Inequity and vulnerability in Latin American Indigenous and non-Indigenous populations with rheumatic diseases: a syndemic approach

Abstract

Syndemics are a framework that documents health inequities and vulnerabilities in populations with rheumatic diseases. Compared with other approaches, syndemics are able to conjunctly consider epidemiological, biological, sociodemographic and economic factors, and their interactions.ObjectiveTo estimate health inequity and vulnerability among Indigenous and non-Indigenous populations with rheumatic and musculoskeletal diseases (RMD) in Latin America using the syndemic approach.DesignThis is a secondary analysis of a previously published large-scale study on the prevalence of RMD.SettingStudies carried out in five Latin American countries (Argentina, Colombia, Ecuador, Mexico and Venezuela). Health inequity and vulnerability in RMD were identified through a syndemic approach using network and cluster analysis.ParticipantsA total of 44 560 individuals were studied: 29.78% self-identified as Indigenous, 60.92% were female, the mean age was 43.25 years. Twenty clusters were identified in the Indigenous population and 17 in the non-Indigenous population.ResultsThe variables associated with RMD among Indigenous populations were rurality, public health system, high joint biomechanical stress, greater pain, disability and alcoholism; and among non-Indigenous people they were being a woman, urban origin, older age, private health system, joint biomechanical stress, greater pain and disability. We identified different health inequities among patients with RMD (ie, lower educational attainment, more comorbidities), associated with factors such as Indigenous self-identification and rural residence.ConclusionsA syndemic approach enables us to identify health inequities in RMD, as shown by higher prevalence of comorbidities, disability and socioeconomic factors like lower educational attainment. These inequities exist for the overall population of patients with RMD, although it is more evident in Indigenous groups with added layers of vulnerability.

Double Disparity of Sexual Minority Status and Rurality in Cardiometabolic Hospitalization Risk: A Secondary Analysis Using Linked Population-Based Data

“…Meanwhile, rural populations are widely shown to experience worse health outcomes than their urban peers, including adverse cardiometabolic outcomes and disproportionate premature mortality, likely associated with poorer access to primary care and other socioenvironmental inequalities [18][19][20][21]. It has been advanced that socioeconomic deprivation associated with rural residence may syndemically reinforce prolonged stress and, in turn, preventable and treatable chronic morbidity among minority populations [19,22,23]. Yet, many existing studies on rural health rely on small subsets of rural settings, limited accounting for individual socioeconomic status or socially entrenched gender norms, and approaches that fail to consider the heterogeneity of rural and remote communities [24][25][26][27].…”