of Adult Health (Estudo Longitudinal de Saúde do Adulto), ELSA-Brasil. Methods The study examined baseline (2008–2010) data for 14 099 ELSA-Brasil participants who self-reported being white, mixed-race, or black. A list of 16 morbidities was used to evaluate multimorbidity, operationalised by simple count into ≥ 2, ≥ 3, ≥ 4, ≥ 5 and ≥ 6 morbidities, in addition to evaluating the number of coexisting conditions. Prevalence ratios (PR) were estimated from logistic models and a quantile model was used to examine racial differences graphically in the distribution quantiles for the number of morbidities. Results Overall prevalence of multimorbidity (≥ 2 morbidities) was 70% and, after controlling for age and sex, was greater among mixed-race and black participants – by 6% (PR: 1.06; 95% CI: 1.03–1.08) and 9% (PR: 1.09; 95% CI: 1.06–1.12), respectively – than among white participants. As the cutoff value for defining multimorbidity was raised, so the strength of the association increased, especially among blacks: if set at ≥ 6 morbidities, the prevalence was 27% greater for those of mixed-race (PR: 1.27; 95% CI: 1.07–1.50) and 47% greater for blacks (PR: 1.47; 95% CI: 1.22–1.76) than for whites. The disparities were smaller in the lower morbidity distribution quantiles and larger in the upper quantiles, indicating a heavier burden of disease, particularly on blacks. Conclusions Multimorbidity was common among adults and older adults in a Brazilian cohort, but important racial inequalities were found. Raising the cutoff point for defining multimorbidity revealed stronger associations between race/skin colour and multimorbidity, indicating a higher prevalence of multimorbidity among mixed-race and black individuals than among whites and that the former groups coexisted more often with more complex health situations (with more coexisting morbidities). Interventions to prevent and manage the condition of multimorbidity that consider the social determinants of health and historically discriminated populations in low- and middle-income regions are necessary.
Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13715-7.
Collapse
Affiliation(s)
| | - Rosane Harter Griep
- Laboratory of Health and Environment Education, Oswaldo Cruz Institute, Rio de Janeiro, Brazil.
| | - Dora Chor
- Sérgio Arouca National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Luana Giatti
- Department of Preventive and Social Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Luciana A C Machado
- Clinical Hospital/EBSERH, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Sandhi Maria Barreto
- Department of Preventive and Social Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | | | | | | |
Collapse
|
5
|
Mendes PM, Nobre AA, Griep RH, Juvanhol LL, Barreto SM, Fonseca MJM, Chor D. Association between race/color and incidence of hypertension in the ELSA-Brasil population: investigating the mediation of racial discrimination and socioeconomic position. ETHNICITY & HEALTH 2022; 27:1047-1057. [PMID: 33356472 DOI: 10.1080/13557858.2020.1861586] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Accepted: 12/03/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To investigate the mediation effect of socioeconomic position and racial discrimination in the association between race/color and incidence of hypertension in 4-years follow up. METHODS We included 8,370 participants of the Longitudinal Study of Adult Health (ELSA-Brasil). A latent variable was constructed to represent socioeconomic position (SEP). The perception of discrimination was measured through an adaptation of the Lifetime Major Events Scale; and hypertension was defined using standard criteria. We investigated Body Mass Index (BMI) due to its role in proximal risk for hypertension. To investigate the mediating role of SEP and racial discrimination, we used structural equation modeling. RESULTS SEP had a direct and negative effect on HT incidence (HT incidence increased in worse SEP categories), while the effect of BMI on HT was direct and positive. We did not find significant direct effects of race/color and racial discrimination on HT. As for indirect effects, we observed associations between race/color and HT only through SEP mediation. CONCLUSION According to our results, race/color is indirectly related to HT incidence, mediated by SEP. Racial discrimination was not a mediator in the relationship between race/color and HT in the follow-up period.
Collapse
Affiliation(s)
- P M Mendes
- Faculdade de Nutrição, Universidade Federal do Pará, Belém, Brasil
| | - A A Nobre
- Programa de Computação Científica, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| | - R H Griep
- Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| | - L L Juvanhol
- Departamento de Nutrição e Saúde, Universidade Federal de Viçosa, Viçosa, Brasil
| | - S M Barreto
- Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brasil
| | - M J M Fonseca
- Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| | - D Chor
- Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| |
Collapse
|
6
|
Dixon AR, Adams LB, Ma T. Perceived healthcare discrimination and well-being among older adults in the United States and Brazil. SSM Popul Health 2022; 18:101113. [PMID: 35664925 PMCID: PMC9160820 DOI: 10.1016/j.ssmph.2022.101113] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 04/02/2022] [Accepted: 04/29/2022] [Indexed: 11/26/2022] Open
Abstract
Despite well-documented evidence illustrating the relationship between discrimination and health, less is known about the influence of unfair treatment when receiving medical care. Moreover, our current knowledge of cross-national and racial variations in healthcare discrimination is limited in aging populations. This article addresses these gaps using two harmonized data sets of aging populations to clarify the relationship between healthcare discrimination and health in the United States and Brazil. We use nationally representative, harmonized data from the Health and Retirement Study in the United States and the Brazilian Longitudinal Study of Aging to examine and compare perceived discrimination in the healthcare setting and its relationship to self-rated health, depression diagnosis, and depressive symptoms across national contexts. Using Poisson regression models and population attributable risk percent estimates, we found that aging adults reporting healthcare discrimination were at higher risk of poor self-rated health, diagnosed depression, and depressive symptoms. Our results also suggest that reducing perceived healthcare discrimination may contribute to improved self-rated health and mental well-being in later life across racialized societies. In two comparative settings, we highlight the differential impact of healthcare discrimination on self-rated health and depression. We describe the implications of our study's findings for national public health strategies focused on eliminating discrimination in the healthcare setting, particularly among aging countries.
Collapse
Affiliation(s)
| | - Leslie B. Adams
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Maryland, United States
| | - Tszshan Ma
- Gangarosa Department of Environmental Health, Emory University, Georgia
| |
Collapse
|
7
|
Camelo LV, Machado AV, Chor D, Griep RH, Mill JG, Brant LCC, Barreto SM. Racial discrimination is associated with greater arterial stiffness and carotid intima-media thickness: The ELSA-Brasil study. Ann Epidemiol 2022; 72:40-47. [DOI: 10.1016/j.annepidem.2022.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 03/14/2022] [Accepted: 03/18/2022] [Indexed: 11/01/2022]
|
8
|
Pereira NP, Bastos JL, Lisboa CSDM. Etapas iniciais da adaptação transcultural do Intersectional Discrimination Index para o português do Brasil. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2022. [DOI: 10.1590/1980-549720220028.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
RESUMO Objetivo: O presente estudo realizou a adaptação transcultural do Intersectional Discrimination Index (InDI) para o português do Brasil. Trata-se de um instrumento composto de 31 itens, que visa mensurar os impactos para a saúde de experiências interseccionais com discriminação antecipada (InDI-A), cotidiana (InDI-D) e maior (InDI-M). Métodos: Foram percorridas as seguintes etapas: (1) traduções independentes; (2) síntese das traduções; (3) avaliação por comitê de especialistas; (4) análise por membros da população-alvo; (5) tradução reversa; e (6) pré-teste. Calculou-se igualmente o coeficiente de validade de conteúdo (CVC) de cada um dos itens e de todo o instrumento. O CVC foi empregado por permitir identificar quais itens necessitavam de ajustes de acordo com os critérios de clareza de linguagem, relevância teórica e pertinência prática. Resultados: Dos 31 itens do instrumento, 24 foram considerados adequados e sete necessitaram de ajustes de linguagem. Os valores dos CVC foram satisfatórios para os critérios de clareza de linguagem (CVCt=0,86), pertinência prática (CVCt=0,87) e relevância teórica (CVCt=0,87), e o público-alvo considerou satisfatória a compreensão do instrumento (média=4,44; desvio padrão=1,36). O tempo médio de resposta foi de 15,5 minutos e não foram registradas dúvidas adicionais. A tradução reversa foi aprovada pelos autores originais do instrumento. Conclusão: As etapas iniciais do processo de adaptação transcultural mostraram que o InDI parece promissor para uso no Brasil. Estudos futuros ainda precisam examinar as propriedades psicométricas do instrumento para confirmar os resultados positivos do presente trabalho, bem como sua utilidade para a avaliação dos impactos para a saúde de experiências interseccionais com discriminação.
Collapse
|
9
|
Camelo LV, Coelho CG, Chor D, Griep RH, Almeida MDCCD, Giatti L, Barreto SM. Racismo e iniquidade racial na autoavaliação de saúde ruim: o papel da mobilidade social intergeracional no Estudo Longitudinal de Saúde do Adulto (ELSA-Brasil). CAD SAUDE PUBLICA 2022; 38:e00341920. [DOI: 10.1590/0102-311x000341920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 06/11/2021] [Indexed: 11/22/2022] Open
Abstract
Resumo: Pretos e pardos apresentam grandes desvantagens de saúde, possuem menores chances de ascensão na hierarquia social no curso de vida e menores níveis socioeconômicos do que brancos como resultado do racismo estrutural. Entretanto, pouco se sabe sobre o papel mediador da mobilidade intergeracional na associação entre racismo e saúde. O objetivo do presente estudo foi investigar a associação entre racismo e a autoavaliação de saúde, e verificar em que medida a mobilidade social intergeracional media essa associação. Estudo transversal realizado com dados de 14.386 participantes da linha de base (2008-2010) do Estudo Longitudinal de Saúde do Adulto (ELSA-Brasil). Escolaridade materna, escolaridade do participante, classe sócio-ocupacional do chefe de família e classe sócio-ocupacional do participante compuseram os indicadores de mobilidade social intergeracional (educacional e sócio-ocupacional). Modelos de regressão logística foram utilizados. A prevalência de autoavaliação de saúde ruim foi de 15%, 24% e 28% entre brancos, pardos e pretos, respectivamente. Após ajustes por idade, sexo e centro de investigação foram encontradas maiores chances de autoavaliação de saúde ruim entre pretos (OR = 2,15; IC95%: 1,92-2,41) e pardos (OR = 1,82; IC95%: 1,64-2,01) quando comparados aos brancos. A mobilidade educacional e sócio-ocupacional intergeracional mediaram, respectivamente, 66% e 53% da associação entre a raça/cor e autoavaliação de saúde ruim em pretos, e 61% e 51% em pardos, respectivamente. Resultados confirmam a iniquidade racial na autoavaliação de saúde e apontam que a mobilidade social intergeracional desfavorável é um importante mecanismo para explicar essa iniquidade.
Collapse
|
10
|
Machado AV, Camelo LV, Chor D, Griep RH, Guimarães JMN, Giatti L, Barreto SM. Racial inequality, racial discrimination and obesity incidence in adults from the ELSA-Brasil cohort. J Epidemiol Community Health 2021; 75:695-701. [PMID: 33419789 DOI: 10.1136/jech-2020-214740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 11/24/2020] [Accepted: 12/16/2020] [Indexed: 11/03/2022]
Abstract
BACKGROUND This study investigated whether self-reported race/skin colour and perceived racial discrimination predict higher obesity incidence after approximately 4-year follow-up of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). We also investigated whether these associations are modified by educational level. METHODS Following exclusion of individuals defined as obese (body mass index ≥30 kg/m2) at baseline, associations between race/skin colour and obesity incidence between the first (2008-2010) and second (2012-2014) visits were investigated in 10 130 participants. Next, associations between perceived racial discrimination and obesity incidence among black (n=1532) and brown (n=2958) individuals were investigated separately. Racial discrimination (yes/no) was assessed using the Lifetime Major Event Scale. Logistic regression models adjusted for age, sex and research site were used. All analyses were stratified for educational level. RESULTS Obesity risk was higher in Blacks with high education compared with white individuals to the same education level (OR: 2.22; 95% CI 1.62 to 3.04) following adjustments. After adjustments, obesity incidence was higher among black individuals reporting racial discrimination compared with peers who did not report this experience, but only among the low education group (OR: 1.64; 95% CI 1.08 to 2.51). No statistical association with perceived discrimination was observed among brown individuals. CONCLUSION Results are congruent with findings from other studies reporting associations between racial inequality and obesity incidence and also suggest racial discrimination may be one of the mechanisms leading to such inequalities. Also, it supports the paradox theory by which education modify the association in distinct directions.
Collapse
Affiliation(s)
- Amanda Viana Machado
- Postgraduate Program in Public Health, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Lidyane V Camelo
- Department of Preventive and Social Medicine, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Dora Chor
- Department of Epidemiology and Quantitative Methods, National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Rosane H Griep
- Laboratory of Health and Environment Education, Oswaldo Cruz Foundation-National School of Public Health, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Joanna M N Guimarães
- Department of Epidemiology and Quantitative Methods, National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Luana Giatti
- Department of Preventive and Social Medicine, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Sandhi Maria Barreto
- Department of Preventive and Social Medicine, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| |
Collapse
|
11
|
Braga LDS, Caiaffa WT, Ceolin APR, de Andrade FB, Lima-Costa MF. Perceived discrimination among older adults living in urban and rural areas in Brazil: a national study (ELSI-Brazil). BMC Geriatr 2019; 19:67. [PMID: 30832588 PMCID: PMC6399885 DOI: 10.1186/s12877-019-1076-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 02/18/2019] [Indexed: 12/02/2022] Open
Abstract
Background Research on discrimination and health focused on older adults has been scarce, comparatively with younger and middle-aged adults. Considering where people live matters, accurate measures of perceived discrimination might consider how the place of residence interferes on discriminatory experiences. This study aimed to assess the association between perceived discrimination and urban/rural place of residence among a representative sample of older adults in Brazil. Methods Data came from the baseline of the Brazilian Longitudinal Study of Aging (ELSI-Brazil), conducted in 2015/2016, with individuals aged 50 years and older. Perceived Discrimination was measured by means of the following question: “In the past 12 months have you felt a victim of any type of discrimination” with five possible answers: (1)“when you sought medical services or health care?”, (2)“in social gatherings?”, (3)“in the work place?”, (4)“within the family?”, (5)“due to where you live?”. Participants who answered yes for any of the five domains were coded as having reported an experience of discrimination. The main exposure variable was the urban-rural classification of the households, carried out according to the methods employed by the Brazilian Institute of Geography and Statistics during the 2010 Population Census. Other covariates included: age, sex, skin color, household wealth and education. Multiple Poisson regression was used to estimate prevalence ratios and their respective 95% confidence interval for the association between discrimination and independent variables. Results Prevalence of any perceived discrimination among Brazilian older adults was 16.8%. Regardless the place of residence (either urban or rural), participants reported health care settings as the most common domain where discriminatory experiences occurred and the work place as the least common. According to the adjusted model, perceived discrimination was significantly higher among urban dwellers when compared to their rural counterparts, independent of sociodemographic characteristics, health status and neighborhood social environment. The outcome was significant associated with skin color, education and health status. Conclusions Urban environment plays a core role in perceived discrimination and health care settings constitute the most common domain where discriminatory experiences occurred. Our findings may contribute to fulfill the knowledge gap on discrimination among older adults living in developing countries. Electronic supplementary material The online version of this article (10.1186/s12877-019-1076-4) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Luciana de Souza Braga
- Observatório de Saúde Urbana de Belo Horizonte, Faculdade de Medicina, Universidade Federal de Minas Gerais, Avenida Professor Alfredo Balena, n° 190, Belo Horizonte, Minas Gerais, 30130-100, Brazil.
| | - Waleska Teixeira Caiaffa
- Observatório de Saúde Urbana de Belo Horizonte, Faculdade de Medicina, Universidade Federal de Minas Gerais, Avenida Professor Alfredo Balena, n° 190, Belo Horizonte, Minas Gerais, 30130-100, Brazil
| | - Ana Paula Romanelli Ceolin
- Observatório de Saúde Urbana de Belo Horizonte, Faculdade de Medicina, Universidade Federal de Minas Gerais, Avenida Professor Alfredo Balena, n° 190, Belo Horizonte, Minas Gerais, 30130-100, Brazil
| | - Fabíola Bof de Andrade
- Instituto René Rachou, Fundação Oswaldo Cruz, Avenida Augusto de Lima, n°1715, Belo Horizonte, 30190-002, Brazil
| | - Maria Fernanda Lima-Costa
- Instituto René Rachou, Fundação Oswaldo Cruz, Avenida Augusto de Lima, n°1715, Belo Horizonte, 30190-002, Brazil
| |
Collapse
|
12
|
Dixon AR. Colorism and classism confounded: Perceptions of discrimination in Latin America. SOCIAL SCIENCE RESEARCH 2019; 79:32-55. [PMID: 30857667 DOI: 10.1016/j.ssresearch.2018.12.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2017] [Revised: 11/10/2018] [Accepted: 12/10/2018] [Indexed: 06/09/2023]
Abstract
Despite competing narratives of mestizaje (race-mixing) emphasizing class discrimination and social movements highlighting the existence of racial discrimination in Latin America, little work has examined the overlap of class and color in people's understandings of discrimination. This study moves beyond the color/class binary by examining perceptions of only class, only color, and both class and color discrimination (dual discrimination). I also examine whether individuals have difficulty attributing the causes of discrimination by expanding upon the social psychological concept of attributional ambiguity. Using nationally representative data from the 2010 LAPOP's Americas Barometer survey, I find that color-based explanations have not replaced class-based explanations. Instead, both class and color appear to be part of schemas drawn upon by individuals to understand the unfavorable treatment they perceive-in line with scholarship showing both class disadvantage and color conjointly influence the stratification systems of Latin America. There is also suggestive evidence that individuals may have trouble disentangling the causes of the discrimination they perceive.
Collapse
Affiliation(s)
- Angela R Dixon
- Center for Population and Development Studies, Harvard University, USA.
| |
Collapse
|
13
|
Patrão AL, Almeida MDC, Matos SMA, Goes EF, Nogueira C, Aquino EML. Association Between Perceived Discrimination and Alcohol and Tobacco Consumption in ELSA-Brasil Cohort: Focusing on Gender Differences. Subst Use Misuse 2019; 54:1214-1225. [PMID: 30799670 DOI: 10.1080/10826084.2019.1573838] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Discrimination is detrimental to physical and mental health, particularly insofar as health-risk behaviors are concerned. Particular attention has been paid to excess alcohol consumption and smoking in view of the ready availability of these substances in Western societies. OBJECTIVES To determine whether an association exists between perceived discrimination and excess alcohol intake and smoking in women and men enrolled in the ELSA-Brasil cohort study. METHODS The sample included in the ELSA-Brasil cohort consisted of 15,105 civil servants. Data from waves 1 and 2 of the study were used. A multidimensional questionnaire was used to collect sociodemographic characteristics and evaluate perceived discrimination, alcohol consumption, and smoking. RESULTS An association was found between excess alcohol intake and perceived discrimination only in the men, with this association remaining significant in the youngest age group, in university-educated individuals, and in the group classified as middle-class. An association was found between smoking and lifetime perceived discrimination in women, particularly in those ≥60 years of age, brown-skinned women, those who had completed elementary school, and those classified as upper social class. This same association was found in the men, mainly those of 50-59 years of age, white-skinned males, those who had completed high school, those with a university education, and those classified as upper social class. Conclusions/Importance: Investing in public health policies aimed at combating the different forms of discrimination would appear essential. Not only does discrimination contribute to social injustice, but it also encourages health-risk behaviors such as excess alcohol intake and smoking.
Collapse
Affiliation(s)
- Ana Luísa Patrão
- a Institute of Collective Health , Federal University of Bahia , Salvador , Brazil
| | | | - Sheila M Alvim Matos
- a Institute of Collective Health , Federal University of Bahia , Salvador , Brazil
| | | | - Conceição Nogueira
- c c Faculty of Psychology and Educational Sciences , Porto University , Porto , Portugal
| | - Estela M L Aquino
- a Institute of Collective Health , Federal University of Bahia , Salvador , Brazil
| |
Collapse
|
14
|
Bernardo FR, Bastos JL, Moretti-Pires RO. A dança dos números: aferindo experiências de discriminação em grupos multiplamente marginalizados. CAD SAUDE PUBLICA 2018; 34:e00167117. [DOI: 10.1590/0102-311x00167117] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2017] [Accepted: 06/21/2018] [Indexed: 11/22/2022] Open
Abstract
Resumo: O objetivo deste estudo foi analisar a Escala de Discriminação Explícita (EDE), buscando identificar sua capacidade em refletir experiências de discriminação interseccionais sob a perspectiva do cruzamento entre cor/raça, sexo/gênero e posição socioeconômica. Trata-se de estudo baseado em dados de uma pesquisa realizada com uma amostra representativa de estudantes (n = 1.023) da Universidade Federal de Santa Catarina, regularmente matriculados no primeiro semestre de 2012. A análise estatística incluiu estimação das frequências relativas de cada um dos 18 itens da EDE, bem como de suas principais motivações, estratificadas por sexo/gênero, cor/raça e posição socioeconômica. Modelos de regressão binomial negativa possibilitaram avaliar se sexo/gênero, cor/raça e posição socioeconômica constituem preditores do escore de discriminação obtido com o instrumento, mesmo após o ajuste para covariáveis que potencialmente afetam as relações de interesse. Os resultados da análise de cada um dos 18 itens do instrumento sugerem que a EDE possibilita a mensuração da discriminação dentro de um quadro interseccional, uma vez que traz à tona as experiências discriminatórias vivenciadas por subgrupos minoritários, tais como mulheres negras e de posição socioeconômica baixa. Contudo, tal tendência não foi observada no escore global do instrumento, sugerindo que ele não permite situar os respondentes num espectro de variação de discriminação, que inclui graus menos e mais intensos do fenômeno. Pesquisas futuras são necessárias a fim de enfrentar a limitação observada e, assim, dar maior visibilidade às experiências de discriminação de grupos multiplamente marginalizados.
Collapse
|