Socioeconomic status and chronic disease in Palestinians living in and outside refugee camps in the West Bank and the Gaza Strip: an observational study

Abstract

BackgroundPeople living in the occupied Palestinian territory have high levels of poverty and unemployment and low educational level. The aim of this study was to investigate the association between socioeconomic status and self-reported chronic disease and to determine whether this association differed between Palestinians living in and outside refugee camps. MethodsThe study was based on representative samples of Palestinians living in the occupied Palestinian territory (West Bank and Gaza Strip), aged 25 years and older, collected by the Palestinian Central Bureau of Statistics in 2006 and 2010. Educational level, wealth, and employment status were used as measures of socioeconomic status. Participants reporting a diagnosis and treatment for at least one chronic disease were categorised as having a chronic disease. We used logistic regression models to estimate the association between socioeconomic status and chronic disease and to compare the prevalence of chronic disease between Palestinians living in or outside refugee camps adjusted by socioeconomic status. FindingsThe sample included 38 888 participants. Associations between all measures of socioeconomic status and chronic disease were highly significant. In 2010, the odds ratio (OR) of reported chronic disease in illiterate men and women were 1·37 (95% CI 1·21–1·56) and 1·45 (1·29–1·63), respectively, compared with men and women with elementary or preparatory educational levels. Compared with the richest quintile, the OR in the poorest quintile was 1·70 (1·47–1·96) for men and 1·80 (1·56–2·07) for women. Compared with employed people, the OR in unemployed people was 1·50 (1·31–1·71) for men and 1·12 (0·76–1·65) for women. Similar results were found for 2006. The prevalence of chronic disease was substantially higher in Palestinians living in refugee camps (29%) than in those living outside refugee camps (24%). The associations between socioeconomic status and chronic disease did not differ between people living in or outside refugee camps. InterpretationWe found highly significant associations between socioeconomic status and self-reported chronic disease. Although the prevalence of chronic disease was highest in Palestinians living in refugee camps, the pattern of association between socioeconomic status and chronic disease did not differ between Palestinians living in and outside refugee camps. FundingNone.