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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)

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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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Data Availability

The data used in this study are available for reasearch proposals upon reasonable request to the ELSA-Brasil’s Datacenter (estatisticaelsa@ufrgs.br).

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Acknowledgements

We thank all ELSA-Brasil participants for their invaluable contribution to this study.

Funding

ELSA-Brasil was supported by the Brazilian Ministry of Health and Ministry of Science, Technology and Innovation (FINEP, Financiadora de Estudos e Projetos) (Grant numbers 01 06 0010.00 RS, 01 06 0212.00 BA, 01 06 0300.00 ES, 01 06 0278.00 MG, 01 06 0115.00 SP, 01 06 0071.00 RJ). Dr Joanna MN Guimarães was supported by the Coordination for the Improvement of Higher Education Personnel (CAPES, Coordenação de Aperfeiçoamento de Pessoal de Nível Superior) (Finance code 001). Dr John W Jackson was supported by the National Heart, Lung, and Blood Institute (Grant number HL145320).

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Authors and Affiliations

  1. National School of Public Health, Oswaldo Cruz Foundation, R Leopoldo Bulhões 1480, Manguinhos, Rio de Janeiro, RJ, Cep 21041-210, Brazil

    Joanna M. N. Guimarães, Maria de J. M. da Fonseca, Leticia de O. Cardoso & Dora Chor

  2. Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA

    John W. Jackson

  3. Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, PA, USA

    Sharrelle Barber

  4. Laboratory of Health and Environment Education, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil

    Rosane H. Griep

  5. Department of Preventive and Social Medicine, Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil

    Lidyane V. Camelo & Sandhi M. Barreto

  6. Postgraduate Program in Epidemiology, Hospital das Clínicas de Porto Alegre, Federal University of Rio Grande Do Sul, Porto Alegre, RS, Brazil

    Maria Inês Schmidt & Bruce B. Duncan

  7. Laboratory of Genetics and Molecular Cardiology, Heart Institute, University of São Paulo, São Paulo, SP, Brazil

    Alexandre C. Pereira

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  1. Joanna M. N. Guimarães
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Contributions

Joanna MN Guimarães drafted the article and conducted the analyses. John W Jackson designed and conducted the analyses. Joanna MN Guimarães, Dora Chor, Sharrelle Barber, and John W Jackson conceived the article and interpreted the data. All authors interpreted the data, revised it critically for important intellectual content, approved the final manuscript, and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Corresponding author

Correspondence to Joanna M. N. Guimarães.

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Ethics Approval

ELSA-Brasil was approved at each of the six study centers by the local Institutional Review Board addressing research in human subjects and also by the National Research Ethics Committee (CONEP). This study was performed in line with the principles of the Declaration of Helsinki.

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Informed consent was obtained from all individual participants included in the study.

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The authors declare no competing interests.

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Guimarães, J.M.N., Jackson, J.W., Barber, S. et al. 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 and Ethnic Health Disparities 11, 1024–1032 (2024). https://doi.org/10.1007/s40615-023-01582-w

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