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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] [What about the content of this article? (0)] [Affiliation(s)] [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.
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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
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Guimarães JMN, Pescarini JM, de Sousa Filho JF, Ferreira A, de Almeida MDCC, Gabrielli L, dos-Santos-Silva I, Santos G, Barreto ML, Aquino EML. Income Segregation, Conditional Cash Transfers, and Breast Cancer Mortality Among Women in Brazil. JAMA Netw Open 2024; 7:e2353100. [PMID: 38270952 PMCID: PMC10811554 DOI: 10.1001/jamanetworkopen.2023.53100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 12/04/2023] [Indexed: 01/26/2024] Open
Abstract
Importance Women living in income-segregated areas are less likely to receive adequate breast cancer care and access community resources, which may heighten breast cancer mortality risk. Objective To investigate the association between income segregation and breast cancer mortality and whether this association is attenuated by receipt of the Bolsa Família program (BFP), the world's largest conditional cash-transfer program. Design, Setting, and Participants This cohort study was conducted using data from the 100 Million Brazilian Cohort, which were linked with nationwide mortality registries (2004-2015). Data were analyzed from December 2021 to June 2023. Study participants were women aged 18 to 100 years. Exposure Women's income segregation (high, medium, or low) at the municipality level was obtained using income data from the 2010 Brazilian census and assessed using dissimilarity index values in tertiles (low [0.01-0.25], medium [0.26-0.32], and high [0.33-0.73]). Main Outcomes and Measures The main outcome was breast cancer mortality. Mortality rate ratios (MRRs) for the association of segregation with breast cancer deaths were estimated using Poisson regression adjusted for age, race, education, municipality area size, population density, area of residence (rural or urban), and year of enrollment. Multiplicative interactions of segregation and BFP receipt (yes or no) in the association with mortality (2004-2015) were assessed. Results Data on 21 680 930 women (mean [SD] age, 36.1 [15.3] years) were analyzed. Breast cancer mortality was greater among women living in municipalities with high (adjusted MRR [aMRR], 1.18; 95% CI, 1.13-1.24) and medium (aMRR, 1.08; 95% CI, 1.03-1.12) compared with low segregation. Women who did not receive BFP had higher breast cancer mortality than BFP recipients (aMRR, 1.17; 95% CI, 1.12-1.22). By BFP strata, women who did not receive BFP and lived in municipalities with high income segregation had a 24% greater risk of death from breast cancer compared with those living in municipalities with low income segregation (aMRR, 1.24: 95% CI, 1.14-1.34); women who received BFP and were living in areas with high income segregation had a 13% higher risk of death from breast cancer compared with those living in municipalities with low income segregation (aMRR, 1.13; 95% CI, 1.07-1.19; P for interaction = .008). Stratified by the amount of time receiving the benefit, segregation (high vs low) was associated with an increase in mortality risk for women receiving BFP for less time but not for those receiving it for more time (<4 years: aMRR, 1.16; 95% CI, 1.07-1.27; 4-11 years: aMRR, 1.09; 95% CI, 1.00-1.17; P for interaction <.001). Conclusions and Relevance These findings suggest that place-based inequities in breast cancer mortality associated with income segregation may be mitigated with BFP receipt, possibly via improved income and access to preventive cancer care services among women, which may be associated with early detection and treatment and ultimately reduced mortality.
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Affiliation(s)
| | - Julia M. Pescarini
- Center for Data and Knowledge Integration for Health, Fiocruz, Salvador, Brazil
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | - Andrea Ferreira
- Center for Data and Knowledge Integration for Health, Fiocruz, Salvador, Brazil
- Ubuntu Center on Racism, Global Movements and Population Health Equity, Drexel University Dornsife School of Public Health, Philadelphia, Pennsylvania
| | | | - Ligia Gabrielli
- Secretaria de Saúde do Estado da Bahia, Centro de Diabetes e Endocrinologia da Bahia, Salvador, Brazil
| | - Isabel dos-Santos-Silva
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Gervasio Santos
- Center for Data and Knowledge Integration for Health, Fiocruz, Salvador, Brazil
| | - Mauricio L. Barreto
- Center for Data and Knowledge Integration for Health, Fiocruz, Salvador, Brazil
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Brazil
| | - Estela M. L. Aquino
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Brazil
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Góes EF, Guimarães JMN, Almeida MDCC, Gabrielli L, Katikireddi SV, Campos AC, Matos SMA, Patrão AL, Oliveira Costa ACD, Quaresma M, Leyland AH, Barreto ML, Dos-Santos-Silva I, Aquino EML. The intersection of race/ethnicity and socioeconomic status: inequalities in breast and cervical cancer mortality in 20,665,005 adult women from the 100 Million Brazilian Cohort. Ethn Health 2024; 29:46-61. [PMID: 37642313 DOI: 10.1080/13557858.2023.2245183] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 08/01/2023] [Indexed: 08/31/2023]
Abstract
OBJECTIVES There is limited evidence regarding the impact of race/racism and its intersection with socioeconomic status (SES) on breast and cervical cancer, the two most common female cancers globally. We investigated racial inequalities in breast and cervical cancer mortality and whether SES (education and household conditions) interacted with race/ethnicity. DESIGN The 100 Million Brazilian Cohort data were linked to the Brazilian Mortality Database, 2004-2015 (n = 20,665,005 adult women). We analysed the association between self-reported race/ethnicity (White/'Parda'(Brown)/Black/Asian/Indigenous) and cancer mortality using Poisson regression, adjusting for age, calendar year, education, household conditions and area of residence. Additive and multiplicative interactions were assessed. RESULTS Cervical cancer mortality rates were higher among Indigenous (adjusted Mortality rate ratio = 1.80, 95%CI 1.39-2.33), Asian (1.63, 1.20-2.22), 'Parda'(Brown) (1.27, 1.21-1.33) and Black (1.18, 1.09-1.28) women vs White women. Breast cancer mortality rates were higher among Black (1.10, 1.04-1.17) vs White women. Racial inequalities in cervical cancer mortality were larger among women of poor household conditions, and low education (P for multiplicative interaction <0.001, and 0.02, respectively). Compared to White women living in completely adequate (3-4) household conditions, the risk of cervical cancer mortality in Black women with 3-4, 1-2, and none adequate conditions was 1.10 (1.01-1.21), 1.48 (1.28-1.71), and 2.03 (1.56-2.63), respectively (Relative excess risk due to interaction-RERI = 0.78, 0.18-1.38). Among 'Parda'(Brown) women the risk was 1.18 (1.11-1.25), 1.68 (1.56-1.81), and 1.84 (1.63-2.08), respectively (RERI = 0.52, 0.16-0.87). Compared to high-educated White women, the risk in high-, middle- and low-educated Black women was 1.14 (0.83-1.55), 1.93 (1.57-2.38) and 2.75 (2.33-3.25), respectively (RERI = 0.36, -0.05-0.77). Among 'Parda'(Brown) women the risk was 1.09 (0.91-1.31), 1.99 (1.70-2.33) and 3.03 (2.61-3.52), respectively (RERI = 0.68, 0.48-0.88). No interactions were found for breast cancer. CONCLUSION Low SES magnified racial inequalities in cervical cancer mortality. The intersection between race/ethnicity, SES and gender needs to be addressed to reduce racial health inequalities.
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Affiliation(s)
- Emanuelle F Góes
- Centre for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Bahia, Brazil
| | - Joanna M N Guimarães
- Centre for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Bahia, Brazil
| | | | - Ligia Gabrielli
- Centro de Diabetes e Endocrinologia da Bahia, Secretaria de Saúde do Estado da Bahia, Bahia, Brazil
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Brazil
| | | | - Ana Clara Campos
- Centre for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Bahia, Brazil
| | | | - Ana Luísa Patrão
- Center for Psychology, Faculty of Psychology and Education Science, University of Porto, Porto, Portugal
| | | | - Manuela Quaresma
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Alastair H Leyland
- MRC/CSO Social & Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Mauricio L Barreto
- Centre for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Bahia, Brazil
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Brazil
| | - Isabel Dos-Santos-Silva
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Estela M L Aquino
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Brazil
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Machado AV, Camelo LV, Menezes STD, Guimarães JMN, Chor D, Griep RH, Matos SMAD, Molina MDCB, Giatti L, Barreto SM. Racial discrimination predicts the increase in body weight and BMI in Black individuals from ELSA-Brasil cohort. Cien Saude Colet 2023; 28:1655-1662. [PMID: 37255143 DOI: 10.1590/1413-81232023286.14992022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 11/29/2022] [Indexed: 06/01/2023] Open
Abstract
We investigated whether racial discrimination accelerates the weight and Body Mass Index (BMI) gain in Blacks and Browns participants of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) in four years of follow-up. We compared body weight and BMI between the 1st (2008-2010) and 2nd visit (2012-2014) of 5,983 Blacks and Browns participants. Exposure to racial discrimination and covariates (age, sex, education, and research center) were obtained at the 1st visit. Linear mixed effects models stratified by race/skin color were used. Report of racial discrimination was more frequent among Blacks (32.1%) than Browns (6.3%). During the follow-up period, Blacks and Browns gained an average of 1.4kg and 1.2kg, respectively. This increase was greater among those who reported discrimination when compared to those who did not, both in Blacks (2.1kg vs.1.0kg, p < 0.001) and Browns (1.9kg vs. 1.1kg, p < 0.05). The results of the interaction between racial discrimination and time showed that Blacks, but not Browns, who reported racial discrimination had greater weight and BMI gains between visits. Our results suggest that reducing racial discrimination would contribute to prevent and/or control obesity increase in the country.
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Affiliation(s)
- Amanda Viana Machado
- Programa de Pós-Graduação em Saúde Coletiva, Faculdade de Medicina, Universidade Federal de Minas Gerais. Belo HorizonteMG Brasil
| | - Lidyane V Camelo
- Escola de Medicina e Hospital de Clínicas da Universidade Federal de Minas Gerais. Av. Professor Alfredo Balena 190. 30130-100 Belo Horizonte MG Brasil.
| | - Sara Teles de Menezes
- Programa de Pós-Graduação em Saúde Coletiva, Faculdade de Medicina, Universidade Federal de Minas Gerais. Belo HorizonteMG Brasil
| | - Joanna M N Guimarães
- Departamento de Epidemiologia e Métodos Quantitativos, Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz. Rio de Janeiro RJ Brasil
| | - Dora Chor
- Departamento de Epidemiologia e Métodos Quantitativos, Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz. Rio de Janeiro RJ Brasil
| | - Rosane Harter Griep
- Laboratório de Educação em Saúde e Meio Ambiente, Fundação Oswaldo Cruz. Rio de Janeiro RJ Brasil
| | | | - Maria Del Carmen Bisi Molina
- Programa de Pós-Graduação em Saúde Coletiva, Universidade Federal do Espírito Santo. Programa de Pós-Graduação em Nutrição e Saúde da Universidade Federal de Ouro Preto. Vitória ES Brasil
| | - Luana Giatti
- Escola de Medicina e Hospital de Clínicas da Universidade Federal de Minas Gerais. Av. Professor Alfredo Balena 190. 30130-100 Belo Horizonte MG Brasil.
| | - Sandhi Maria Barreto
- Escola de Medicina e Hospital de Clínicas da Universidade Federal de Minas Gerais. Av. Professor Alfredo Balena 190. 30130-100 Belo Horizonte MG Brasil.
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Guimarães JMN, Acharya B, Moore K, López-Olmedo N, de Menezes MC, Stern D, Friche AADL, Wang X, Delclòs-Alió X, Rodriguez DA, Sarmiento OL, de Oliveira Cardoso L. City-Level Travel Time and Individual Dietary Consumption in Latin American Cities: Results from the SALURBAL Study. Int J Environ Res Public Health 2022; 19:13443. [PMID: 36294020 PMCID: PMC9602577 DOI: 10.3390/ijerph192013443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 10/05/2022] [Accepted: 10/12/2022] [Indexed: 06/16/2023]
Abstract
There is limited empirical evidence on how travel time affects dietary patterns, and even less in Latin American cities (LACs). Using data from 181 LACs, we investigated whether longer travel times at the city level are associated with lower consumption of vegetables and higher consumption of sugar-sweetened beverages and if this association differs by city size. Travel time was measured as the average city-level travel time during peak hours and city-level travel delay time was measured as the average increase in travel time due to congestion on the street network during peak hours. Vegetables and sugar-sweetened beverages consumption were classified according to the frequency of consumption in days/week (5-7: "frequent", 2-4: "medium", and ≤1: "rare"). We estimate multilevel ordinal logistic regression modeling for pooled samples and stratified by city size. Higher travel time (Odds Ratio (OR) = 0.65; 95% Confidence Interval (CI) 0.49-0.87) and delay time (OR = 0.57; CI 0.34-0.97) were associated with lower odds of frequent vegetable consumption. For a rare SSB consumption, we observed an inverse association with the delay time (OR = 0.65; CI 0.44-0.97). Analysis stratified by city size show that these associations were significant only in larger cities. Our results suggest that travel time and travel delay can be potential urban determinants of food consumption.
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Affiliation(s)
- Joanna M. N. Guimarães
- Epidemiology Department, National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro 21041-210, Brazil
| | - Binod Acharya
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA 19104, USA
| | - Kari Moore
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA 19104, USA
| | - Nancy López-Olmedo
- Population Health Research Center, National Instituto Nacional de Salud Pública, Cuernavaca 62100, Mexico
| | | | - Dalia Stern
- CONACyT-Population Health Research Center, National Instituto Nacional de Salud Pública, Cuernavaca 62100, Mexico
| | - Amélia Augusta de Lima Friche
- Department of Speech, Language and Audiology Sciences, Observatory for Urban Health in Belo Horizonte, School of Medicine, Federal University of Minas Gerais, Belo Horizonte 30310-692, Brazil
| | - Xize Wang
- Department of Real Estate, National University of Singapore, Singapore 119245, Singapore
| | - Xavier Delclòs-Alió
- Research Group on Territorial Analysis and Tourism Studies (GRATET), Department of Geography, Universitat Rovira i Virgili, 43480 Vila-seca, Catalonia, Spain
| | - Daniel A. Rodriguez
- Institute of Transportation Studies, Department of City and Regional Planning, University of California, Berkeley, CA 94720, USA
| | - Olga Lucia Sarmiento
- Department of Public Health, School of Medicine, Universidad de Los Andes, Bogota 111711, Colombia
| | - Leticia de Oliveira Cardoso
- Epidemiology Department, National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro 21041-210, Brazil
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Guimarães JMN, Yamada G, Barber S, Caiaffa WT, Friche AADL, de Menezes MC, Santos G, Santos I, Cardoso LDO, Diez Roux AV. Racial Inequities in Self-Rated Health Across Brazilian Cities: Does Residential Segregation Play a Role? Am J Epidemiol 2022; 191:1071-1080. [PMID: 35244147 PMCID: PMC9169054 DOI: 10.1093/aje/kwac001] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 12/23/2021] [Accepted: 01/04/2022] [Indexed: 11/14/2022] Open
Abstract
Racial health inequities may be partially explained by area-level factors such as residential segregation. In this cross-sectional study, using a large, multiracial, representative sample of Brazilian adults (n = 37,009 individuals in the 27 state capitals; National Health Survey (Pesquisa Nacional de Saúde), 2013), we investigated 1) whether individual-level self-rated health (SRH) (fair or poor vs. good or better) varies by race (self-declared White, Brown, or Black) and 2) whether city-level economic or racial residential segregation (using dissimilarity index values in tertiles: low, medium, and high) interacts with race, increasing racial inequities in SRH. Prevalence of fair or poor SRH was 31.5% (Black, Brown, and White people: 36.4%, 34.0%, and 27.3%, respectively). Marginal standardization based on multilevel logistic regression models, adjusted for age, gender, and education, showed that Black and Brown people had, respectively, 20% and 10% higher prevalence of fair or poor SRH than did White people. Furthermore, residential segregation interacted with race such that the more segregated a city, the greater the racial gap among Black, Brown, and White people in fair or poor SRH for both income and race segregation. Policies to reduce racial inequities may need to address residential segregation and its consequences for health.
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Affiliation(s)
- Joanna M N Guimarães
- Correspondence to Dr. Joanna M.N. Guimarães, National School of Public Health, Oswaldo Cruz Foundation, R. Leopoldo Bulhões 1480, Manguinhos, Cep 21041-210, Rio de Janeiro, RJ, Brazil (e-mail: )
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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] [What about the content of this article? (0)] [Affiliation(s)] [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.
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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
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Schmidt MI, Bracco P, Canhada S, Guimarães JMN, Barreto SM, Chor D, Griep R, Yudkin JS, Duncan BB. Regression to the Mean Contributes to the Apparent Improvement in Glycemia 3.8 Years After Screening: The ELSA-Brasil Study. Diabetes Care 2021; 44:81-88. [PMID: 33444159 PMCID: PMC7783938 DOI: 10.2337/dc20-2030] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Accepted: 10/10/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Glycemic regression is common in real-world settings, but the contribution of regression to the mean (RTM) has been little investigated. We aimed to estimate glycemic regression before and after adjusting for RTM in a free-living cohort of adults with newly ascertained diabetes and intermediate hyperglycemia (IH). RESEARCH DESIGN AND METHODS The Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) is a cohort study of 15,105 adults screened between 2008 and 2010 with standardized oral glucose tolerance test and HbA1c, repeated after 3.84 ± 0.42 years. After excluding those receiving medical treatment for diabetes, we calculated partial or complete regression before and after adjusting baseline values for RTM. RESULTS Regarding newly ascertained diabetes, partial or complete regression was seen in 49.4% (95% CI 45.2-53.7); after adjustment for RTM, in 20.2% (95% CI 12.1-28.3). Regarding IH, regression to normal levels was seen in 39.5% (95% CI 37.9-41.3) or in 23.7% (95% CI 22.6-24.3), depending on use of the World Health Organization (WHO) or the American Diabetes Association (ADA) definition, respectively; after adjustment, corresponding frequencies were 26.1% (95% CI 22.4-28.1) and 19.4% (95% CI 18.4-20.5). Adjustment for RTM reduced the number of cases detected at screening: 526 to 94 cases of diabetes, 3,118 to 1,986 cases of WHO-defined IH, and 6,182 to 5,711 cases of ADA-defined IH. Weight loss ≥2.6% was associated with greater regression from diabetes (relative risk 1.52, 95% CI 1.26-1.84) and IH (relative risk 1.30, 95% CI 1.17-1.45). CONCLUSIONS In this quasi-real-world setting, regression from diabetes at ∼4 years was common, less so for IH. Regression was frequently explained by RTM but, in part, also related to improved weight loss and homeostasis over the follow-up.
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Affiliation(s)
- Maria Inês Schmidt
- Postgraduate Program in Epidemiology, School of Medicine and Hospital de Clínicas, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Paula Bracco
- Postgraduate Program in Epidemiology, School of Medicine and Hospital de Clínicas, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Scheine Canhada
- Postgraduate Program in Epidemiology, School of Medicine and Hospital de Clínicas, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | | | - Sandhi Maria Barreto
- School of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.,Division of Medicine, University College London, London, U.K
| | - Dora Chor
- Laboratory of Health and Environment Education, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Rosane Griep
- Laboratory of Health and Environment Education, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - John S Yudkin
- Division of Medicine, University College London, London, U.K
| | - Bruce B Duncan
- Postgraduate Program in Epidemiology, School of Medicine and Hospital de Clínicas, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
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9
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Brandão JM, Nobre AA, Guimarães JMN, de Jesus Mendes da Fonseca M, Matos SMA, Luft VC, de Oliveira Cardoso L. Influence of internal migration on body mass index: Results of the ELSA-Brasil study. Am J Hum Biol 2019; 32:e23377. [PMID: 31850598 DOI: 10.1002/ajhb.23377] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 12/04/2019] [Accepted: 12/05/2019] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVES To investigate the association between internal migration and body mass index (BMI) in the adult population with data from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) and to determine whether the association differs by the urban hierarchical levels (or influence regions) of Brazilian municipalities. METHODS Baseline data from 13 084 participants aged 35 to 74 (2008-2010) in the ELSA-Brasil were analyzed. A migrant was defined as an individual whose municipality of residence at the beginning of schooling (origin) was different from the municipality of residence at the study baseline (destination). The origin and destination municipalities were classified by urban hierarchical levels, or influence regions, and migration was categorized as nonmigrant, stable migrant, downward migrant, or upward migrant. RESULTS Of the ELSA-Brasil participants, 51% were migrants. Using gamma regression models, it was observed that for women and men, upward migration was associated with lower mean BMI after adjusting for age, mother's education level, participant's education level, and income. Downward migration, on the other hand, was associated with the highest mean BMI, but this result was statistically significant only for women. CONCLUSION These findings highlight the role of environmental factors on nutritional status, noting that the effects on BMI may be positive or negative, depending on the trajectory of displacements between origin and destination.
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Affiliation(s)
- Joana M Brandão
- National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Aline A Nobre
- Scientific Computing Program, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Joanna M N Guimarães
- National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | | | - Sheila M A Matos
- Public Health Institute, Federal University of Bahia, Salvador, Brazil
| | - Vivian C Luft
- Social Medicine Department, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
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10
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Guimarães JMN, Griep RH, Fonseca MJM, Duncan BB, Schmidt MI, Mill JG, Lotufo PA, Bensenor IJ, Barreto SM, Giatti L, Matos SMA, Molina MDB, Pacheco AG, Chor D. Four-year adiposity change and remission of hypertension: an observational evaluation from the Longitudinal Study of Adult Health (ELSA-Brasil). J Hum Hypertens 2019; 34:68-75. [PMID: 31740697 DOI: 10.1038/s41371-019-0289-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 10/23/2019] [Accepted: 11/04/2019] [Indexed: 02/01/2023]
Abstract
The degree to which weight reduction leads to the remission of hypertension in population studies is not clear. We investigated whether the changes in adiposity measures predicted the remission of hypertension in a racially admixed population over a mean 4-year follow-up. All 4847 hypertensive individuals at baseline (2008-2010) from the multicenter Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) were included. Changes in weight, waist circumference (WC), or body mass index (BMI) (reduction or increase ≥5% from baseline values, vs stability) and remission of hypertension (SBP < 140 and DBP < 90 mmHg and no use of antihypertensive medication at follow-up visit, in 2012-2014) were investigated using mixed effects logistic regression models. Proportional attributable benefit was additionally calculated. Analyses were stratified by sex and antihypertensive medication use at baseline. Remission of hypertension was 11.3% (n = 546). Among men, after adjustments, the reduction of weight (OR = 1.52 95% CI 1.10-2.10), WC (OR = 1.56 95% CI 1.04-2.35) or BMI (OR = 1.60 95% CI 1.13-2.27) was associated with the remission of hypertension. Among those not taking antihypertensive medication at baseline, after adjustments, the reduction of weight (OR = 1.64 95% CI 1.18-2.27), WC (OR = 1.76 95% CI 1.18-2.61) or BMI (OR = 1.57 95% CI 1.10-2.25) was associated with the remission of hypertension. Proportional attributable benefit among those with adiposity reduction was about 30%, indicating its potential for prevention. In conclusion, our study reinforces the role of adiposity-reducing strategies (e.g., healthy diet and regular physical activity) for the treatment and prevention of hypertension, which might have potential applications for clinical practice.
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Affiliation(s)
- Joanna M N Guimarães
- Department of Epidemiology and Quantitative Methods, National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil
| | - Rosane H Griep
- Laboratory of Health and Environment Education, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil
| | - Maria J M Fonseca
- Department of Epidemiology and Quantitative Methods, National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil
| | - Bruce B Duncan
- Postgraduate Program in Epidemiology, School of Medicine, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Maria I Schmidt
- Postgraduate Program in Epidemiology, School of Medicine, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - José G Mill
- Department of Physiological Sciences, Federal University of Espírito Santo, Vitoria, ES, Brazil
| | - Paulo A Lotufo
- Center for Clinical and Epidemiological Research, University Hospital, University of São Paulo, São Paulo, SP, Brazil
| | - Isabela J Bensenor
- Center for Clinical and Epidemiological Research, University Hospital, University of São Paulo, São Paulo, SP, Brazil
| | - Sandhi M Barreto
- Faculty of Medicine and Clinical Hospital, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | - Luana Giatti
- Faculty of Medicine and Clinical Hospital, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | - Sheila M A Matos
- Institute of Collective Health, Federal University of Bahia, Salvador, BA, Brazil
| | - Maria delC B Molina
- Department of Physiological Sciences, Federal University of Espírito Santo, Vitoria, ES, Brazil
| | - Antonio G Pacheco
- Scientific Computing Program, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil
| | - Dora Chor
- Department of Epidemiology and Quantitative Methods, National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil.
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11
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Guimarães JMN, Griep RH, Clarke PJ, Fonseca MJM, Barreto SM, Giatti L, Lotufo PA, Mill JG, Pacheco AG, Chor D. Intragenerational Social Mobility and Changes in Blood Pressure: Longitudinal Analysis From the ELSA-Brasil Study. Am J Hypertens 2018; 31:672-678. [PMID: 29438464 DOI: 10.1093/ajh/hpy026] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2017] [Accepted: 02/08/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND During the past 4 decades, the highest worldwide blood pressure (BP) levels have shifted from high-income countries to low- and middle-income countries. We investigated the association of intragenerational social mobility with changes in BP and also with the incidence of hypertension over a 4-year follow-up. METHODS Data for 6,529 baseline participants from ELSA-Brasil born between 1938 and 1975 were used. Based on a social mobility matrix, occupational social mobility was defined as the change in occupational social class between participants' first occupation and current occupation (stable high; upward; downward; stable low). Incident hypertension was defined as systolic blood pressure (SBP) ≥ 140 mm Hg or diastolic blood pressure (DBP) ≥ 90 mm Hg or use of antihypertensive medication. Hypertensive participants at baseline were excluded. Mixed effects regression models were used. RESULTS Compared to the stable high group, the downwardly mobile group showed a higher increase over time in both SBP (β = 1.49, 95% CI 0.60; 2.37) and DBP (β = 0.96, 95% CI 0.32; 1.59) after adjustments for background characteristics and also proximal risk factors such as health-related behaviors and body mass index as time-dependent covariates, and diabetes. In contrast, upward mobility had no influence on BP changes (β = 0.67, 95% CI -0.07; 1.41 for SBP, and β = 0.47, 95% CI -0.05; 1.00 for DBP). Social mobility was not associated with the incidence of hypertension. CONCLUSIONS We showed socioeconomic inequalities in BP progression over the life course. The longitudinal changes in BP varied by social mobility groups in the context of low- and middle-income countries, where high BP has become most prevalent.
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Affiliation(s)
- Joanna M N Guimarães
- National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil
| | - Rosane H Griep
- Laboratory of Health and Environment Education, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil
| | - Philippa J Clarke
- Institute for Social Research, University of Michigan, Ann Arbor, Michigan, USA
| | - Maria J M Fonseca
- National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil
| | - Sandhi M Barreto
- Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | - Luana Giatti
- Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | - Paulo A Lotufo
- School of Medicine, University of São Paulo, São Paulo, SP, Brazil
| | - Jose G Mill
- Department of Physiological Sciences, Federal University of Espirito Santo, Vitoria, ES, Brazil
| | - Antonio G Pacheco
- Scientific Computation Program, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil
| | - Dora Chor
- National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil
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12
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Griep RH, Toivanen S, van Diepen C, Guimarães JMN, Camelo LV, Juvanhol LL, Aquino EM, Chor D. Work-Family Conflict and Self-Rated Health: the Role of Gender and Educational Level. Baseline Data from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). Int J Behav Med 2017; 23:372-382. [PMID: 26597924 PMCID: PMC4863030 DOI: 10.1007/s12529-015-9523-x] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Purpose This study examined gender differences in the association between work–family conflict and self-rated health and evaluated the effect of educational attainment. Method We used baseline data from ELSA-Brasil, a cohort study of civil servants from six Brazilian state capitals. Our samples included 12,017 active workers aged 34–72 years. Work–family conflict was measured by four indicators measuring effects of work on family, effects of family in work and lack of time for leisure and personal care. Results Women experienced more frequent work–family conflict, but in both genders, increased work–family conflict directly correlated with poorer self-rated health. Women’s educational level interacted with three work–family conflict indicators. For time-based effects of work on family, highly educated women had higher odds of suboptimal self-rated health (OR = 1.54; 95 % CI = 1.19–1.99) than less educated women (OR = 1.14; 95 % CI = 0.92–1.42). For strain-based effects of work on family, women with higher and lower education levels had OR = 1.91 (95 % CI 1.48–2.47) and OR = 1.40 (95 % CI 1.12–1.75), respectively. For lack of time for leisure and personal care, women with higher and lower education levels had OR = 2.60 (95 % CI = 1.95–3.47) and OR = 1.11 (95 % CI = 0.90–1.38), respectively. Conclusion Women’s education level affects the relationship between work–family conflict and self-rated health. The results may contribute to prevention activities.
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Affiliation(s)
- Rosane Härter Griep
- Laboratory of Health and Environment Education, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Avenida Brasil, 4365, Manguinhos, Rio de Janeiro, 21040-360, Brazil. .,Centre for Health Equity Studies, Stockholm University and Karolinska Institutet, Stockholm, Sweden.
| | - Susanna Toivanen
- Centre for Health Equity Studies, Stockholm University and Karolinska Institutet, Stockholm, Sweden
| | | | - Joanna M N Guimarães
- National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Lidyane V Camelo
- Postgraduate Program in Public Health, Faculty of Medicine, Universidade Federal de Minas Gerais, Minas Gerais, Brazil
| | - Leidjaira Lopes Juvanhol
- National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Estela M Aquino
- Institute of Collective Health, Federal University of Bahia, Salvador, Bahia, Brazil
| | - Dóra Chor
- National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, Rio de Janeiro, Brazil
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13
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Faleiro JC, Giatti L, Barreto SM, Camelo LDV, Griep RH, Guimarães JMN, Fonseca MDJMD, Chor D, Chagas MDCA. [Lifetime socioeconomic status and health-related risk behaviors: the ELSA-Brazil study]. CAD SAUDE PUBLICA 2017; 33:e00017916. [PMID: 28380138 DOI: 10.1590/0102-311x00017916] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 07/08/2016] [Indexed: 11/21/2022] Open
Abstract
Our objective was to investigate the association between lifetime socioeconomic status and intra-generational social mobility and low consumption of fruits and vegetables, leisure-time physical inactivity, and smoking among 13,216 men and women participating in the baseline of the ELSA-Brazil study (2008-2010). Socioeconomic status in childhood, adolescence, and adulthood was measured by maternal schooling, socio-occupational class of the first occupation, and socio-occupational class of the current occupation, respectively. Social disadvantages in adulthood were consistently associated with higher prevalence of the three behaviors analyzed in men and women. However, socioeconomic status in youth and childhood was less consistently associated with the behaviors. For example, while low maternal schooling reduced the odds of past smoking (women) and current smoking (men and women), it was associated with higher odds of leisure-time physical inactivity in women. Meanwhile, low socioeconomic status in youth increased the odds of past smoking (men and women) and current smoking (women). Analysis of social trajectories lent additional support to the relevance of disadvantages in adulthood for risk behaviors, since only individuals that rose to the high socio-occupational class did not show higher odds of these behaviors when compared to participants that had always belonged to the high socio-occupational class. Our findings indicate that socioeconomic disadvantages in adulthood appear to be more relevant for risk behaviors than disadvantages in childhood and adolescence.
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Affiliation(s)
| | - Luana Giatti
- Universidade Federal de Minas Gerais, Belo Horizonte, Brasil
| | | | | | | | - Joanna M N Guimarães
- Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| | | | - Dóra Chor
- Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
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