Abstract
BackgroundWe investigated a) whether urbanicity is associated with individual-level non-communicable diseases (NCD) risk factors and whether urbanicity modifies trends over time in risk factors; and (b) whether educational inequalities in NCD risk factors change over time or are modified by province urbanicity.MethodsWe used data from three large national surveys on NCD risk factors (Encuesta Nacional de Factores de Riesgo; ENFR2005–2009-2013) conducted in urban areas of Argentina (n = 108,489). We used gender-stratified logistic random-intercept models (individuals nested within provinces) to determine adjusted associations of self-reported individual NCD risk factors (hypertension, diabetes, obesity, and current smoking) with education and urbanicity.ResultsIn both men and women, the prevalence of obesity and diabetes increased over time but smoking decreased. Hypertension prevalence increased over time in men. Higher urbanicity was associated with higher odds of smoking and lower odds of hypertension in women but was not associated with NCD risk factors in men. Obesity increased more over time in more compared to less urbanized provinces (in men) while smoking decreased more over time in less urbanized provinces. All risk factors had a higher prevalence in persons with lower education (stronger in women than in men), except for diabetes in men and smoking in women. Educational inequalities in obesity (in men) and hypertension (in men and women) became stronger over time, while an initial inverse social gradient in smoking for women reverted and became similar to other risk factors over time. In general, the inverse associations of education with the risk factors became stronger with increasing levels of province urbanicity.ConclusionIncreasing prevalence of diabetes and obesity over time and growing inequities by education highlight the need for policies aimed at reducing NCD risk factors among lower socioeconomic populations in urban environments in Argentina.
Highlights
We investigated a) whether urbanicity is associated with individual-level non-communicable diseases (NCD) risk factors and whether urbanicity modifies trends over time in risk factors; and (b) whether educational inequalities in NCD risk factors change over time or are modified by province urbanicity
Sample Data used in this study included three large repeat cross-sectional surveys conducted as part of the Argentine National Survey of Risk Factors (‘Encuesta Nacional de Factores de Riesgo’, ENFR), carried out in urban areas of Argentina in 2005, 2009, and 2013
The prevalence of obesity increased over time and the prevalence of smoking decreased over time
Summary
We investigated a) whether urbanicity is associated with individual-level non-communicable diseases (NCD) risk factors and whether urbanicity modifies trends over time in risk factors; and (b) whether educational inequalities in NCD risk factors change over time or are modified by province urbanicity. Macro-level and contextual factors affect individual health by exposing people to different levels of social and economic opportunities and constraints [2,3,4]. These exposures, in turn, may shape individuals’ behavioral patterns, stress levels and coping resources, which are directly relevant to their health outcomes [5]. Urbanization, a process by which populations migrate from rural to urban areas has consequences for health [6] Whether these consequences are positive or negative depends on a number of factors, including specific contexts, times, and health outcomes [7]. Rapid and recent urbanization has been associated with unhealthy changes in diet, lower physical activity, more smoking and alcohol consumption, and higher inflammation [10, 12,13,14]
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