Ideal cardiovascular health at ELSA-Brasil: non-additivity effects of gender, race, and schooling by using additive and multiplicative interactions

Freitas, Roberta Souza; Santos, Itamar de Souza; Matos, Sheila Maria Alvim de; Aquino, Estela Maria Leão de; Amorim, Leila Denise Alves Ferreira

doi:10.1590/0102-311XEN266221

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ARTICLE • Cad. Saúde Pública 38 (8) • 2022 • https://doi.org/10.1590/0102-311XEN266221 copy

Ideal cardiovascular health at ELSA-Brasil: non-additivity effects of gender, race, and schooling by using additive and multiplicative interactions

Saúde cardiovascular ideal na ELSA-Brasil: efeitos não-aditivos de gênero, raça e escolaridade através do uso de interações aditivas e multiplicativas

Salud cardiovascular ideal en ELSA-Brasil: efectos no aditivos de género, raza y educación a través del uso de interacciones aditivas y multiplicativas

Authorship SCIMAGO INSTITUTIONS RANKINGS

This study aims to assess the non-additivity effects of gender, race, and schooling on ideal cardiovascular health among participants of the Brazilian Longitudinal Study of Adult Health - ELSA-Brasil. This is a cross-sectional study using data from the baseline of ELSA-Brasil, conducted from 2008 to 2010. The American Heart Association defined a score of ideal cardiovascular health (ICH) as the sum of indicators for the presence of seven favorable health factors and behaviors: non-smoking, ideal body mass index, physical activity and healthy diet, adequate levels of total cholesterol, normal blood pressure, and absence of diabetes mellitus. Multiplicative and additive interactions between gender, race, and schooling were assessed using the Poisson regression model to discuss intersectionality. The mean cardiovascular health score was 2.49 (SD = 1.31). This study showed a positive interaction between gender and schooling (women with high school and higher education) in both additive and multiplicative scales for the score of ideal cardiovascular health. We observed a trend towards higher mean values of cardiovascular health for increased schooling, with a marked difference among women. The lowest cardiovascular health scores observed reinforce the importance of understanding the psychosocial experiences that influence health attitudes, access to health care, and healthy lifestyle choices, which affect ICH, to reduce inequities in health and propose more adequate public policies that assist and prevent cardiovascular diseases.

Keywords:
Intersectionality; Heart Diseases; Cardiovascular Diseases; Risk Factors; Cross-sectional Studies

Interaction	RERI *	AP	SI
Gender-Race
Brown/Woman	0.03 (-0.03; 0.09)	0.03 (-0.02; 0.07)	1.19 (0.82; 1.72)
White/Woman	0.10 (0.04; 0.15)	0.07 (0.03; 0.11)	1.41 (1.09; 1.83)
Gender-Schooling
Woman/Middle school	0.10 (-0.01; 0.21)	0.09 (-0.01; 0.20)	-
Woman/High school	0.15 (0.06; 0.24)	0.13 (0.05; 0.21)	-
Woman/College or above	0.24 (0.16; 0.32)	0.17 (0.11; 0.24)	2.77 (1.22; 6.29)
Race-Schooling
Brown/Middle school	0.03 (-0.11; 0.16)	0.03 (-0.11; 0.16)	2.12 (0.00; 1763.01)
Brown/High school	0.05 (-0.06; 0.16)	0.05 (-0.06; 0.15)	2.14 (0.08; 60.38)
Brown/College or above	0.09 (-0.02; 0.20)	0.07 (-0.02; 0.17)	1.54 (0.67; 3.52)
White/Middle school	0.04 (-0.11; 0.19)	0.04 (-0.10; 0.17)	2.19 (0.01; 465.38)
White/High school	0.07 (-0.05; 0.19)	0.06 (-0.05; 0.17)	2.12 (0.17; 26.23)
White/College or above	0.15 (0.03; 0.27)	0.11 (0.02; 0.21)	1.78 (0.80; 3.97)

Characteristic	Final model
	Estimate (β)	SE
	Estimate (β)	Poisson	Quasi-Poisson
Gender
Men	Reference
Women	-0.065	0.061	0.048
Race
Black	Reference
Brown	0.047	0.028	0.022
White	0.070	0.027	0.021
Schooling level
Incomplete middle school	Reference
Complete middle school	-0.022	0.046	0.036
Complete high school	0.021	0.037	0.028
College or above	0.146	0.036	0.028
Two-way interactions
Gender-Race
Brown/Woman	0.009	0.036	0.028
White/Woman	0.051	0.034	0.026
Gender-Schooling level
Woman/Middle school	0.097	0.074	0.058
Woman/High school	0.140	0.060	0.046
Woman/College or above	0.180	0.059	0.046

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[1] Correspondence
R. S. Freitas Instituto de Saúde Coletiva, Universidade Federal da Bahia. Rua Basílio da Gama s/n, Salvador, BA 40110-040, Brasil. roberta.sfreitas@hotmail.com