Social inequities in cardiovascular risk factors in women and men by autonomous regions in Spain

Pedro Gullón; Julia Díez; Miguel Cainzos-Achirica; Manuel Franco; Usama Bilal

doi:10.1016/j.gaceta.2020.04.014

Social inequities in cardiovascular risk factors in women and men by autonomous regions in Spain

Gac Sanit. 2021 Jul-Aug;35(4):326-332. doi: 10.1016/j.gaceta.2020.04.014. Epub 2020 Jul 13.

Authors

Pedro Gullón¹, Julia Díez², Miguel Cainzos-Achirica³, Manuel Franco⁴, Usama Bilal⁵

Affiliations

¹ Public Health and Epidemiology Research Group, School of Medicine and Health Sciences, Universidad de Alcalá, Alcalá de Henares, Madrid, Spain; Urban Health Collaborative, Drexel Dornsife School of Public Health, Philadelphia, PA, USA. Electronic address: pedro.gullon@edu.uah.es.
² Public Health and Epidemiology Research Group, School of Medicine and Health Sciences, Universidad de Alcalá, Alcalá de Henares, Madrid, Spain.
³ Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins Medical Institutions, Baltimore, MD, USA.
⁴ Public Health and Epidemiology Research Group, School of Medicine and Health Sciences, Universidad de Alcalá, Alcalá de Henares, Madrid, Spain; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
⁵ Public Health and Epidemiology Research Group, School of Medicine and Health Sciences, Universidad de Alcalá, Alcalá de Henares, Madrid, Spain; Urban Health Collaborative, Drexel Dornsife School of Public Health, Philadelphia, PA, USA; Department of Epidemiology and Biostatistics, Dornsife School of Public Health Drexel University, Philadelphia, PA, USA.

Abstract
in English, Spanish

Objective: To describe social inequities in cardiovascular risk factors in women and men by autonomous regions in Spain.

Method: We used data from 20,406 individuals aged 18 or older from the 2017 Spanish National Health Survey. We measured socioeconomic position using occupational social class and used data on self-reported cardiovascular risk factors: high cholesterol, diabetes, hypertension, obesity, and smoking. We estimated the relative risk of inequality using Poisson regression models. Analyses were stratified by men and women and by region (autonomous communities).

Results: Overall, the relative risk of inequality was 1.02, 1.13, 1.06, 1.17 and 1.09 for high cholesterol, diabetes, hypertension, obesity, and current smoking, respectively. Ocuupational social class inequities in diabetes, hypertension, and obesity was stronger for women. Results showed a large regional heterogeneity in these inequities; some regions (e.g. Asturias and Balearic Islands) presented wider social inequities in cardiovascular risk factors than others (e.g. Galicia, Navarra or Murcia).

Conclusion: In Spain, we found marked social inequities in the prevalence of cardiovascular risk factors, with wide regional and women/men heterogeneity in these inequities. Education, social, economic and health policies at the regional level could reduce health inequities in cardiovascular risk factors and, thus, prevent cardiovascular disease.

Objetivo: El objetivo de nuestro trabajo fue describir las desigualdades sociales en factores de riesgo cardiovascular en hombres y mujeres por Comunidad Autónoma en España.

Método: Los sujetos de estudio fueron 20.406 personas de 18 años o mayores que participaron en la Encuesta Nacional de Salud de 2017. Como medida de posición socioeconómica, se utilzó la clase social ocupacional, y se tomaron medidas auto-reportadas de factores de riesgo cardiovascular: hipercolesterolemia, diabetes, hipertensión, obesidad, y tabaquismo. Estimamos el Índice Relativo de Desigualdad (IRR) usando modelos de regresión de Poisson. Los análisis fueron estratificados por mujeres y hombres y por Comunidad Autónoma.

Resultados: El IRR fue de 1.02, 1.13, 1.06, 1.17 y 1.09 para hipercolesterolemia, diabetes, hipertensión, obesidad y tabaquismo, respectivamente. Las desigualdades por clase social ocupacional en diabetes, hipertensión y obesidad fueron más altas en mujeres. Se mostró una alta heterogeneidad en éstas desigualdades; algunas Comunidades Autónomas (p.ej. Asturias y las Islas Baleares) presentan IRR más altas en factores de riesgo cardiovascular que otras (p.ej. Galicia, Navarra o Murcia).

Conclusiones: En España encontramos marcadas desigualdades sociales en la prevalencia de factores de riesgo cardiovascular, con gran heterogeneidad por mujeres y hombres y por Comunidad Autónoma. Las políticas eductivas, sociales, económicas y de salud a nivel de Comunidad Autónoma podrían reducir las desigualdades sociales en factores de riesgo cardiovascular y, por tanto, prevenir enfermedades cardiovasculares.

Keywords: Cardiovascular risk factors; Desigualdades sociales en salud; Determinantes sociales de la salud; Diferencias en salud; Epidemiology; Epidemiología; Factores de riesgo cardiovascular; Health disparities; Health inequities; Social determinants of health.

MeSH terms

Cardiovascular Diseases* / epidemiology
Cross-Sectional Studies
Female
Heart Disease Risk Factors
Humans
Male
Risk Factors
Socioeconomic Factors
Spain / epidemiology

Grants and funding

DP5 OD026429/OD/NIH HHS/United States

Abstract in English, Spanish

MeSH terms

Grants and funding

Abstract
in English, Spanish