Abstract
ObjectivesTo estimate socioeconomic inequalities in hypertension and asthma prevalence in Indonesia, to compare estimates based on self-report (SR) to those based on objective assessment (OA), and to assess the role of sensitivity and specificity of SR.MethodsWe used data from the 2014 Indonesia Family Life Survey (n = 34,257). We measured inequalities in hypertension and asthma prevalence in relation to educational level and income, using standardised prevalence rate and the relative index of inequality (RII). Using OA as standard, we calculated the sensitivity and specificity of SR.ResultsFor hypertension, reversed inequalities were found when estimated by SR instead of OA (RII for education 0.86, 95% CI 0.74–0.99 vs. RII 1.29, 95% CI 1.16–1.44). For asthma, a similar but even larger reversal of inequalities was found. The sensitivity of SR was low overall, and especially for the lowest education or income group.ConclusionsResults imply that the use of SR may lead to underestimation of socioeconomic inequalities in disease prevalence in a low-income country such as Indonesia. The use of OA is recommended for monitoring inequalities in non-communicable disease prevalence.
Highlights
A reduction in health inequalities is a priority worldwide
Results imply that the use of SR may lead to underestimation of socioeconomic inequalities in disease prevalence in a low-income country such as Indonesia
For both educational level and income, the prevalence rates of hypertension measured by self-report were lower in the lowest socioeconomic status (SES) group compared to the highest SES group, whereas the prevalence rates measured by objective assessment were always higher in the lowest SES groups compared to the highest SES groups
Summary
A reduction in health inequalities is a priority worldwide. There is considerable evidence that inequalities in disease prevalence lead to unnecessary and avoidable mortality and other negative health outcomes (Mackenbach et al 2000, 2008). Accurate estimation of inequalities in disease prevalence is essential to identify existing and emerging inequalities that require policy action This is relevant in the context of low- and middle-income countries (LMICs), where sizeable inequalities in health are Hypertension is a disease with a high global burden and a major risk factor for cardiovascular disorders (Kearney et al 2005). An international comparative study showed that the prevalence of hypertension in LMICs is consistently higher in the lowest income group compared to the highest income group when measured using objective assessment (Palafox et al 2016) Other studies in both high-income countries and LMICs showed that, compared to objective assessment, self-report provides different estimates of socioeconomic inequalities in the prevalence of hypertension (Beltran-Sanchez and Andrade 2016; Dalstra et al 2005; Johnston et al 2009; Kaplan et al 2010; Vellakkal et al 2013, 2014)
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