Disparities in Hypertension in Colombia: A Mixed-Method Study.

Abstract

Cardiovascular disease is the leading cause of death in Colombia. However, in Colombia both the prevalence and social distribution of hypertension, the main risk factor for cardiovascular disease, have been understudied. Likewise, although macroeconomic factors have been highlighted to explain the growing burden of hypertension in poorer countries, the contribution of these factors remains poorly explained and measured. Finally, although Colombian municipalities play an important role in addressing living conditions that may influence the risk and disparities in hypertension, no previous studies have aimed to understand how social and political actors include living conditions in how they frame hypertension. The frames of these actors are likely to structure the decisions they make or implement with regard to prevention of and disparities in hypertension. This dissertation encompasses a mixed-methods study aimed at filling these research gaps. Chapter 1 describes the state of research on hypertension disparities in Latin American and proposes a broad conceptual model that guides this dissertation. Results of Chapter 2 suggest that education, markers of material resources, ethnicity/race and sex/gender are important in terms of shaping the social patterning of hypertension in the Colombian adult population. Chapter 3 examines the association between macroeconomic factors and hypertension and suggests that those adults who live in departments that for more than a decade have had high levels of income inequality are more likely to have hypertension than those living in less economically unequal departments. Chapter 4 describes a single-case study in which social and political actors identified that unemployment, unplanned urban space, and forced displacement, in combination with processes of stratification and marginalization, shape living conditions of residents of Quibdó and influence the development of and disparities in hypertension in this municipality. Chapter 5 proposes comprehensive recommendations for preventing and eliminating hypertension disparities. This dissertation provides evidence that the social patterning of hypertension in Colombia is linked to indicators of social position and income inequalities at the departmental level. These patterns and the role of living conditions are recognized by social actors, and inform both clinical and policy initiatives necessary to reduce hypertension risk and disparities in Colombia.