Inequalities In Non-communicable Diseases Research Articles

Socioeconomic inequalities in noncommunicable diseases in Portugal: an analysis of three decades

Abstract Background Least favored people experience poorer health than those with higher socioeconomic (SE) status. These inequalities are mainly due to disparities in noncommunicable diseases (NCD). Over the last decades, Portugal experienced important SE challenges, including the recession, making it fundamental to assess how health inequalities have been affected. Hence, this study aimed to examine the evolution of SE inequalities in the prevalence of NCD in Portugal in the last 32 years. Methods We used data from all the six National Health Interview Surveys (1987, 1995, 1999, 2005, 2014, and 2019). Considering the main causes of morbimortality and data availability, we selected seven self-reported NCD: diabetes, hypertension, stroke, acute myocardial infarction (AMI), chronic obstructive pulmonary disease (COPD), asthma, and depression. We estimated the relative (RII) and absolute (SII) indexes of inequalities using education and income as proxies for SE status, adjusted for sex and age, for each NCD and survey. Results Regarding education, RII decreased until 2005 but increased since 2005 for diabetes (RII87=4.4; RII05=2.0; RII19=2.6) and hypertension (RII87=1.8; RII05=1.3; RII19=1.8). For asthma, RII oscillated until 2005 but increased since then (RII05=0.9; RII19=1.9). Although data for the remaining diseases are only available since 2005, an upward trend in educational RII is noticeable in stroke (RII05= 2.1; RII19=4.3), AMI (RII05=0.9; RII19=3.4), COPD (RII05=1.4; RII19=2.2), and depression (RII05=0.9; RII19=2.1). The results for SII and using income as SE indicator followed similar trends. Conclusions This study found persisting inequalities in NCD, with an increasing trend after 2005. These findings are of concern since they emphasize the persistence of health inequalities and the vulnerability of the most deprived groups to economic crisis. Health and social policies are crucial to attenuate these inequalities, especially considering the announced financial crisis. Key messages • In Portugal, socioeconomic inequalities in noncommunicable diseases have been increasing since 2005. • It is crucial to tackle inequalities in health, especially considering the predicted economic crisis and the vulnerability of the most deprived groups to such events.

Inequidades relacionadas à escolaridade na prevalência de doenças crônicas não transmissíveis: uma análise da Pesquisa Nacional de Saúde, 2013 e 2019

This study assesses changes in the prevalence and distribution of noncommunicable diseases (NCDs) and related risk factors among Brazilian adults from the 2013 and 2019 Brazilian National Health Surveys (PNS). It is based on the hypothesis that deteriorating socioeconomic conditions over this period would lead to increased NCDs among the least advantaged populations. We estimated adjusted prevalence ratios by education category and three inequality measures - the slope index of inequality (SII), the relative index of inequality (RII), and population attributable fraction (PAF) - for obesity, hypertension, arthritis, asthma, cancer, depression, diabetes, heart disease, having any chronic condition, and multimorbidity by survey year. We also estimated the 27 Brazilian Federative Units RII and prevalence rates for diabetes and multimorbidity per year and plotted the RII against prevalence by year. Results showed that all NCDs increased over the period observed, ranging from an 8% increase in the adjusted prevalence of arthritis to a 24% increase in the adjusted prevalence of obesity. Measures of inequality showed that most conditions exhibited significant educational inequities in both 2013 and 2019. However, on average, education-based inequities did not significantly change between the two periods. Considering the deterioration of the socioeconomic conditions of most Brazilians, the erosion of social protections, and the continuing economic, political, and health crises occurring in the nation, we observed an urgent need for discussion about the best way to adopt equity-promoting health policies and programs and action to reduce socioeconomic and geographic inequalities in NCDs throughout the country.

Inequalities in non-communicable diseases across the European Union: current state and trends from 2000 to 2019

Abstract Background Non-communicable diseases (NCDs) remain the leading cause of disease burden in the European Union (EU). However, this burden varies across Member States, driven by the socioeconomic and demographic structure of the populations, as well as health care and social support systems in each country. This geographical gradient in the burden of NCDs represents health inequalities that may have expanded as a result of population ageing, migration, and economic crisis, and historic backgrounds. Methods Using data from the GBD 2019 study, we quantify the inequality gap between EU countries, characterize the geographical gradient of total and individual NCDs, and analyze the trends over the last 20 years. Results A considerable gap exists in the rates of NCD-related DALYs between the country with the lowest burden (Slovenia in 2019) and the highest (Bulgaria in 2019), with a constant (p-trend > 0.05) ratio of 1.6 (95%CI, 1.57; 1.64) since the year 2000. The largest inequality was observed for the burden of stroke between the lowest (France in 2019) and the highest (Bulgaria in 2019) with a ratio of 7.47 (6.78; 8.24) Increasing steadily (p-trend < 0.001) since 2000. Using the relative index of inequality to characterize the gradient of inequalities across the EU, a decreasing trend (p < 0.001) can be observed for NCD-related DALYs rates from 1.56 (1.44; 1.7) in 2000 to in 1.42 (1.33; 1.52) 2019. Conclusions Despite overall improvements in health, spatial disparities related to NCDs in the EU persist. Our estimates provide a baseline to inform future equitable health policies.

Geographical, gender and age inequalities in non-communicable diseases both at national and provincial levels in Iran

Over 80% of deaths due to non-communicable diseases (NCDs) occur in low and middle-income countries, indicating an inequality in the health care system around the world. Conducted studies at provincial level in developed countries have shown that mortality rates due to this group of diseases are higher in the populations with lower education, income, and social class. NCDs account for 71.3% of total world deaths in 2016 and 79.2% of total deaths in Iran in the same year. Improving the health of Iranian population and reducing the number of communicable diseases over the past decades have made NCDs as a major health problem in Iran. In this study, we describe the status of most lethal NCDs in the country at national and provincial level. In addition, study on the inequality of deaths due to NCDs at provincial level in Iran showed that there is a considerable difference between different provinces. Furthermore, there is an age inequality so that mortality of main NCDs increased dramatically after the age of 70. Therefore, health policy makers and decision makers should adopt appropriate policies to reduce gender, geographic and age disparities to reduce gender and inter-provincial inequalities in Iran.

The contribution of employment and working conditions to occupational inequalities in non-communicable diseases in Europe.

BackgroundSocial inequalities in non-communicable diseases (NCDs) are evident across all European regions. Employment and working conditions are important determinants of NCDs, however, few comparative studies have examined how these conditions contribute to health inequalities. This study therefore examines the association of non-standard employment and poor working conditions with occupational inequalities in multiple NCDs and whether there are differences by gender and across European regions.MethodsWe used cross-sectional data from 20 European countries for women and men aged 25–75 (n = 19 876), from round 7 of the European Social Survey. Data were analyzed for self-rated health (SRH) and 9 NCDs: heart/circulatory problems, high blood pressure, arm/hand pain, breathing problems, diabetes, severe headaches, cancer, obesity and depression. We used logistic regression models, stratified by gender, and adjusted rate ratios to examine whether occupational inequalities in NCDs were reduced after adjusting for non-standard employment and poor working conditions, across European regions.ResultsAfter adjustment, occupational inequalities were significantly reduced across all regions of Europe. Reductions were particularly large among the lowest occupational group and for poor-SRH, depression and obesity. For these conditions, reductions were in the range of 60–99%.ConclusionsEmployment and working conditions are important determinants of occupational inequalities in NCDs. Labour market regulations should therefore be considered in the formulation of NCD prevention strategies.

Intersecting gender inequalities in non-communicable disease risk factors in Kerala: A primary study

Abstract Evidence globally and in India indicates intersecting gender inequalities in Non-Communicable Diseases (NCDs) risk factors. These are understudied in Kerala, which is at an advanced stage of an epidemiological transition. We estimated sex differences in self-reported prevalence and screening coverage of blood pressure (BP) and blood glucose (BG) grouped by the socio-economic status. A multistage cluster random sampling survey of 3398 women and 2982 men was conducted in 4 districts of Kerala from July to October 2019. Descriptive, Relative Concentration Index (RCI) for age, wealth and education and Population Attributed Fraction (PAF) for caste/tribal groups and religion were computed using Stata 12 and WHO's Health Equity Assessment Toolkit (HEAT) Plus. More women reported BP and BG screening than men (BP - W: 90.3%; 95%CI: (89.1, 91.4) vs M: 80.8%; 95%CI: (78.5, 82.9); BG- W: 86.2%; 95%CI: 84.9, 87.4 vs M: 78.3%; (95%CI: 75.9, 80.6)).BP prevalence was significantly higher among women than men (BP - W: 11.2%; 95%CI: (9.0, 13.9) vs M: 7.9%; 95%CI: (6.6, 9.6). BP screening was concentrated among less educated women (WRCI: -0.2: 95%CI: -0.2, -0.1), older (WRCI: 0.3: 95%CI: 0.2, 0.4; MRCI: 0.5: 95%CI: 0.4,0.7) and wealthier populations (WRCI: 0.1: 95%CI: 0.03, 0.2; MRCI: 0.3: 95%CI: 0.1, 0.4).High BP was concentrated among more educated women (WRCI: 0.9: 95%CI: 0.1, 1.6) and less educated men (MRCI: -1.6: 95%CI: -2.6, -0.6). High BG was concentrated among less educated women (WRCI: -1.6: 95%CI: -2.4, -0.8) and more educated men (MRCI: 0.9: 95%CI: -0.1, -1.6). Religion inequality in high BG among women was -19.1(95%CI:-28.0, -10.2).We found distinct patterns of sex related inequalities in NCD risk factors in Kerala. There is a need for greater screening among men but also sub populations of women who may be under-served by screening services. These patterns require further exploration to understand contexts and pathways to ensure program design leaves no one behind. Key messages Intersecting gender inequalities in prevalence and screening coverage of NCD risk factors in Kerala, India. NCD screening should reach all gender equitably despite of their social economic status.

Temporal trends in educational inequalities in non-communicable diseases in Korea, 2007-2015.

BackgroundSocioeconomic inequalities in non-communicable diseases are known to exist; however there is a paucity of research describing the secular trends in these inequalities. To this end, the current study aims to explore the recent time trends in social patterning of selected non-communicable diseases among Korean adults between 2007 and 2015.MethodsUsing data from the Korea National Health and Nutrition Examination Survey (KNHANES), temporal trends in socioeconomic inequalities in diabetes, arthritis, asthma and depressive symptoms were assessed across three time points. Respondents were adults aged 20 years or over (N = 47,091, 20,180 men and 26,911 women). Socioeconomic circumstance was assessed based on highest level of educational attainment. We estimated prevalence ratios with 95% confidence intervals using Poisson regression with robust variance estimation (adjusted for age, smoking status, alcohol consumption, obesity, and physical activity) separately for men and women. The magnitude of the inequalities was computed using the relative index of inequality (RII).ResultsIn men, diabetes was not associated with educational attainment, while there was evidence of a negative association in women across surveys. Similar inverse associations were found with arthritis and depressive symptoms, but these associations were less clear for asthma. RII showed a non-significant increasing trend in educational disparities in depressive symptoms. Meanwhile, relative inequalities in diabetes, arthritis and asthma have narrowed. These trends were, in general, more pronounced in women.ConclusionsThe findings of this study indicate higher burden of selected NCDs among the lower educational groups, particularly among women. In addition, our results indicated some improvements in inequalities in diabetes, arthritis and asthma in recent years. These findings have important implications for understanding the causes of social patterning of NCDs and for the targeting of effective interventions.

Occupational inequalities in self-rated health and non-communicable diseases in different regions of Europe: findings from the European Social Survey (2014) special module on the social determinants of health.

Socioeconomic inequalities in the prevalence of non-communicable diseases (NCDs) are evident across European populations. Several previous studies have addressed the question of whether occupational inequalities in health differ across European regions. It is uncertain however, the degree to which occupational inequalities in NCDs are similar or dissimilar across different European regions. Using 2014 European Social Survey data from 20 countries, this article examines occupational inequalities in poor self-rated health (SRH) and 14 self-reported NCDs separately for women and men, by European region: heart/circulatory problems, high blood pressure, back pain, arm/hand pain, foot/leg pain, allergies, breathing problems, stomach/digestion problems, skin conditions, diabetes, severe headaches, cancer, obesity and depression. Age-controlled adjusted risk ratios were calculated and separately compared a working class and intermediate occupational group with a salariat group. Working class Europeans appear to have the highest risk of reporting poor SRH and a number of NCDs. We find inequalities in some NCDS to be the largest in the Northern region, suggesting further evidence of a Nordic paradox. Like some previous work, we did not find larger inequalities in poor SRH in the Central/East region. However, we did find the largest inequalities in this region for some NCDs. Our results do not align completely with previous work which finds smaller health inequalities in Southern Europe. This work provides a first look at occupational inequalities across a range of NCDs for European men and women by region. Future work is needed to identify the underlying determinants behind regional differences.

The contribution of housing and neighbourhood conditions to educational inequalities in non-communicable diseases in Europe: findings from the European Social Survey (2014) special module on the social determinants of health.

Social gradients have been found across European populations, where less affluent groups are more often affected by poor housing and neighbourhood conditions. While poor housing and neighbourhood quality have been associated with a range of non-communicable diseases (NCDs), these conditions have rarely been applied to the examination of socioeconomic differences in NCDs. This study therefore asks ‘to what extent does adjusting for poor housing and neighbourhood conditions reduce inequalities in NCDs among men and women in Europe’? Our analysis used pooled-data from 20 European countries for women (n= 12 794) and men (n= 11 974), aged 25–75, from round 7 of the European Social Survey. Fourteen NCDs were investigated: heart/circulatory problems, high blood pressure, back pain, arm/hand pain, foot/leg pain, allergies, breathing problems, stomach/digestion problems, skin conditions, diabetes, severe headaches, cancer, obesity and depression. We used binary logistic regression models, stratified by gender, and adjusted rate ratios to examine whether educational inequalities in NCDs were reduced after controlling for poor housing and neighbourhood quality. Overall, we find that adjusting for poor housing and neighbourhood quality reduces inequalities in NCDs. While reductions were relatively small for some NCDs–for high blood pressure, reductions were found in the range of 0–4.27% among women—for other conditions reductions were more considerable. Controlling for both housing and neighbourhood conditions for example, reduced inequalities by 16–24% for severe headaches and 14–30% for breathing problems. Social gradients in poor housing and neighbourhood quality could be an important contributor to educational inequalities in some NCDs.

The socioeconomic distribution of non-communicable diseases in Europe: findings from the European Social Survey (2014) special module on the social determinants of health.

A range of non-communicable diseases (NCDs) has been found to follow a social pattern whereby socioeconomic status predicts either a higher or lower risk of disease. Comprehensive evidence on the socioeconomic distribution of NCDs across Europe, however, has been limited. Using cross-sectional 2014 European Social Survey data from 20 countries, this paper examines socioeconomic inequalities in 14 self-reported NCDs separately for women and men: heart/circulatory problems, high blood pressure, back pain, arm/hand pain, foot/leg pain, allergies, breathing problems, stomach/digestion problems, skin conditions, diabetes, severe headaches, cancer, obesity and depression. Using education to measure socioeconomic status, age-controlled adjusted risk ratios were calculated and separately compared a lower and medium education group with a high education group. At the pooled European level, a social gradient in health was observed for 10 NCDs: depression, diabetes, obesity, heart/circulation problems, hand/arm pain, high blood pressure, breathing problems, severe headaches, foot/leg pain and cancer. An inverse social gradient was observed for allergies. Social gradients were observed among both genders, but a greater number of inequalities were observed among women. Country-specific analyses show that inequalities in NCDs are present everywhere across Europe and that inequalities exist to different extents for each of the conditions. This study provides the most up-to-date overview of socioeconomic inequalities for a large number of NCDs across 20 European countries for both women and men. Future investigations should further consider the diseases, and their associated determinants, for which socioeconomic differences are the greatest.

Socioeconomic inequalities in non-communicable diseases and their risk factors: an overview of systematic reviews.

BackgroundNon-communicable diseases (NCDs) are the largest cause of premature death worldwide. Socioeconomic inequalities contribute to a disparity in the burden of NCDs among disadvantaged and advantaged populations in low (LIC), middle (MIC), and high income countries (HIC). We conducted an overview of systematic reviews to systematically and objectively assess the available evidence on socioeconomic inequalities in relation to morbidity and mortality of NCDs and their risk factors.MethodsWe searched PubMed, The Cochrane Library, EMBASE, SCOPUS, Global Health, and Business Source Complete for relevant systematic reviews published between 2003 and December 2013. Two authors independently screened abstracts and full-text publications and determined the risk of bias of the included systematic reviews.ResultsWe screened 3302 abstracts, 173 full-text publications and ultimately included 22 systematic reviews. Most reviews had major methodological shortcomings; however, our synthesis showed that having low socioeconomic status (SES) and/or living in low and middle income countries (LMIC) increased the risk of developing cardiovascular diseases (CVD), lung and gastric cancer, type 2 diabetes, and chronic obstructive pulmonary disease (COPD). Furthermore, low SES increased the risk of mortality from lung cancer, COPD, and reduced breast cancer survival in HIC. Reviews included here indicated that lower SES is a risk factor for obesity in HIC, but this association varied by SES measure. Early case fatalities of stroke were lower and survival of retinoblastoma was higher in MIC compared to LIC.ConclusionsThe current evidence supports an association between socioeconomic inequalities and NCDs and risk factors for NCDs. However, this evidence is incomplete and limited by the fairly low methodological quality of the systematic reviews, including shortcomings in the study selection and quality assessment process.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-015-2227-y) contains supplementary material, which is available to authorized users.

Non-communicable diseases: 2015 to 2025

Non-communicable diseases: 2015 to 2025

Heavy burden of non-communicable diseases at early age and gender disparities in an adult population of Burkina Faso: world health survey

BackgroundWHO estimates suggest that age-specific death rates from non-communicable diseases are higher in sub-Saharan Africa than in high-income countries. The objectives of this study were to examine, in Burkina Faso, the prevalence of non-communicable disease symptoms by age, gender, socioeconomic group and setting (rural/urban), and to assess gender and socioeconomic inequalities in the prevalence of these symptoms.MethodsWe obtained data from the Burkina Faso World Health Survey, which was conducted in an adult population (18 years and over) with a high response rate (4822/4880 selected individuals). The survey used a multi-stage stratified random cluster sampling strategy to identify participants. The survey collected information on socio-demographic and economic characteristics, as well as data on symptoms of a variety of health conditions. Our study focused on joint disease, back pain, angina pectoris, and asthma. We estimated prevalence correcting for the sampling design. We used multiple Poisson regression to estimate associations between non-communicable disease symptoms, gender, socioeconomic status and setting.ResultsThe overall crude prevalence and 95% confidence intervals (CI) were: 16.2% [13.5; 19.2] for joint disease, 24% [21.5; 26.6] for back pain, 17.9% [15.8; 20.2] for angina pectoris, and 11.6% [9.5; 14.2] for asthma. Consistent relationships between age and the prevalence of non-communicable disease symptoms were observed in both men and women from rural and urban settings. There was markedly high prevalence in all conditions studied, starting with young adults. Women presented higher prevalence rates of symptoms than men for all conditions: prevalence ratios and 95% CIs were 1.20 [1.01; 1.43] for joint disease, 1.42 [1.21; 1.66] for back pain, 1.68 [1.39; 2.04] for angina pectoris, and 1.28 [0.99; 1.65] for asthma. Housewives and unemployed women had the highest prevalence rates of non-communicable disease symptoms.ConclusionsOur work suggests that social inequality extends into the distribution of non-communicable diseases among social groups and supports the thesis of a differential vulnerability in Burkinabè women. It raises the possibility of an abnormally high rate of premature morbidity that could manifest as a form of premature aging in the adult population. Increased prevention, screening and treatment are needed in Burkina Faso to address high prevalence and gender inequalities in non-communicable diseases.