Gender Differences in Social Determinants of Hypertension Among Older Brazilian Adults Residing in Urban Areas: A Multilevel Approach from the ELSI-Urbe

Despite growing interest in the social determinants of hypertension, nationally representative studies analyzing the intra-urban effects of individual and contextual socioeconomic conditions within highly unequal urban areas, such as those in Latin America, remain scarce. This paper describes gender disparities in the association of individual and contextual socioeconomic conditions with hypertension among older adults residing in urban areas of Brazil. Data from 6,767 participants from the baseline (2015–2016) of the Brazilian Longitudinal Study of Aging (ELSI-Brazil), a cohort with a nationally representative sample of community-dwelling adults aged ≥ 50 years, were analyzed. Hypertension was self-reported. The measure of individual socioeconomic condition was individual education, and the contextual measure was the Brazilian Deprivation Index (IBP; acronym in Portuguese) of the census tract of the participant’s residence. Multilevel logistic regression models (individuals and census tracts), adjusted for age and stratified by gender, were used. The prevalence of hypertension according to individual education and the IBP differed between men and women. In women, higher individual education (≥ 9 years versus ≤ 4 years of schooling) was associated with a lower chance of hypertension (odds ratio [OR] = 0.62; 95% confidence interval [CI] = 0.52–0.74), and residing in census tracts with higher deprivation was associated with a higher chance of hypertension (OR per standard deviation [SD] = 1.04; 95%CI = 1.01–1.09). In men, there was no significant association between individual education or IBP and hypertension. Our results suggest that public policies addressing this disease’s burden in middle- and low-income countries, such as Brazil, should adopt gender-sensitive strategies and consider the context in which these individuals reside.