title: Educational health disparities in hypertension and diabetes mellitus among African descent populations in the Caribbean and the USA: a comparative analysis from the Spanish town cohort (Jamaica) and the Jackson heart study (USA).
abstract: Studies have suggested that social inequalities in chronic disease outcomes differ between industrialized and developing countries, but few have directly compared these effects. We explored inequalities in hypertension and diabetes prevalence between African-descent populations with different levels of educational attainment in Jamaica and in the United States of America (USA), comparing disparities within each location, and between countries.
  
  
  
  We analyzed baseline data from the Jackson Heart Study (JHS) in the USA and Spanish Town Cohort (STC) in Jamaica. Participants reported their highest level of educational attainment, which was categorized as 'less than high school' (<HS), high school (HS) and 'more than high school' (>HS). Educational disparities in the prevalence of hypertension and diabetes were examined using prevalence ratios (PR), controlling for age, sex and body mass index (BMI).
  
  
  
  Analyses included 7248 participants, 2382 from STC and 4866 from JHS, with mean age of 47 and 54 years, respectively (p < 0.001). Prevalence for both hypertension and diabetes was significantly higher in the JHS compared to STC, 62% vs. 25% (p < 0.001) and 18% vs. 13% (p < 0.001), respectively. In bivariate analyses there were significant disparities by education level for both hypertension and diabetes in both studies; however, after accounting for confounding or interaction by age, sex and BMI these effects were attenuated. For hypertension, after adjusting for age and BMI, a significant education disparity was found only for women in JHS, with PR of 1.10 (95% CI 1.04-1.16) for < HS vs > HS and 1.07 (95% CI 1.01-1.13) for HS vs > HS. For diabetes; when considering age-group and sex specific estimates adjusted for BMI, among men: significant associations were seen only in the 45-59 years age-group in JHS with PR 1.84 (95% CI 1.16-2.91) for < HS vs > HS. Among women, significant PR comparing < HS to > HS was seen for all three age-groups for JHS, but not in STC; PR were 3.95 (95% CI 1.94-8.05), 1.53 (95% CI 1.10-2.11) and 1.32 (95% CI 1.06-1.64) for 25-44, 45-59 and 60-74 age-groups, respectively.
  
  
  
  In Jamaica, educational disparities were largely explained by age, sex and BMI, while in the USA these disparities were larger and persisted after accounting these variables.
authors.affiliation: Department of Epidemiology and Biostatistics, Indiana University School of Public Health - Bloomington, Bloomington, IN, USA. abidules@indiana.edu.
authors.forename: Aurelian
authors.identifier: 0000-0001-8211-8309
authors.initials: A
authors.lastname: Bidulescu
authors.affiliation: Epidemiology Research Unit, Tropical Medicine Research Institute, The University of the West Indies, Kingston, West Indies, Jamaica.
authors.forename: Trevor S
authors.initials: TS
authors.lastname: Ferguson
authors.affiliation: Chronic Disease Research Centre, Tropical Medicine Research Institute, The University of the West Indies, Bridgetown, West Indies, Barbados.
authors.forename: Ian
authors.initials: I
authors.lastname: Hambleton
authors.affiliation: Epidemiology Research Unit, Tropical Medicine Research Institute, The University of the West Indies, Kingston, West Indies, Jamaica.
authors.forename: Novie
authors.initials: N
authors.lastname: Younger-Coleman
authors.affiliation: Epidemiology Research Unit, Tropical Medicine Research Institute, The University of the West Indies, Kingston, West Indies, Jamaica.
authors.forename: Damian
authors.initials: D
authors.lastname: Francis
authors.affiliation: Epidemiology Research Unit, Tropical Medicine Research Institute, The University of the West Indies, Kingston, West Indies, Jamaica.
authors.forename: Nadia
authors.initials: N
authors.lastname: Bennett
authors.affiliation: Center of Biostatistics and Bioinformatics, University of Mississippi Medical Center, Jackson, MS, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Griswold
authors.affiliation: University of Mississippi Medical Center, Jackson, MS, USA.
authors.forename: Ervin
authors.initials: E
authors.lastname: Fox
authors.affiliation: Department of Medical Education, Morehouse School of Medicine, Atlanta, Georgia.
authors.forename: Marlene
authors.initials: M
authors.lastname: MacLeish
authors.affiliation: Epidemiology Research Unit, Tropical Medicine Research Institute, The University of the West Indies, Kingston, West Indies, Jamaica.
authors.forename: Rainford
authors.initials: R
authors.lastname: Wilks
authors.affiliation: The University of the West Indies, Kingston, West Indies, Jamaica.
authors.forename: E Nigel
authors.initials: EN
authors.lastname: Harris
authors.affiliation: The Sullivan Alliance, Alexandria, VA, USA.
authors.forename: Louis W
authors.initials: LW
authors.lastname: Sullivan
mesh_terms: D000328:Adult; D044383:Black People; D017691:Caribbean Region / Q000453:epidemiology; D015331:Cohort Studies; D019049:Developed Countries; D003906:Developing Countries; D003920:Diabetes Mellitus / Q000453:epidemiology*; D004522:Educational Status; D005260:Female; D054624:Health Status Disparities; D006801:Humans; D006973:Hypertension / Q000453:epidemiology*; D007563:Jamaica / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D014481:United States / Q000453:epidemiology; D001741:Black or African American
keywords: African Americans; Afro-Caribbean; Blacks; Diabetes; Education; Health disparities; Hypertension; Jackson Heart Study; Jamaica; Social determinants