Socioeconomic Inequalities in Cardiovascular Risk Factors in Turkey, 2008-2016

Abstract

Abstract Background This study aims to investigate the magnitude of occupational class (OC) and educational inequalities in cardiovascular risk factors in Turkey from 2008 to 2016. Methods We used the Turkey Health Survey, a bi-annual health interview survey among a representative sample of the Turkish population. We calculated the age-standardized prevalence of four cardiovascular risk factors (obesity, overweight, hypertension, diabetes and smoking) by OC and education, and summarized inequalities with the Relative Index of Inequality (RII) and Slope Index of Inequality (SII). To determine whether the RII/SII changed over time we estimated a regression model with an interaction term between survey year and OC/education. Results We found different patterns for men and women. Among men, smoking was the only risk factor with a higher prevalence in both lower OC and education groups (RII = 1.18 (95% CI: 1.08-1.28) and 1.40 (1.26-1.55), respectively). Obesity, overweight and diabetes was higher among higher OC (e.g., for overweight RII = 0.83, 95% CI 0.76-0.90) whereas obesity was higher among lower educated (RII = 1.32, (95% CI: 1.08-1.61)) and no inequalities were found for hypertension by socioeconomic status. However, among women, all risk factors except smoking had a higher prevalence in lower OC and education groups (e.g., for overweight RII = 1.14 (1.06-1.24) and 2.98 (2.71-3.29), respectively), whereas for smoking we found a higher prevalence in higher socioeconomic groups (RII for OC = 0.77 (95% CI: 0.65-0.90 and for education = 0.36 (0.29-0.44)). Significant interactions with survey year were only found in a few cases, mainly pointing to emergence or widening of inequalities to the disadvantage of lower socioeconomic groups. Conclusions Inequalities in cardiovascular risk factors are less systematic in Turkey than in most high-income countries, but if current trends continue similar inequalities will emerge in the near future. Key messages In Turkey, in men obesity, overweight and diabetes are concentrated among higher occupational classes, obesity is concentrated among lower education groups and lower socioeconomic groups smoke more. In Turkey, in women obesity, overweight, hypertension and diabetes are concentrated among lower socioeconomic groups however higher socioeconomic groups smoke more.