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

Abstract

Background 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. Methods 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. Results 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. Conclusion 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.

Associations between education and dementia in the Caribbean and the United States: An international comparison

“…While we could not use the same education categories between the Caribbean and US settings due to differences in education systems and levels of educational attainment, the current categorizations of education allow us to divide each population (Caribbean or US) into subgroups of comparable size, such that the subgroup in each level of education (low, medium, or high) occupies a similar position between the two settings in terms of relative educational attainment in the population. This approach is consistent with a large body of literature comparing the United States to low‐ and middle‐income countries that have lower average attainment 23,47–49 …”

“…This approach is consistent with a large body of literature comparing the United States to low‐ and middle‐income countries that have lower average attainment. 23 , 47 , 48 , 49 …”

“… 10 Prior studies have attributed dementia disparities between Hispanic and non‐Hispanic populations to inequities in socioeconomic status, 11 , 12 access to health care, 13 stress, 14 and education. 15 This builds upon a large body of extant literature highlighting the role of socioeconomic status and education in explaining racial disparities in a number of chronic health conditions, 16 , 17 , 18 , 19 , 20 including cardiovascular disease, 21 , 22 , 23 , 24 diabetes, 25 , 26 and stroke. 27 , 28 , 29 , 30 Studies also find biological differences by genetic admixture of European, African, and native American ancestry, including differences in the frequencies of genetic variants that modify risks for Alzheimer's disease (AD), and alterations in inflammatory response and in AD cerebrospinal fluid (CSF) biomarkers.…”

An Approach to Cultural Competence Education into the Pharmacy Curriculum: Glances from the Cuban Framework

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Formulation and Evaluation of Norfloxacin Ocular In-situ Gel

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