Cuba's cardiovascular risk factors: International comparison of levels and education gradients.

<h4>Background</h4>Cuba's life expectancy at 79 is third highest in Latin America. Many attribute this to social investments in health and education, but comparative research is sparse, thus we compare Cuba with neighboring Dominican Republic, Costa Rica due to its strong social pro...

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Autores principales:	Maria Dieci, Juan J Llibre-Rodriguez, Daisy Acosta, William H Dow
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/78ef1919e8df4a94a247f924b7759a9e
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spelling	oai:doaj.org-article:78ef1919e8df4a94a247f924b7759a9e2021-11-25T06:23:48ZCuba's cardiovascular risk factors: International comparison of levels and education gradients.1932-620310.1371/journal.pone.0247831https://doaj.org/article/78ef1919e8df4a94a247f924b7759a9e2021-01-01T00:00:00Zhttps://doi.org/10.1371/journal.pone.0247831https://doaj.org/toc/1932-6203<h4>Background</h4>Cuba's life expectancy at 79 is third highest in Latin America. Many attribute this to social investments in health and education, but comparative research is sparse, thus we compare Cuba with neighboring Dominican Republic, Costa Rica due to its strong social protections, and the U.S. Given high cardiovascular mortality, we focus on cardiovascular risk factor levels. To assess the role of health care, we distinguish medically amenable biomarkers from behavioral risk factors. To assess the role of Cuba's focus on equity, we compare education gradients in risk factors.<h4>Methods</h4>We analyze Cuban data from the 10/66 Dementia Research Group baseline survey of urban adults ages 65 plus. Comparison samples are drawn from the Dominican Republic 10/66 survey, the Costa Rican CRELES, and U.S. NHANES. We analyze cross-country levels and education gradients of medically amenable (hypertension, diabetes, hypercholesterolemia, access to health care) and behavioral (smoking, obesity) risk factors,-using sex-stratified weighted means comparisons and age-adjusted logistic regression.<h4>Results</h4>Neither medically amenable nor behavioral risk factors are uniformly better in Cuba than comparison countries. Obesity is lower in Cuba, but male smoking is higher. Hypertension, diabetes, and hypercholesterolemia levels are high in all countries, though Cuba's are lower than Costa Rica. Hypertension awareness in Cuba is similar to Costa Rica. Cuba has a higher proportion of hypertensives on treatment than Costa Rica, though lower than the U.S. Comparative gradients by education are similarly mixed. For behavioral factors, Cuba shows the strongest gradients (primarily for men) among the countries compared: smoking improves, but obesity worsens with education. Hypertension awareness also improves with education in Cuba, but Cuba shows no significant differences by education in hypertension treatment.<h4>Conclusion</h4>Smoking is comparatively high in Cuba, but obesity is low, and the resulting biomarkers show comparatively mixed patterns. Cuba's social protections have not eliminated strong educational gradients in behavioral risk factors, but the healthcare system appears to have eliminated disparities such as in hypertension treatment.Maria DieciJuan J Llibre-RodriguezDaisy AcostaWilliam H DowPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 16, Iss 3, p e0247831 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Maria Dieci Juan J Llibre-Rodriguez Daisy Acosta William H Dow Cuba's cardiovascular risk factors: International comparison of levels and education gradients.
description	<h4>Background</h4>Cuba's life expectancy at 79 is third highest in Latin America. Many attribute this to social investments in health and education, but comparative research is sparse, thus we compare Cuba with neighboring Dominican Republic, Costa Rica due to its strong social protections, and the U.S. Given high cardiovascular mortality, we focus on cardiovascular risk factor levels. To assess the role of health care, we distinguish medically amenable biomarkers from behavioral risk factors. To assess the role of Cuba's focus on equity, we compare education gradients in risk factors.<h4>Methods</h4>We analyze Cuban data from the 10/66 Dementia Research Group baseline survey of urban adults ages 65 plus. Comparison samples are drawn from the Dominican Republic 10/66 survey, the Costa Rican CRELES, and U.S. NHANES. We analyze cross-country levels and education gradients of medically amenable (hypertension, diabetes, hypercholesterolemia, access to health care) and behavioral (smoking, obesity) risk factors,-using sex-stratified weighted means comparisons and age-adjusted logistic regression.<h4>Results</h4>Neither medically amenable nor behavioral risk factors are uniformly better in Cuba than comparison countries. Obesity is lower in Cuba, but male smoking is higher. Hypertension, diabetes, and hypercholesterolemia levels are high in all countries, though Cuba's are lower than Costa Rica. Hypertension awareness in Cuba is similar to Costa Rica. Cuba has a higher proportion of hypertensives on treatment than Costa Rica, though lower than the U.S. Comparative gradients by education are similarly mixed. For behavioral factors, Cuba shows the strongest gradients (primarily for men) among the countries compared: smoking improves, but obesity worsens with education. Hypertension awareness also improves with education in Cuba, but Cuba shows no significant differences by education in hypertension treatment.<h4>Conclusion</h4>Smoking is comparatively high in Cuba, but obesity is low, and the resulting biomarkers show comparatively mixed patterns. Cuba's social protections have not eliminated strong educational gradients in behavioral risk factors, but the healthcare system appears to have eliminated disparities such as in hypertension treatment.
format	article
author	Maria Dieci Juan J Llibre-Rodriguez Daisy Acosta William H Dow
author_facet	Maria Dieci Juan J Llibre-Rodriguez Daisy Acosta William H Dow
author_sort	Maria Dieci
title	Cuba's cardiovascular risk factors: International comparison of levels and education gradients.
title_short	Cuba's cardiovascular risk factors: International comparison of levels and education gradients.
title_full	Cuba's cardiovascular risk factors: International comparison of levels and education gradients.
title_fullStr	Cuba's cardiovascular risk factors: International comparison of levels and education gradients.
title_full_unstemmed	Cuba's cardiovascular risk factors: International comparison of levels and education gradients.
title_sort	cuba's cardiovascular risk factors: international comparison of levels and education gradients.
publisher	Public Library of Science (PLoS)
publishDate	2021
url	https://doaj.org/article/78ef1919e8df4a94a247f924b7759a9e
work_keys_str_mv	AT mariadieci cubascardiovascularriskfactorsinternationalcomparisonoflevelsandeducationgradients AT juanjllibrerodriguez cubascardiovascularriskfactorsinternationalcomparisonoflevelsandeducationgradients AT daisyacosta cubascardiovascularriskfactorsinternationalcomparisonoflevelsandeducationgradients AT williamhdow cubascardiovascularriskfactorsinternationalcomparisonoflevelsandeducationgradients
_version_	1718413752089444352

Cuba's cardiovascular risk factors: International comparison of levels and education gradients.

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