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BMC Public Health
Published in: BMC Public Health 1/2012

Open Access 01-12-2012 | Research article

Socioeconomic inequality in the prevalence of noncommunicable diseases in low- and middle-income countries: Results from the World Health Survey

Authors: Ahmad Reza Hosseinpoor, Nicole Bergen, Shanthi Mendis, Sam Harper, Emese Verdes, Anton Kunst, Somnath Chatterji

Published in: BMC Public Health | Issue 1/2012

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Abstract

Background

Noncommunicable diseases are an increasing health concern worldwide, but particularly in low- and middle-income countries. This study quantified and compared education- and wealth-based inequalities in the prevalence of five noncommunicable diseases (angina, arthritis, asthma, depression and diabetes) and comorbidity in low- and middle-income country groups.

Methods

Using 2002–04 World Health Survey data from 41 low- and middle-income countries, the prevalence estimates of angina, arthritis, asthma, depression, diabetes and comorbidity in adults aged 18 years or above are presented for wealth quintiles and five education levels, by sex and country income group. Symptom-based classification was used to determine angina, arthritis, asthma and depression rates, and diabetes diagnoses were self-reported. Socioeconomic inequalities according to wealth and education were measured absolutely, using the slope index of inequality, and relatively, using the relative index of inequality.

Results

Wealth and education inequalities were more pronounced in the low-income country group than the middle-income country group. Both wealth and education were inversely associated with angina, arthritis, asthma, depression and comorbidity prevalence, with strongest inequalities reported for angina, asthma and comorbidity. Diabetes prevalence was positively associated with wealth and, to a lesser extent, education. Adjustments for confounding variables tended to decrease the magnitude of the inequality.

Conclusions

Noncommunicable diseases are not necessarily diseases of the wealthy, and showed unequal distribution across socioeconomic groups in low- and middle-income country groups. Disaggregated research is warranted to assess the impact of individual noncommunicable diseases according to socioeconomic indicators.
Appendix
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Literature
1.
World Health Organization: 2008–2013 action plan for the global strategy for the prevention and control of noncommunicable diseases: prevent and control cardiovascular diseases, cancers, chronic respiratory diseases and diabetes. 2008, World Health Organization, Geneva
2.
Magnusson RS: Global health governance and the challenge of chronic, non-communicable disease. J Law Med Ethics. 2010, 38: 490-507. 10.1111/j.1748-720X.2010.00508.x.CrossRefPubMed
3.
World Health Organization: World Health Organization: Global status report on noncommunicable diseases. 2011, World Health Organization, Geneva
4.
Moussavi S, Chatterji S, Verdes E, Tandon A, Patel V, Ustun B: Depression, chronic diseases, and decrements in health: results from the World Health Surveys. Lancet. 2007, 370: 851-858. 10.1016/S0140-6736(07)61415-9.CrossRefPubMed
5.
Gabriel SE: The epidemiology of rheumatoid arthritis. Rheum Dis Clin North Am. 2001, 27: 269-281. 10.1016/S0889-857X(05)70201-5.CrossRefPubMed
6.
Leeder S, Raymond S, Greenberg H, Liu H, Esson K: A race against time: the challenge of cardiovascular disease in developing economies. 2004, The Center for Global Health and Economic Development, New York
7.
Kaplan GA, Keil JE: Socioeconomic factors and cardiovascular disease: a review of the literature. Circulation. 1993, 88: 1973-1998. 10.1161/01.CIR.88.4.1973.CrossRefPubMed
8.
Theme-Filha MM, Szwarcwald CL, Souza-Junior PR: Socio-demographic characteristics, treatment coverage, and self-rated health of individuals who reported six chronic diseases in Brazil, 2003. Cad Saude Publica. 2005, 21 (Suppl): 43-53.PubMed
9.
Dalstra JA, Kunst AE, Borrell C, Breeze E, Cambois E, Costa G, Geurts JJ, Lahelma E, Van OH, Rasmussen NK, Regidor E, Spadea T, Mackenbach JP: Socioeconomic differences in the prevalence of common chronic diseases: an overview of eight European countries. Int J Epidemiol. 2005, 34: 316-326. 10.1093/ije/dyh386.CrossRefPubMed
10.
Liu L, Ma J, Yin X, Kelepouris E, Eisen HJ: Global variability in angina pectoris and its association with body mass index and poverty. Am J Cardiol. 2011, 107: 655-661. 10.1016/j.amjcard.2010.10.040.CrossRefPubMed
11.
Lee G, Carrington M: Tackling heart disease and poverty. Nurs Health Sci. 2007, 9: 290-294. 10.1111/j.1442-2018.2007.00363.x.CrossRefPubMed
12.
Callahan LF: Social epidemiology and rheumatic disease. Curr Opin Rheumatol. 2003, 15: 110-115. 10.1097/00002281-200303000-00004.CrossRefPubMed
13.
Callahan LF, Shreffler J, Mielenz T, Schoster B, Kaufman JS, Xiao C, Randolph R, Sloane PD: Arthritis in the family practice setting: associations with education and community poverty. Arthritis Rheum. 2008, 59: 1002-1008. 10.1002/art.23834.CrossRefPubMed
14.
Bengtsson C, Nordmark B, Klareskog L, Lundberg I, Alfredsson L: Socioeconomic status and the risk of developing rheumatoid arthritis: results from the Swedish EIRA study. Ann Rheum Dis. 2005, 64: 1588-1594. 10.1136/ard.2004.031666.CrossRefPubMedPubMedCentral
15.
Busija L, Hollingsworth B, Buchbinder R, Osborne RH: Role of age, sex, and obesity in the higher prevalence of arthritis among lower socioeconomic groups: a population-based survey. Arthritis Rheum. 2007, 57: 553-561. 10.1002/art.22686.CrossRefPubMed
16.
Canizares M, Power JD, Perruccio AV, Badley EM: Association of regional racial/cultural context and socioeconomic status with arthritis in the population: a multilevel analysis. Arthritis Rheum. 2008, 59: 399-407. 10.1002/art.23316.CrossRefPubMed
17.
Callahan LF, Shreffler J, Siaton BC, Helmick CG, Schoster B, Schwartz TA, Chen JC, Renner JB, Jordan JM: Limited educational attainment and radiographic and symptomatic knee osteoarthritis: a cross-sectional analysis using data from the Johnston County (North Carolina) Osteoarthritis Project. Arthritis Res Ther. 2010, 12: R46-10.1186/ar2956.CrossRefPubMedPubMedCentral
18.
Stewart AW, Mitchell EA, Pearce N, Strachan DP, Weiland SK: The relationship of per capita gross national product to the prevalence of symptoms of asthma and other atopic diseases in children (ISAAC). Int J Epidemiol. 2001, 30: 173-179. 10.1093/ije/30.1.173.CrossRefPubMed
19.
Sembajwe G, Cifuentes M, Tak SW, Kriebel D, Gore R, Punnett L: National income, self-reported wheezing and asthma diagnosis from the World Health Survey. Eur Respir J. 2010, 35: 279-286. 10.1183/09031936.00027509.CrossRefPubMed
20.
Volmer T: The socio-economics of asthma. Pulm Pharmacol Ther. 2001, 14: 55-60. 10.1006/pupt.2000.0268.CrossRefPubMed
21.
Lai CK, Beasley R, Crane J, Foliaki S, Shah J, Weiland S: Global variation in the prevalence and severity of asthma symptoms: phase three of the International Study of Asthma and Allergies in Childhood (ISAAC). Thorax. 2009, 64: 476-483. 10.1136/thx.2008.106609.CrossRefPubMed
22.
Littlejohns P, Macdonald LD: The relationship between severe asthma and social class. Respir Med. 1993, 87: 139-143. 10.1016/0954-6111(93)90142-M.CrossRefPubMed
23.
Patel V: Cultural factors and international epidemiology. Br Med Bull. 2001, 57: 33-45. 10.1093/bmb/57.1.33.CrossRefPubMed
24.
Lorant V, Deliege D, Eaton W, Robert A, Philippot P, Ansseau M: Socioeconomic inequalities in depression: a meta-analysis. Am J Epidemiol. 2003, 157: 98-112. 10.1093/aje/kwf182.CrossRefPubMed
25.
Connolly V, Unwin N, Sherriff P, Bilous R, Kelly W: Diabetes prevalence and socioeconomic status: a population based study showing increased prevalence of type 2 diabetes mellitus in deprived areas. J Epidemiol Community Health. 2000, 54: 173-177. 10.1136/jech.54.3.173.CrossRefPubMedPubMedCentral
26.
Glover JD, Hetzel DM, Tennant SK: The socioeconomic gradient and chronic illness and associated risk factors in Australia. Aust New Zealand Health Policy. 2004, 1: 8-10.1186/1743-8462-1-8.CrossRefPubMedPubMedCentral
27.
Goyal A, Bhatt DL, Steg PG, Gersh BJ, Alberts MJ, Ohman EM, Corbalan R, Eagle KA, Gaxiola E, Gao R, Goto S, D'Agostino RB, Califf RM, Smith SC, Wilson PW: Attained educational level and incident atherothrombotic events in low- and middle-income compared with high-income countries. Circulation. 2010, 122: 1167-1175. 10.1161/CIRCULATIONAHA.109.919274.CrossRefPubMed
28.
Fleischer NL, Diez Roux AV, Alazraqui M, Spinelli H: Social patterning of chronic disease risk factors in a Latin American city. J Urban Health. 2008, 85: 923-937. 10.1007/s11524-008-9319-2.CrossRefPubMedPubMedCentral
29.
Minh HV, Huong DL, Giang KB: Self-reported chronic diseases and associated sociodemographic status and lifestyle risk factors among rural Vietnamese adults. Scand J Public Health. 2008, 36: 629-634. 10.1177/1403494807086977.CrossRefPubMed
30.
Van MH, Ng N, Juvekar S, Razzaque A, Ashraf A, Hadi A, Soonthornthada K, Kanungsukkasem U, Bich TH, Byass P: Self-reported prevalence of chronic diseases and their relation to selected sociodemographic variables: a study in INDEPTH Asian sites, 2005. Prev Chronic Dis. 2008, 5: A86-
31.
32.
Alwan A, Maclean DR, Riley LM, DESpaignet ET, Mathers CD, Stevens GA, Bettcher D: Monitoring and surveillance of chronic non-communicable diseases: progress and capacity in high-burden countries. Lancet. 2010, 376: 1861-1868. 10.1016/S0140-6736(10)61853-3.CrossRefPubMed
33.
Yach D, Kellogg M, Voute J: Chronic diseases: an increasing challenge in developing countries. Trans R Soc Trop Med Hyg. 2005, 99: 321-324. 10.1016/j.trstmh.2005.02.001.CrossRefPubMed
34.
A prioritized research agenda for prevention and control of noncommunicable diseases. Edited by: Mendis S, Alwan A. 2011, World Health Organization, Geneva, 11-
35.
Wissow LS: Diabetes, poverty, and Latin America. Patient Educ Couns. 2006, 61: 169-170. 10.1016/j.pec.2006.03.007.CrossRefPubMed
36.
37.
Ustun TB, Chatterji S, Mechbal A, Murray CJL: The World Health Surveys. In Health systems performance assessment debates, methods and empiricisms. Edited by: Murray C, Evans D. 2003, World Health Organization, Geneva, 97-808.
38.
39.
Hosseinpoor AR, Stewart Williams J, Amin A, Araujo DC I, Beard J, Boerma T, Kowal P, Naidoo N, Chatterji S: Social determinants of self-reported health in women and men: understanding the role of gender in population health. PLoS One. 2012, 7: e34799-10.1371/journal.pone.0034799.CrossRefPubMedPubMedCentral
40.
World Bank: World Development Report 2003: Sustainable development in a dynamic world. Transforming institutions, growth and quality of life. 2002, World Bank, Washington DCCrossRef
41.
Rose G: The diagnosis of ischaemic heart pain and intermittent claudication in field surveys. Bull World Health Organ. 1962, 27: 645-658.PubMedPubMedCentral
42.
Veenhof C, Bijlsma JW, van den Ende CH, van Dijk GM, Pisters MF, Dekker J: Psychometric evaluation of osteoarthritis questionnaires: a systematic review of the literature. Arthritis Rheum. 2006, 55: 480-492. 10.1002/art.22001.CrossRefPubMed
43.
Pekkanen J, Pearce N: Defining asthma in epidemiological studies. Eur Respir J. 1999, 14: 951-957. 10.1034/j.1399-3003.1999.14d37.x.CrossRefPubMed
44.
Torén K, Brisman J, Järvholm B: Asthma and asthma-like symptoms in adults assessed by questionnaires. Chest. 1993, 104: 600-608. 10.1378/chest.104.2.600.CrossRefPubMed
45.
World Health Organization: The ICD-10 classification of mental and behavioural disorders: diagnosis criteria for research (DCR-10). 1993, World Health Organization, Geneva
46.
Kessler RC, Ustun TB: The World Mental Health (WMH) Survey Initiative Version of the World Health Organization (WHO) Composite International Diagnostic Interview (CIDI). Int J Methods Psychiatr Res. 2004, 13: 93-121. 10.1002/mpr.168.CrossRefPubMed
47.
Armitage P, Berry G, Matthews JNS: Statistical methods in epidemiology. Statistical methods in medical research. 4th edition. 2002, Blackwell Science Ltd, Malden, 648-716.CrossRef
48.
Gakidou E, Oza S, Vidal FC, Li AY, Lee DK, Sousa A, Hogan MC, Vander HS, Ezzati M: Improving child survival through environmental and nutritional interventions: the importance of targeting interventions toward the poor. JAMA. 2007, 298: 1876-1887. 10.1001/jama.298.16.1876.CrossRefPubMed
49.
Ferguson BD, Tandon A, Gakidou E, Murray CJ: Estimating permanent income using asset and indicator variables. Health systems performance assessment: debates, methods and empiricism. Edited by: Murray CJL, Evans DB. 2003, World Health Organization, Geneva, 747-760.
50.
Hosseinpoor AR, Mohammad K, Majdzadeh R, Naghavi M, Abolhassani F, Sousa A, Speybroeck N, Jamshidi HR, Vega J: Socioeconomic inequality in infant mortality in Iran and across its provinces. Bull World Health Organ. 2005, 83: 837-844.PubMedPubMedCentral
51.
Ahmad O, Boschi-Pint C, Lopez A, Murray C, Lozano R, Inoue M: Age standardization of rates: a new WHO standard. 2001, World Health Organization, Geneva
52.
Harper S, Lynch J: Measuring inequalities in health. Methods in social epidemiology. Edited by: Oakes J, Kaufman JS. 2006, Jossey-Bass, San Francisco, 134-168.
53.
Barros AJ, Hirakata VN: Alternatives for logistic regression in cross-sectional studies: an empirical comparison of models that directly estimate the prevalence ratio. BMC Med Res Methodol. 2003, 3: 21-10.1186/1471-2288-3-21.CrossRefPubMedPubMedCentral
54.
Mackenbach JP, Stirbu I, Roskam AJ, Schaap MM, Menvielle G, Leinsalu M, Kunst AE: Socioeconomic inequalities in health in 22 European countries. N Engl J Med. 2008, 358: 2468-2481. 10.1056/NEJMsa0707519.CrossRefPubMed
55.
Royston P: Multiple imputation of missing values: update. The Stata Journal. 2005, 5: 188-201.
56.
57.
Eagan TM, Gulsvik A, Eide GE, Bakke PS: The effect of educational level on the incidence of asthma and respiratory symptoms. Respir Med. 2004, 98: 730-736. 10.1016/j.rmed.2004.02.008.CrossRefPubMed
58.
Li X, Sundquist J, Sundquist K: Socioeconomic and occupational groups and risk of asthma in Sweden. Occup Med (Lond). 2008, 58: 161-168. 10.1093/occmed/kqn009.CrossRef
59.
Yunming L, Changsheng C, Haibo T, Wenjun C, Shanhong F, Yan M, Yongyong X, Qianzhen H: Prevalence and risk factors for depression in older people in Xi'an China: a community-based study. Int J Geriatr Psychiatry. 2012, 27: 31-39. 10.1002/gps.2685.CrossRefPubMed
60.
Muhammad Gadit AA, Mugford G: Prevalence of depression among households in three capital cities of Pakistan: need to revise the mental health policy. PLoS One. 2007, 2: e209-10.1371/journal.pone.0000209.CrossRefPubMedPubMedCentral
61.
Lee J: Pathways from Education to Depression. J Cross Cult Gerontol. 2011, 26: 121-135. 10.1007/s10823-011-9142-1.CrossRefPubMed
62.
Hamad R, Fernald LC, Karlan DS, Zinman J: Social and economic correlates of depressive symptoms and perceived stress in South African adults. J Epidemiol Community Health. 2008, 62: 538-544. 10.1136/jech.2007.066191.CrossRefPubMed
63.
Commission on Social Determinants of Health: Closing the gap in a generation: health equity through action on the social determinants of health: final report of the commission on social determinants of health. 2008, World Health Organization, Geneva
64.
World Health Organization: Preventing chronic diseases: a vital investment: WHO global report. 2005, World Health Organization, Geneva
65.
Unwin N, Alberti KG: Chronic non-communicable diseases. Ann Trop Med Parasitol. 2006, 100: 455-464. 10.1179/136485906X97453.CrossRefPubMed
66.
Acosta D, Rottbeck R, Rodriguez JG, Gonzalez LM, Almanzar MR, Minaya SN, Ortiz MC, Ferri CP, Prince MJ: The prevalence and social patterning of chronic diseases among older people in a population undergoing health transition. A 10/66 Group cross-sectional population-based survey in the Dominican Republic. BMC Public Health. 2010, 10: 344-10.1186/1471-2458-10-344.CrossRefPubMedPubMedCentral
67.
Singh R, Bhansali A, Sialy R, Aggarwal A: Prevalence of metabolic syndrome in adolescents from a north Indian population. Diabet Med. 2007, 24: 195-199. 10.1111/j.1464-5491.2007.02066.x.CrossRefPubMed
68.
Reddy KS: Cardiovascular diseases in the developing countries: dimensions, determinants, dynamics and directions for public health action. Public Health Nutr. 2002, 5: 231-237.CrossRefPubMed
69.
70.
Fortin M, Lapointe L, Hudon C, Vanasse A, Ntetu AL, Maltais D: Multimorbidity and quality of life in primary care: a systematic review. Health Qual Life Outcomes. 2004, 2: 51-10.1186/1477-7525-2-51.CrossRefPubMedPubMedCentral
71.
Alonso J, Ferrer M, Gandek B, Ware JE, Aaronson NK, Mosconi P, Rasmussen NK, Bullinger M, Fukuhara S, Kaasa S, Leplege A: Health-related quality of life associated with chronic conditions in eight countries: results from the International Quality of Life Assessment (IQOLA) Project. Qual Life Res. 2004, 13: 283-298.CrossRefPubMed
72.
Ball HA, Siribaddana SH, Kovas Y, Glozier N, McGuffin P, Sumathipala A, Hotopf M: Epidemiology and symptomatology of depression in Sri Lanka: a cross-sectional population-based survey in Colombo District. J Affect Disord. 2010, 123: 188-196. 10.1016/j.jad.2009.08.014.CrossRefPubMedPubMedCentral
73.
World Health Organization: Global health risks: mortality and burden of disease attributable to selected major risks. 2009, World Health Organization, Geneva
74.
Abegunde DO, Mathers CD, Adam T, Ortegon M, Strong K: The burden and costs of chronic diseases in low-income and middle-income countries. Lancet. 2007, 370: 1929-1938. 10.1016/S0140-6736(07)61696-1.CrossRefPubMed
75.
Kehoe R, Wu SY, Leske MC, Chylack LT: Comparing self-reported and physician-reported medical history. Am J Epidemiol. 1994, 139: 813-818.PubMed
76.
Mackenbach JP, Looman CW, van der Meer JB: Differences in the misreporting of chronic conditions, by level of education: the effect on inequalities in prevalence rates. Am J Public Health. 1996, 86: 706-711. 10.2105/AJPH.86.5.706.CrossRefPubMedPubMedCentral
77.
Greenberg H, Raymond SU, Leeder SR: Cardiovascular disease and global health: threat and opportunity. Health Aff (Millwood). 2005, Web Suppl: W5 31-W5 41.
78.
Stuckler D, Basu S, McKee M: Commentary: UN high level meeting on non-communicable diseases: an opportunity for whom?. In BMJ. 2011, 343: d5336-10.1136/bmj.d5336.CrossRef
Metadata
Title
Socioeconomic inequality in the prevalence of noncommunicable diseases in low- and middle-income countries: Results from the World Health Survey
Authors
Ahmad Reza Hosseinpoor
Nicole Bergen
Shanthi Mendis
Sam Harper
Emese Verdes
Anton Kunst
Somnath Chatterji
Publication date
01-12-2012
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2012
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/1471-2458-12-474

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