Intersection Between Race and Gender in the Incidence and Control of Hypertension in ELSA Brasil

Background: Few investigations examined the associations of race and gender with the incidence and control of hypertension (HTN) considering the synergies and heterogeneous experiences of intersectional groups. Hypothesis: HTN incidence and inadequate blood pressure (BP) control is higher in black men and women, brown men, and women, compared to their white counterparts. Inequalities are more pronounced in higher education vis-a-vis lower education group. Methods: Using data from the ELSA-Brasil, 6 intersectional groups of race/gender were identified: white, brown, and black men and women. We calculated by intersectional category: the HTN incidence between baseline (2008-2010) and visit 2 (2012-2014) in 8,528 individuals free of HTN or cardiovascular disease at baseline; and inadequate BP control prevalence in 4,571 individuals with drug treated HTN at visit 2. Generalized linear models with Poisson distribution and logarithmic link function were used. Results: After age and HTN family history adjustment, the HTN risk was higher in black men (IDR:2.25; 95%CI:1.65-3.08), brown men (IDR:1.89; 95%CI:1.59-2.25), black women (IDR:1.85; 95%CI:1.50-2.30), brown women (IDR:1.47; 95%CI:1.31-1.67), and white men (IDR:1.76; 95%CI:1.49-2.08) compared to white women. All associations remained significant in fully-adjusted models for sociodemographic, behavioral and health conditions The association between intersectional categories and inadequate BP control varied according to education level in fully-adjusted models: 1) in lower education participants, white men (PR:1.70; 95%CI:1.42-2.04), brown men (PR:1.67; 95%CI:1.43-1.94), black men (PR:1.60; 95%CI:1.37-1.87), and black women (PR:1.28; 95%CI:1.00-1.64) had worse BP control than white women; 2) in higher education participants, only black men (PR:1.55; 95%CI:1.08-2.22) and women (PR:1.49; 95%CI:1.05-2.13) showed worse control than white women. Conclusion: Our findings reinforce previous studies regarding the higher risk of HTN and worse BP control in black men, but also reveal that the intersectional approach accentuates the heterogeneity in the incidence and control of HTN, evidencing specific experiences of socially marginalized groups, especially that of black women.