Racial inequalities in the development of multimorbidity of chronic conditions: results from a Brazilian prospective cohort.

Autor: Oliveira FEG; Sérgio Arouca National School of Public Health, Oswaldo Cruz Foundation, 4365 Brazil Avenue, Manguinhos, Rio de Janeiro, 21040900, Brazil. fergarrides@gmail.com., Griep RH; Laboratory of Health and Environment Education, Oswaldo Cruz Institute, Rio de Janeiro, Brazil., Chor D; Sérgio Arouca National School of Public Health, Oswaldo Cruz Foundation, 4365 Brazil Avenue, Manguinhos, Rio de Janeiro, 21040900, Brazil., Barreto SM; Department of Preventive and Social Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil., Molina MDCB; Federal University of Espírito Santo, Vitória, Brazil., Machado LAC; Clinical Hospital/EBSERH, Federal University of Minas Gerais, Belo Horizonte, Brazil.; Executive Office, Science Integrity Alliance, Sunrise, Florida, US., Fonseca MJMD; Sérgio Arouca National School of Public Health, Oswaldo Cruz Foundation, 4365 Brazil Avenue, Manguinhos, Rio de Janeiro, 21040900, Brazil., Bastos LS; Scientific Computing Program, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil.
Jazyk: angličtina
Zdroj: International journal for equity in health [Int J Equity Health] 2024 Jun 12; Vol. 23 (1), pp. 120. Date of Electronic Publication: 2024 Jun 12.
DOI: 10.1186/s12939-024-02201-8
Abstrakt: Background: The occurrence of multimorbidity and its impacts have differentially affected population subgroups. Evidence on its incidence has mainly come from high-income regions, with limited exploration of racial disparities. This study investigated the association between racial groups and the development of multimorbidity and chronic conditions in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil).
Methods: Data from self-reported white, brown (pardos or mixed-race), and black participants at baseline of ELSA-Brasil (2008-2010) who were at risk for multimorbidity were analysed. The development of chronic conditions was assessed through in-person visits and self-reported diagnosis via telephone until the third follow-up visit (2017-2019). Multimorbidity was defined when, at the follow-up visit, the participant had two or more morbidities. Cumulative incidences, incidence rates, and adjusted incidence rate ratios (IRRs) were estimated using Poisson models.
Results: Over an 8.3-year follow-up, compared to white participants: browns had a 27% greater incidence of hypertension and obesity; and blacks had a 62% and 45% greater incidence, respectively. Blacks also had 58% more diabetes. The cancer incidence was greater among whites. Multimorbidity affected 41% of the participants, with a crude incidence rate of 57.5 cases per 1000 person-years (ranging from 56.3 for whites to 63.9 for blacks). Adjusted estimates showed a 20% higher incidence of multimorbidity in black participants compared to white participants (IRR: 1.20; 95% CI: 1.05-1.38).
Conclusions: Significant racial disparities in the risk of chronic conditions and multimorbidity were observed. Many associations revealed a gradient increase in illness risk according to darker skin tones. Addressing fundamental causes such as racism and racial discrimination, alongside considering social determinants of health, is vital for comprehensive multimorbidity care. Intersectoral, equitable policies are essential for ensuring health rights for historically marginalized groups.
(© 2024. The Author(s).)
Databáze: MEDLINE
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