Basu, Sanjay

Siddiqi, Arjumand

American Journal of Epidemiology

PubMed

Sanjay Basu

Arjumand Siddiqi

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Basu and Siddiqi Respond to “Context, Behaviors, and Hypertension Inequalities”

LSHTM Research Online

Response to Invited CommentaryBasu and Siddiqi Respond to “Context, Behaviors, and Hypertension Inequalities”Sanjay Basu* and Arjumand Siddiqi* Correspondence to Dr. Sanjay Basu, Stanford University School of Medicine, Medical School Office Building, X322, 1265 Welch Road,Mail Code 5411, Stanford, CA 94305-5411 (e-mail: basus@stanford.edu).Initially submitted March 13, 2015; accepted for publication March 24, 2015.We thank Dr. Hicken for her commentary (1) on our articleregarding disparities in the distributions of blood pressureacross racial/ethnic groups in the United States (2). She cor-rectly places our results, which largely show that proximaterisk factors are inadequate to explain disparities, in the con-text of a larger body of literature that suggests that broadersocial determinants of health must be addressed for such dis-parities to be reduced. Indeed, we have written extensivelyabout social welfare policies, political inequalities, and broadersocioeconomic power disparities as the ultimate drivers ofpoor health and of health inequalities (3, 4). Although weagree with Dr. Hicken that multilevel analyses, includinganalyses of social and political determinants of health, aretherefore more useful for modifying disparities, our aim inour article was primarily methodological. Our goal was to il-lustrate the implementation of decomposition methods thatcan be used to study disparities at any level of analysis. Un-fortunately, our nation’s largest surveys of hypertension pri-marily record data at the level of proximate risk factors forhypertension; hence, we focused on the most commonly uti-lized metrics of risk for a demonstration analysis. However,decomposition is not limited to proximate factors, and our il-lustration is intended as a starting point for the more compre-hensive analysis of disparities of outcomes that are measuredas continuous variables, which we hope will add a new toolfor epidemiologic analysis at any level.ACKNOWLEDGMENTSAuthor afﬁliations: Stanford Prevention Research Center,Stanford University, Stanford, California (Sanjay Basu);Center for Health Policy, Stanford University, Stanford, Cal-ifornia (Sanjay Basu); Center for Primary Care and Out-comes Research, Stanford University, Stanford, California(Sanjay Basu); Center on Poverty and Inequality, StanfordUniversity, Stanford, California (Sanjay Basu); Depart-ment of Public Health and Policy, London School of Hy-giene and Tropical Medicine, London, United Kingdom(Sanjay Basu); Division of Epidemiology, Dalla Lana Schoolof Public Health, University of Toronto, Toronto, Canada(Arjumand Siddiqi); Division of Social and Behavioral HealthSciences, Dalla Lana School of Public Health, University ofToronto, Toronto, Canada (Arjumand Siddiqi); and Depart-ment of Health Behavior, Gillings School of Global PublicHealth, University of North Carolina, Chapel Hill (ArjumandSiddiqi).Research reported in this publication was supported by theNational Heart, Lung, and Blood Institute of the National In-stitutes of Health under award number K08HL121056.The content is solely the responsibility of the authors anddoes not necessarily represent the ofﬁcial views of the Na-tional Institutes of Health.Conﬂict of interest: none declared.REFERENCES1. Hicken MT. Invited commentary: fundamental causes, socialcontext, and modiﬁable risk factors in the racial/ethnicinequalities in blood pressure and hypertension. Am J Epidemiol.2015;182(4):354–357.2. Basu S, Hong A, Siddiqi A. Using decomposition analysis toidentify modiﬁable racial disparities in the distribution of bloodpressure in the United States. Am J Epidemiol. 2015;182(4):345–353.3. Stuckler D, Basu S. The Body Economic: Why Austerity Kills.London, UK: Penguin Press; 2013.4. Siddiqi A, Kawachi I, Keating DP, et al. A comparative study ofpopulation health in the United States and Canada during theneoliberal era, 1980–2008. Int J Health Serv. 2013;43(2):193–216.358 Am J Epidemiol. 2015;182(4):358American Journal of Epidemiology© The Author 2015. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health.This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License(http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium,provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.comVol. 182, No. 4DOI: 10.1093/aje/kwv078Advance Access publication:July 21, 2015

Basu and Siddiqi Respond to "Context, Behaviors, and Hypertension Inequalities".

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Basu and Siddiqi Respond to "Context, Behaviors, and Hypertension Inequalities".

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