Job stress and chronic low back pain: incidence, number of episodes, and severity in a 4-year follow-up of the ELSA-Brasil Musculoskeletal cohort.

ABSTRACT: We investigated the association between job stress, as assessed by the effort-reward imbalance model, and the incidence of chronic low back pain (CLBP) over a 4-year period. A total of 1733 participants from the ELSA-Brasil Musculoskeletal cohort, who were free from LBP at baseline (2012-2014), were included. Episodes of LBP in the past 30 days, intensity, and the presence of disability were investigated in annual telephone follow-ups (2015-2018). Chronic LBP was defined as episodes of LBP lasting >3 months with at least moderate intensity. We analyzed the incidence of at least one episode of CLBP (yes/no), the number of CLBP episodes (0, 1, ≥2), and CLBP severity/disability (absent, nondisabling, severe/disabling). The association between these outcomes and tertiles of the effort-to-reward ratio, as well as each dimension of the effort-reward imbalance model, was investigated using multinomial logistic and Poisson regression models adjusting for sociodemographic and occupational variables. The cumulative incidence of CLBP over 4 years was 24.8%. High effort-reward imbalance increased the chances of experiencing multiple CLBP episodes and severe/disabling CLBP by 67% (95% confidence interval [CI]: 1.12-2.47) and 70% (95% CI: 1.14-2.53), respectively. High overcommitment increased the incidence of CLBP by 23% (95% CI: 1.01-1.50) and the chances of multiple CLBP episodes and severe/disabling CLBP by 67% (95% CI: 1.11-2.50) and 57% (95% CI: 1.05-2.34), respectively. These results indicate that exposure to job stress is associated with a higher incidence, a greater number of episodes, and increased severity of CLBP over a 4-year period. If this association is causal, measures aimed at reducing exposure to job stress are likely to alleviate the burden of CLBP.

Clinical biomarker-based biological age predicts deaths in Brazilian adults: the ELSA-Brasil study.

Biological age is a construct that seeks to evaluate the biological wear and tear process of the organism that cannot be observed by chronological age. We estimate individuals' biological age based on biomarkers from multiple systems and validate it through its association with mortality from natural causes. Biological age was estimated in 12,109 participants (6621 women and 5488 men) from the first visit of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) who had valid data for the biomarkers used in the analyses. Biological age was estimated using the Klemera and Doubal method. The difference between chronological age and biological age (Δage) was computed. Cox proportional hazard models stratified by sex were used to assess whether Δage was associated with mortality risk after a median follow-up of 9.1 years. The accuracy of the models was estimated by the area under the curve (AUC). Δage had equal mean for men and women, with greater variability for men. Cox models showed that every 1-year increase in Δage was associated with increased mortality in men (HR (95% CI) 1.21; 1.17-1.25) and women (HR (95% CI) 1.24; 1.15-1.34), independently of chronological age. Results of the AUC demonstrated that the predictive power of models that only included chronological age (AUC chronological age = 0.7396) or Δage (AUC Δage = 0.6842) was lower than those that included both, chronological age and Δage (AUC chronological age + Δage = 0.802), in men. This difference was not observed in women. We demonstrate that biological age is strongly related to mortality in both genders and is a valid predictor of death in Brazilian adults, especially among men.

Life satisfaction and ideal cardiovascular health score: A cross-sectional study from ELSA-Brasil.

OBJECTIVES: To investigate whether higher levels of life satisfaction are associated with a higher ideal cardiovascular health (CVH) score in middle-aged and older populations in the Brazilian context. METHOD: Cross-sectional analysis of 12,936 participants of the Brazilian Longitudinal Study of Adult Health, Visit 2 (2012-2014), aged 38-79 years. The response variables were the global, lifestyle, and biological ideal CVH scores, as defined by the American Heart Association Life's Simple 7. The scores were categorized as low, intermediate, and optimal. Life satisfaction was measured by the Satisfaction with the Life Scale. Multinomial logistic regression was used to estimate the magnitude with adjustment for potential confounding factors. Low scores were the categories of reference for the analyses. RESULTS: Only 10.5% of the participants had an optimal (≥5) global ideal CVH score. After total adjustment, 1 SD increment in the life satisfaction score was associated with an odds ratio (OR) of 1.05 (95% confidence interval [CI: 1.01-1.09]) and 1.15 (95% CI [1.07-1.23]) for intermediate and optimal global ideal CVH scores, respectively. Regarding the lifestyle ideal CVH score, the increment of 1 SD in the life satisfaction scale determined an OR of 1.11 (95% CI [1.06-1.15]) and 1.22 (95% CI [1.14-1.31]) for intermediate and optimal lifestyle ideal CVH score, respectively. Life satisfaction was not associated with the biological ideal CVH score. CONCLUSION: The results suggested that the higher the life satisfaction, the higher the CVH. The findings add to the knowledge of assets to promote CVH. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Racial Inequities in the Control of Hypertension and the Explanatory Role of Residential Segregation: a Decomposition Analysis in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil).

The mechanisms underlying racial inequities in uncontrolled hypertension have been limited to individual factors. We investigated racial inequities in uncontrolled hypertension and the explanatory role of economic segregation in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). All 3897 baseline participants with hypertension (2008-2010) were included. Uncontrolled hypertension (SBP ≥ 140 mmHg or DBP ≥ 90 mmHg), self-reported race (White/Brown/Black people), and neighborhood economic segregation (low/medium/high) were analyzed cross-sectionally. We used decomposition analysis, which describes how much a disparity would change (disparity reduction; explained portion) and remain (disparity residual; unexplained portion) upon removing racial differences in economic segregation (i.e., if Black people had the distribution of segregation of White people, how much we would expect uncontrolled hypertension to decrease among Black people). Age- and gender-adjusted prevalence of uncontrolled hypertension (39.0%, 52.6%, and 54.2% for White, Brown, and Black participants, respectively) remained higher for Black and Brown vs White participants, regardless of economic segregation. Uncontrolled hypertension showed a dose-response pattern with increasing segregation levels for White but not for Black and Brown participants. After adjusting for age, gender, education, and study center, unexplained portion (disparity residual) of race on uncontrolled hypertension was 18.2% (95% CI 13.4%; 22.9%) for Black vs White participants and 12.6% (8.2%; 17.1%) for Brown vs White participants. However, explained portion (disparity reduction) through economic segregation was - 2.1% (- 5.1%; 1.3%) for Black vs White and 0.5% (- 1.7%; 2.8%) for Brown vs White participants. Although uncontrolled hypertension was greater for Black and Brown vs White people, racial inequities in uncontrolled hypertension were not explained by economic segregation.

Investigation of cancer incidence in ELSA-Brasil.

Low- and middle-income countries have high cancer-related mortality rates, and Brazil has one of the highest incidences of all cancers in South America. Since 2008, the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) follows up 15,105 civil adult servants of college education and research institutions in six Brazilian capitals, collecting relevant information on risk factors for the incidence of cancer and other noncommunicable diseases. This study aimed to describe the methodology for surveillance and investigation of the incidence of primary cancers in ELSA-Brasil. The surveillance and investigation involve annual telephone interviews, data collection of medical registries (biopsy records, chemotherapy/radiotherapy reports, hospital records or death certificates/autopsy statements), eligibility and final classification, date and basis of diagnosis, tumor topography and histological type. The cumulative incidence of all types of cancer in ELSA-Brasil during the first five years of follow-up (2009-2013) was 2.27 %. The challenges encountered in the investigation process are related to the lack of data on the occurrence of distant metastasis and essential details regarding diagnoses. However, the quality control and the adequacy of the methods adopted enables the construction of a solid and pioneering database in the country, which will contribute to advance in research on the natural history of the most frequent types of cancer.

Racial discrimination predicts the increase in body weight and BMI in Black individuals from ELSA-Brasil cohort / Discriminação racial prediz o aumento do peso corporal e do IMC em indivíduos pretos da coorte ELSA-Brasil

Abstract We investigated whether racial discrimination accelerates the weight and Body Mass Index (BMI) gain in Blacks and Browns participants of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) in four years of follow-up. We compared body weight and BMI between the 1st (2008-2010) and 2nd visit (2012-2014) of 5,983 Blacks and Browns participants. Exposure to racial discrimination and covariates (age, sex, education, and research center) were obtained at the 1st visit. Linear mixed effects models stratified by race/skin color were used. Report of racial discrimination was more frequent among Blacks (32.1%) than Browns (6.3%). During the follow-up period, Blacks and Browns gained an average of 1.4kg and 1.2kg, respectively. This increase was greater among those who reported discrimination when compared to those who did not, both in Blacks (2.1kg vs.1.0kg, p < 0.001) and Browns (1.9kg vs. 1.1kg, p < 0.05). The results of the interaction between racial discrimination and time showed that Blacks, but not Browns, who reported racial discrimination had greater weight and BMI gains between visits. Our results suggest that reducing racial discrimination would contribute to prevent and/or control obesity increase in the country.

Resumo Investigou-se se a discriminação racial acelera o ganho de peso corporal e o Índice de Massa Corporal (IMC) em pretos e pardos participantes do Estudo Longitudinal de Saúde do Adulto (ELSA-Brasil) em quatro anos de seguimento. Comparou-se o peso corporal e o IMC entre a 1ª (2008-2010) e a 2ª visita (2012-2014) de 5.983 participantes pretos e pardos. A exposição à discriminação racial e às covariáveis ​​(idade, sexo, escolaridade e centro de pesquisa) foram obtidas na 1ª visita. Foram utilizados modelos lineares de efeitos mistos estratificados por raça/cor da pele. O relato de discriminação racial foi mais frequente entre pretos (32,1%) do que em pardos (6,3%). Durante o período de acompanhamento, pretos e pardos ganharam uma média de 1,4kg e 1,2kg, respectivamente. Esse aumento foi maior entre os que relataram discriminação, quando comparados aos que não relataram, tanto em pretos (2,1 kg vs. 1,0 kg, p < 0,001) quanto em pardos (1,9kg vs. 1,1kg, p < 0,05). Após ajustes, os pretos, mas não os pardos, que relataram discriminação racial apresentaram maiores ganhos de peso e IMC entre as visitas. Nossos resultados sugerem que a redução da discriminação racial pode contribuir para prevenir e/ou controlar o aumento da obesidade no país.

Racial discrimination predicts the increase in body weight and BMI in Black individuals from ELSA-Brasil cohort.

We investigated whether racial discrimination accelerates the weight and Body Mass Index (BMI) gain in Blacks and Browns participants of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) in four years of follow-up. We compared body weight and BMI between the 1st (2008-2010) and 2nd visit (2012-2014) of 5,983 Blacks and Browns participants. Exposure to racial discrimination and covariates (age, sex, education, and research center) were obtained at the 1st visit. Linear mixed effects models stratified by race/skin color were used. Report of racial discrimination was more frequent among Blacks (32.1%) than Browns (6.3%). During the follow-up period, Blacks and Browns gained an average of 1.4kg and 1.2kg, respectively. This increase was greater among those who reported discrimination when compared to those who did not, both in Blacks (2.1kg vs.1.0kg, p < 0.001) and Browns (1.9kg vs. 1.1kg, p < 0.05). The results of the interaction between racial discrimination and time showed that Blacks, but not Browns, who reported racial discrimination had greater weight and BMI gains between visits. Our results suggest that reducing racial discrimination would contribute to prevent and/or control obesity increase in the country.

Gender, race/skin colour and incidence of hypertension in ELSA-Brasil: an intersectional approach.

OBJECTIVE: Race and gender inequities in the incidence of hypertension (HTN) are well documented; however, few empirical investigations looked into these associations, considering the synergies and heterogeneous experiences of intersectional gender and race/skin colour groups. This study investigated the association of intersectional identities defined by gender and race/skin colour with HTN incidence, and verified whether they are affected by educational level in adulthood. DESIGN: We used the Longitudinal Study of Adult Health (ELSA-Brasil) data to estimate the incidence of HTN between visits 1 (2008-2010) and 2 (2012-2014), in 8528 participants without hypertension at visit 1. HTN was defined as systolic blood pressure ≥140 mmHg, or diastolic blood pressure ≥90 mmHg, or use of antihypertensive drugs. Generalized linear models with Poisson distribution and log link function were used to assess the associations. RESULTS: The incidence of HTN was 43.4/1000 person-years, ranging from 30.5/1000 in White women to 59.4/1000 in Black men. After adjusting by age and family history of HTN, the incidence rate ratio (IRR) was higher in Black men (2.25; 95%CI: 1.65-3.08), Brown (Pardo) men (1.89; 95%CI: 1.59-2.25), Black women (1.85; 95%CI: 1.50-2.30), Brown (Parda) women (1.47; 95%CI: 1.31-1.67) and White men (1.76; 95%CI: 1.49-2.08), compared to White women. These associations were maintained even after considering socioeconomic, behavioural and health mediators in the model. No interaction was found between education level and intersectional identities in the IRRs observed. CONCLUSION: By using an intersectional approach, we showed the complex relations between race/skin colour and gender inequities in the incidence of HTN, pointing not only that Black men have the highest risk of developing HTN, but also that the risk of HTN is greater in Black women than in White men, when compared to White women.

Racial discrimination is associated with greater arterial stiffness and carotid intima-media thickness: the ELSA-Brasil study.

PURPOSE: The association between racial discrimination and subclinical cardiovascular markers remains under-examined. We aimed to investigate the association of race/skin color and racial discrimination with pulse wave velocity (PWV) and carotid intima-media thickness (c-IMT) in the Brazilian context. METHODS: We used data from 13,284 participants from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) baseline with information of PWV and 9850 for c-IMT. Self-reported race/skin color and perceived racial discrimination were the exposures. PWV and c-IMT were used continuously and categorizing according to cutoff that indicates increased cardiovascular risk. Linear and logistic regression models were used. RESULTS: Experience of racial discrimination was reported by 7% of total participants, but this prevalence was much higher among Blacks than Browns (PWV sample: 31,9% vs. 6,1%; c-IMT sample: 33,7% vs. 6,8%). After adjustments for age, sex, and research center, Blacks and Browns presented higher means of PWV and c-IMT and had greater chances of PWV>10 m/s and c-IMT≥75th percentile than Whites. The magnitude of all these associations were higher among Blacks and Browns with racial discrimination. In final models adjusted for education this pattern of association remained the same, although an attenuation in the magnitude of the association has been observed. CONCLUSIONS: Blacks and Browns presented worse profiles of subclinical cardiovascular markers compared to Whites and those exposed to racial discrimination seem to have an additional cardiovascular risk.

Job stress and chronic and widespread musculoskeletal pain: a cross-sectional analysis from the Brazilian Longitudinal Study of Adult Health Musculoskeletal.

ABSTRACT: Musculoskeletal pain is a global health concern, and work-related psychosocial stress might be a potential contributing factor. This cross-sectional study investigates whether job stress is associated with chronic and widespread musculoskeletal pain in 2051 Brazilian active civil servants included in the Brazilian Longitudinal Study of Adult Health Musculoskeletal (ELSA-Brasil MSK). Job stress was assessed using the Effort-Reward Imbalance (ERI) questionnaire. Associations between ERI domains, categorized into tertiles, and chronic musculoskeletal pain (CMP) at any site and per number of affected sites (0, 1-2, ≥3-multisite pain) and body regions (0, 1-2, 3-generalized pain), were investigated using binary and multinomial logistic regression, adjusted for sociodemographic, occupational, and health covariates. The prevalence of CMP at any site, multisites, and generalized regions was 52.9%, 18.2%, and 9.5%, respectively. After adjustments, the lower the reward and the greater the overcommitment, the higher the odds of CMP at any site. The ERI domains were more strongly associated with multisite and generalized CMP than with CMP at any site. Multisite CMP was associated with lower reward and with greater effort, overcommitment, and effort-reward imbalance ratio. Chronic musculoskeletal pain according to body regions, especially generalized pain, was also associated with ERI domains effort (OR = 2.06; 95%CI = 1.33-3.21), overcommitment (OR = 3.44; 95%CI = 2.20-5.39), and effort-reward imbalance ratio (OR = 2.06; 95%CI = 1.30-3.27). Results reveal an association between job stress not only with CMP at any site but notably with the pain spread to other body sites or regions. Our findings suggest that lowering stress at work and discouraging overcommitment may help reduce the CMP burden, including reduction of CMP spread from one site or region of the body to another.

Racism and racial iniquities in poor self-rated health: the role of intergenerational social mobility in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). / Racismo e iniquidade racial na autoavaliação de saúde ruim: o papel da mobilidade social intergeracional no Estudo Longitudinal de Saúde do Adulto (ELSA-Brasil).

Blacks and Browns have major health disadvantages, are less likely to rise in the social hierarchy throughout the course of life, and pertain to lower socioeconomic levels than Whites as a result of structural racism. However, little is known about the mediating role of intergenerational mobility in the association between race/skin color and health. The aim of the present study was to investigate the association between racism and self-rated health and to verify to what extent intergenerational social mobility mediates this association. This was a cross-sectional study conducted with data from 14,386 participants from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) baseline (2008-2010). Maternal education, education of the participant, socio-occupational class of the head of household, and socio-occupational class of the participant were used in the indicators of intergenerational social mobility (educational and socio-occupational). Logistic regression models were used. The prevalence of poor self-rated health was 15%, 24%, and 28% among Whites, Browns, and Blacks, respectively. After adjustments for age, sex, and research center, greater chances of poor self-rated health were found among Blacks (OR = 2.15; 95%CI: 1.92-2.41) and Browns (OR = 1.82; 95%CI: 1.64-2.01) when compared to Whites. Intergenerational educational and socio-occupational mobility mediated, respectively, 66% and 53% of the association between race/color and poor self-rated health in Blacks, and 61% and 51% in Browns, respectively. Results confirm racial iniquity in self-rated health and point out that unfavorable intergenerational social mobility is an important mechanism to explain this iniquity.

Pretos e pardos apresentam grandes desvantagens de saúde, possuem menores chances de ascensão na hierarquia social no curso de vida e menores níveis socioeconômicos do que brancos como resultado do racismo estrutural. Entretanto, pouco se sabe sobre o papel mediador da mobilidade intergeracional na associação entre racismo e saúde. O objetivo do presente estudo foi investigar a associação entre racismo e a autoavaliação de saúde, e verificar em que medida a mobilidade social intergeracional media essa associação. Estudo transversal realizado com dados de 14.386 participantes da linha de base (2008-2010) do Estudo Longitudinal de Saúde do Adulto (ELSA-Brasil). Escolaridade materna, escolaridade do participante, classe sócio-ocupacional do chefe de família e classe sócio-ocupacional do participante compuseram os indicadores de mobilidade social intergeracional (educacional e sócio-ocupacional). Modelos de regressão logística foram utilizados. A prevalência de autoavaliação de saúde ruim foi de 15%, 24% e 28% entre brancos, pardos e pretos, respectivamente. Após ajustes por idade, sexo e centro de investigação foram encontradas maiores chances de autoavaliação de saúde ruim entre pretos (OR = 2,15; IC95%: 1,92-2,41) e pardos (OR = 1,82; IC95%: 1,64-2,01) quando comparados aos brancos. A mobilidade educacional e sócio-ocupacional intergeracional mediaram, respectivamente, 66% e 53% da associação entre a raça/cor e autoavaliação de saúde ruim em pretos, e 61% e 51% em pardos, respectivamente. Resultados confirmam a iniquidade racial na autoavaliação de saúde e apontam que a mobilidade social intergeracional desfavorável é um importante mecanismo para explicar essa iniquidade.

Negros y mulatos presentan grandes desventajas de salud, poseen menores oportunidades de ascensión en la jerarquía social en el trascurso de su vida, y menores niveles socioeconómicos que los blancos, como resultado del racismo estructural. No obstante, poco se sabe sobre el papel mediador de la movilidad intergeneracional en la asociación entre racismo y salud. El objetivo de este estudio fue investigar la asociación entre racismo y autoevaluación de salud, así como verificar en qué medida la movilidad social intergeneracional interfiere en esa asociación. Se trata de un estudio transversal, realizado con datos de 14.386 participantes de la base de referencia (2008-2010) del Estudio Longitudinal de Salud de Adultos (ELSA-Brasil). La escolaridad materna, del participante, clase socio-ocupacional del jefe de familia y clase socio-ocupacional del participante compusieron los indicadores de movilidad social intergeneracional (educacional y socio-ocupacional). Se utilizaron modelos de regresión logística. La prevalencia de autoevaluación de mala salud fue de 15%, 24% y 28% entre blancos, mulatos/mestizos y negros, respectivamente. Tras los ajustes por edad, sexo y centro de investigación, se encontraron mayores oportunidades de autoevaluación de mala salud entre negros (OR = 2,15; IC95%: 1,92-2,41) y mulatos/mestizos (OR = 1,82; IC95%: 1,64-2,01), cuando se compara con los blancos. La movilidad educacional y socio-ocupacional intergeneracional mediaron, respectivamente, 66% y 53% de la asociación entre raza/color y autoevaluación de mala salud en negros, y 61% y 51% en mulatos/mestizos, respectivamente. Los resultados confirman la inequidad racial en la autoevaluación de salud y apuntan que la movilidad social intergeneracional desfavorable es un importante mecanismo para explicar esa inequidad.

Racismo e iniquidade racial na autoavaliação de saúde ruim: o papel da mobilidade social intergeracional no Estudo Longitudinal de Saúde do Adulto (ELSA-Brasil) / Racismo e inequidad racial en la autoevaluación de mala salud: el papel de la movilidad social intergeneracional en el Estudio Longitudinal de Salud de Adultos (ELSA-Brasil) / Racism and racial iniquities in poor self-rated health: the role of intergenerational social mobility in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil)

Resumo: Pretos e pardos apresentam grandes desvantagens de saúde, possuem menores chances de ascensão na hierarquia social no curso de vida e menores níveis socioeconômicos do que brancos como resultado do racismo estrutural. Entretanto, pouco se sabe sobre o papel mediador da mobilidade intergeracional na associação entre racismo e saúde. O objetivo do presente estudo foi investigar a associação entre racismo e a autoavaliação de saúde, e verificar em que medida a mobilidade social intergeracional media essa associação. Estudo transversal realizado com dados de 14.386 participantes da linha de base (2008-2010) do Estudo Longitudinal de Saúde do Adulto (ELSA-Brasil). Escolaridade materna, escolaridade do participante, classe sócio-ocupacional do chefe de família e classe sócio-ocupacional do participante compuseram os indicadores de mobilidade social intergeracional (educacional e sócio-ocupacional). Modelos de regressão logística foram utilizados. A prevalência de autoavaliação de saúde ruim foi de 15%, 24% e 28% entre brancos, pardos e pretos, respectivamente. Após ajustes por idade, sexo e centro de investigação foram encontradas maiores chances de autoavaliação de saúde ruim entre pretos (OR = 2,15; IC95%: 1,92-2,41) e pardos (OR = 1,82; IC95%: 1,64-2,01) quando comparados aos brancos. A mobilidade educacional e sócio-ocupacional intergeracional mediaram, respectivamente, 66% e 53% da associação entre a raça/cor e autoavaliação de saúde ruim em pretos, e 61% e 51% em pardos, respectivamente. Resultados confirmam a iniquidade racial na autoavaliação de saúde e apontam que a mobilidade social intergeracional desfavorável é um importante mecanismo para explicar essa iniquidade.

Resumen: Negros y mulatos presentan grandes desventajas de salud, poseen menores oportunidades de ascensión en la jerarquía social en el trascurso de su vida, y menores niveles socioeconómicos que los blancos, como resultado del racismo estructural. No obstante, poco se sabe sobre el papel mediador de la movilidad intergeneracional en la asociación entre racismo y salud. El objetivo de este estudio fue investigar la asociación entre racismo y autoevaluación de salud, así como verificar en qué medida la movilidad social intergeneracional interfiere en esa asociación. Se trata de un estudio transversal, realizado con datos de 14.386 participantes de la base de referencia (2008-2010) del Estudio Longitudinal de Salud de Adultos (ELSA-Brasil). La escolaridad materna, del participante, clase socio-ocupacional del jefe de familia y clase socio-ocupacional del participante compusieron los indicadores de movilidad social intergeneracional (educacional y socio-ocupacional). Se utilizaron modelos de regresión logística. La prevalencia de autoevaluación de mala salud fue de 15%, 24% y 28% entre blancos, mulatos/mestizos y negros, respectivamente. Tras los ajustes por edad, sexo y centro de investigación, se encontraron mayores oportunidades de autoevaluación de mala salud entre negros (OR = 2,15; IC95%: 1,92-2,41) y mulatos/mestizos (OR = 1,82; IC95%: 1,64-2,01), cuando se compara con los blancos. La movilidad educacional y socio-ocupacional intergeneracional mediaron, respectivamente, 66% y 53% de la asociación entre raza/color y autoevaluación de mala salud en negros, y 61% y 51% en mulatos/mestizos, respectivamente. Los resultados confirman la inequidad racial en la autoevaluación de salud y apuntan que la movilidad social intergeneracional desfavorable es un importante mecanismo para explicar esa inequidad.

Abstract: Blacks and Browns have major health disadvantages, are less likely to rise in the social hierarchy throughout the course of life, and pertain to lower socioeconomic levels than Whites as a result of structural racism. However, little is known about the mediating role of intergenerational mobility in the association between race/skin color and health. The aim of the present study was to investigate the association between racism and self-rated health and to verify to what extent intergenerational social mobility mediates this association. This was a cross-sectional study conducted with data from 14,386 participants from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) baseline (2008-2010). Maternal education, education of the participant, socio-occupational class of the head of household, and socio-occupational class of the participant were used in the indicators of intergenerational social mobility (educational and socio-occupational). Logistic regression models were used. The prevalence of poor self-rated health was 15%, 24%, and 28% among Whites, Browns, and Blacks, respectively. After adjustments for age, sex, and research center, greater chances of poor self-rated health were found among Blacks (OR = 2.15; 95%CI: 1.92-2.41) and Browns (OR = 1.82; 95%CI: 1.64-2.01) when compared to Whites. Intergenerational educational and socio-occupational mobility mediated, respectively, 66% and 53% of the association between race/color and poor self-rated health in Blacks, and 61% and 51% in Browns, respectively. Results confirm racial iniquity in self-rated health and point out that unfavorable intergenerational social mobility is an important mechanism to explain this iniquity.

Racial inequality, racial discrimination and obesity incidence in adults from the ELSA-Brasil cohort.

BACKGROUND: This study investigated whether self-reported race/skin colour and perceived racial discrimination predict higher obesity incidence after approximately 4-year follow-up of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). We also investigated whether these associations are modified by educational level. METHODS: Following exclusion of individuals defined as obese (body mass index ≥30 kg/m2) at baseline, associations between race/skin colour and obesity incidence between the first (2008-2010) and second (2012-2014) visits were investigated in 10 130 participants. Next, associations between perceived racial discrimination and obesity incidence among black (n=1532) and brown (n=2958) individuals were investigated separately. Racial discrimination (yes/no) was assessed using the Lifetime Major Event Scale. Logistic regression models adjusted for age, sex and research site were used. All analyses were stratified for educational level. RESULTS: Obesity risk was higher in Blacks with high education compared with white individuals to the same education level (OR: 2.22; 95% CI 1.62 to 3.04) following adjustments. After adjustments, obesity incidence was higher among black individuals reporting racial discrimination compared with peers who did not report this experience, but only among the low education group (OR: 1.64; 95% CI 1.08 to 2.51). No statistical association with perceived discrimination was observed among brown individuals. CONCLUSION: Results are congruent with findings from other studies reporting associations between racial inequality and obesity incidence and also suggest racial discrimination may be one of the mechanisms leading to such inequalities. Also, it supports the paradox theory by which education modify the association in distinct directions.

Night work is related to higher global and central adiposity in Brazil: National Health Survey, 2013.

BACKGROUND: Night work can disturb the natural circadian rhythm, leading to disruptions in metabolic rate and subsequent overall gain weight or even more harmful abdominal adiposity. Our aims were to investigate the associations between night work frequency and markers of overall and central obesity. METHODS: We conducted a cross-sectional analysis of data from the Brazilian National Health Survey on over 35 500 current workers. Exposure to current night work was composed of three categories: daytime work (reference category), less than one night per week, and more than two nights per week. The body mass index and waist circumference were used as adiposity markers. Logistic and multinomial regression models were used, with adjustment for demographic characteristics, work conditions, self-related health, and health-related behaviors. RESULTS: After complete adjustment, individuals who worked two or more nights a week had higher odds of overweight (odds ratio [OR]: 1.20, 95% CI: 1.04-1.38), obesity (OR: 1.38, 95% CI: 1.17-1.64) and increased waist circumference (OR: 1.27, 95% CI: 1.10-1.46) than daytime workers. CONCLUSIONS: Night work was significantly associated with measures of adiposity. Changes in working conditions, such as controlling the numbers of nights worked per week or promoting workplaces with healthy meals and the opportunity to perform physical exercise at work, could be suggested.

Job Stress and Heart Rate Variability: Findings From the ELSA-Brasil Cohort.

OBJECTIVE: Evidence suggests that exposure to psychosocial stress at work can inhibit vagal tonus, influencing the capacity to respond to environmental stimuli. We investigated whether job strain and low control and high demand at work, as separate measures, are associated with a reduction in heart rate variability (HRV). METHODS: This is a cross-sectional study with 9658 active workers at the baseline (2008-2010) of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). HRV was estimated using electrocardiographic recordings for 10 minutes, at rest, examining the following indices were used: root mean square of successive difference, standard deviation of normal to normal, percentage of adjacent R-R intervals with a difference lasting more than 50 ms, low frequency (LF), and high frequency. Job strain was defined based on the demand-control model. Independent associations between job strain and HRV indices were verified using generalized linear models and the magnitude of the association was estimated by evaluating the ratios of arithmetic means. RESULTS: Neither the unfavorable demand-control relation nor job demand dimension separately was associated with HRV. However, the increase of one unit in the control dimension was associated with an increment of 2.2% (95% confidence interval = 1.014-1.029) in the LF mean. After adjustments for sociodemographic characteristics, assessment site, health-related behaviors, and depression, this association remained statistically significant (ratio of arithmetic means = 1.008; 95% confidence interval = 1.0002-1.017). CONCLUSIONS: Job control was associated with HRV in a large cohort of civil servants. Nevertheless, it is important to emphasize that only the LF index remained associated with low job control. Further studies are needed to develop a greater understanding of the relationship of psychosocial aspects and autonomic balance.

Racial differences in the association between early socioeconomic position, birth weight, and arterial stiffness in adults from ELSA-Brasil.

PURPOSE: We investigated the association between social and nutritional adversities in childhood and increased arterial stiffness in adulthood, according to race/skin color. METHODS: We used baseline data (2008-2010) from 13,365 adults (aged 34-75 years) from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). Arterial stiffness was assessed by carotid-femoral pulse wave velocity (cfPWV). Childhood social and nutritional adversities were assessed by maternal education and birth weight. Race/skin color was self-reported. RESULTS: The lower the maternal education, the higher the cfPWV in adulthood in Whites, Browns, and Blacks. This association was no longer significant after adjusting for the participant's education level in Whites, but it persisted after full adjustment among Browns (low vs. high maternal education: ß = 0.18, 95% confidence interval: 0.01; 0.34) and Blacks (low vs. high maternal education: ß = 0.44, 95% confidence interval: 0.18; 0.70). On the other hand, the association between low birth weight and higher cfPWV was found only among Whites. CONCLUSIONS: Our findings regarding the association between maternal education and arterial stiffness are consistent with the disproportionate burden of cardiovascular disease-related morbidity and mortality in Blacks and Browns. The fact that the association between birth weight and arterial stiffness was only present in Whites may have reflected a survival bias.

Greater aortic stiffness is associated with renal dysfunction in participants of the ELSA-Brasil cohort with and without hypertension and diabetes.

BACKGROUND: Arterial stiffness has been associated with renal dysfunction and its progression, but the pathophysiological relation underlying this association has not been fully established, particularly among individuals without hypertension and diabetes. We investigated the cross-sectional associations between arterial stiffness and renal function in adults without cardiovascular disease, and whether this association remained among subjects without hypertension and diabetes. METHODS: All eligible participants from ELSA-Brasil (2008-2010), aged 35 to 74 years (N = 13,586) were included, of whom 7,979 were free from hypertension and diabetes. The response variables were: 1) low glomerular filtration rate (eGFR<60ml/min/1.73m2) estimated by CKD-EPI; 2) increased albumin/creatinine ratio (ACR ≥30mg/g); and 3) chronic kidney disease (CKD). Arterial stiffness was ascertained by the carotid-femoral pulse wave velocity (PWV). The covariates were sex, age, race/color, level of schooling, smoking, body mass index, total cholesterol/HDL-c glycated hemoglobin, diabetes, systolic blood pressure, heart rate and use of antihypertensive drugs. Logistic regression was used to examine the associations. RESULTS: After all adjustments, 1 m/s increase in PWV was associated with ORs equal to 1.10 (95%CI: 1.04-1.16), 1.10 (95%CI: 1.05-1.16) and 1.12 (95%CI: 1.08-1.17) of low eGFR, high ACR, and CKD, respectively. In subjects without hypertension and diabetes, these ORs were 1.19 (95%CI: 1.07-1.33), 1.20 (95%CI: 1.07-1.32) and 1.21 (95%CI: 1.11-1.30), respectively. CONCLUSION: The increase in PWV was associated with all renal dysfunction markers, even in individuals without hypertension and diabetes, suggesting a relation that is not completely mediated by the presence of these conditions.

Racial disparities in renal function: the role of racial discrimination. The Brazilian Longitudinal Study of Adult Health (ELSA-Brasil).

BACKGROUND: Racial discrimination may play a significant role in higher incidence and poorer prognosis of chronic kidney disease among Black individuals. This study set out to investigate the association between racial discrimination and renal function and to estimate the contribution of racial discrimination to existing racial disparities in renal function. METHODS: A cross-sectional analysis using baseline data (2008-2010) of 14 355 participants (35-74 years) in the Brazilian Longitudinal Study of Adult Health cohort study. Renal function was estimated based on estimated glomerular filtration rates (eGFR) obtained by the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation. Racial discrimination was assessed using a modified version of the Lifetime Major Events Scale ; race/colour was self-reported. Covariates included were age, sex, level of education and selected health-related factors. RESULTS: Racial discrimination was reported by 31.6%, 6.3% and 0.8% of Black, Brown and White individuals, respectively. The older the age, the lower the prevalence of racial discrimination among Blacks. Racial discrimination was independently associated with lower mean eGFR (ß=-2.38; 95% CI -3.50 to -1.25); however, associations were limited to individuals aged under 55 years. In this age group, eGFR differences between Black and White individuals were reduced by 31% when exposure to racial discrimination was accounted for. CONCLUSION: Blacks are approximately 40 times more likely to report racial discrimination than Whites. Racial discrimination was associated with lower mean eGFR and explained a significant portion of eGFR differences between Black and White individuals aged under 55 years. Exposure to experiences of racial discrimination should be accounted for in studies investigating racial disparities in renal function.