Social inequalities between neighborhoods and cardiovascular disease: a multilevel analysis in a Latin American city

Abstract

Studies analyzing relations between cardiovascular diseases (CVDs) and environ-mental aspects in Latin American cities are rel-atively recent and limited, since most of them are conducted in high-income countries, analyzing mortality outcomes, and comprising large areas. This research focuses on adults with diabetes and/ or hypertension under clinical follow-up who live in deprived areas. At the individual level we eval-uated sociodemographic and cardiovascular risk factors from patient’s records, and at the neighborhood level, socioeconomic conditions from census data. A multilevel analysis was carried out to study CVD. More women than men were under clinical follow-up, but men had higher fre-quency, higher odds, and shorter time to CVD di-agnosis. Multilevel analysis showed that residing in neighborhoods with worst socioeconomic conditions leads to higher odds of CVDs, even after controlling for individual variables: OR (CI95%) of CVD in quartile 2 (Q2) 3.9 (1.2-12.1); Q3 4.0 (1.3-12.3); Q4 2.3 (0.7-8.0) (vs. highest socioeconomic level quartile). Among individuals living in unequal contexts, we found differences in CVD, which makes visible inequalities within inequali-ties. Differences between women and men should be considered through a gender perspective.