Socioeconomic inequality in unhealthy lifestyles across low and middle income countries: a different case than in high income countries

2019 ◽  
Author(s):  
Charlotte Dieteren ◽  
Igna Bonfrer
Keyword(s):  
Alcohol Use ◽  
Tobacco Use ◽  
Concentration Index ◽  
Lifestyle Factors ◽  
Socioeconomic Inequalities ◽  
High Income ◽  
Unhealthy Lifestyle ◽  
Middle Income ◽  
Middle Income Countries ◽  
The Poor

Abstract Background: The link between unhealthy lifestyle factors and non-communicable diseases is evident from a range of studies. Policy makers in high income settings have access to information identifying segments of the population where unhealthy lifestyles are most prevalent. However, this same information for low and middle income countries (LMICs)remains scarce, making it difficult to inform and target effective interventions. This study aims to quantify the prevalence and socioeconomic inequalities in unhealthy lifestyle factors in LMICs and to identify policy priority areas on the path towards the Sustainable Development Goal of reducing deaths from non-communicable diseases by one third in 2030. Methods: Self-reported data from 1,278,624 adults derived from the Demographics & Health Surveys in 22 LMICs between 2013 and 2018 were used to estimate crude prevalence rates and socioeconomic inequalities in BMI, tobacco use, alcohol use and harmful alcohol use. The variation in lifestyle factors across socioeconomic status is measured by means of the Erreygers concentration index. We identify whether countries that invest more in population health are less likely to exhibit large socioeconomic inequalities in unhealthy lifestyles by correlating the percentage of GDP spent on health with the Erreygers concentration index. We use a four quadrant model to identify countries that should be prioritized because of a “double disadvantage” i.e. both a skewed distribution of unhealthy lifestyles towards the poor and low spending on health nationwide. Results: Tobacco and alcohol use is largely concentrated among the poor, while overweight is heavily concentrated among the better-off in LMICs. Clustering of alcohol and tobacco use in individuals as shown for high income countries, is not found for LMICs. Conclusions: This study emphasized that unhealthy lifestyles play an important role in LMICs, and that different unhealthy lifestyle factors vary in their socioeconomic distribution. The targeting of interventions to reduce the burden from unhealthy lifestyles in LMICs should not be simply copied from high income countries but be tailored towards high-risk populations in LMICs. We identified Congo, Tanzania and Zambia as the most disadvantaged countries in our sample, implying that priority should be given to these populations, allowing for the largest health improvements.

scholarly journals Socioeconomic inequalities in lifestyle risk factors across low- and middle-income countries

2021 ◽  
Author(s):  
Charlotte Dieteren ◽  
Igna Bonfrer
Keyword(s):  
Risk Factors ◽  
Alcohol Use ◽  
Tobacco Use ◽  
Socioeconomic Inequalities ◽  
Middle Income ◽  
Lifestyle Risk Factors ◽  
Middle Income Countries ◽  
The Poor ◽  
Harmful Alcohol ◽  
Lifestyle Risk

Abstract Background The heavy and ever rising burden of non-communicable diseases (NCDs) in low- and middle-income countries (LMICs) warrants interventions to reduce their underlying risk factors, which are often linked to lifestyles. To effectively supplement nationwide policies with targeted interventions, it is important to know how these risk factors are distributed across socioeconomic segments of populations in LMICs. This study quantifies the prevalence and socioeconomic inequalities in lifestyle risk factors in LMICs, to identify policy priorities conducive to the Sustainable Development Goal of a one third reduction in deaths from NCDs by 2030. Methods Data from 1,278,624 adult respondents to Demographic & Health Surveys across 22 LMICs between 2013 and 2018 are used to estimate crude prevalence rates and socioeconomic inequalities in tobacco use, overweight, harmful alcohol use and the clustering of these three in a household. Inequalities are measured by a concentration index and correlated with the percentage of GDP spent on health. We estimate a multilevel model to examine associations of individual characteristics with the different lifestyle risk factors. Results The prevalence of tobacco use among men ranges from 59.6% (Armenia) to 6.6% (Nigeria). The highest level of overweight among women is 83.7% (Egypt) while this is less than 12% in Burundi, Chad and Timor-Leste. 82.5% of women in Burundi report that their partner is “often or sometimes drunk” compared to 1.3% in Gambia. Tobacco use is concentrated among the poor, except for the low share of men smoking in Nigeria. Overweight, however, is concentrated among the better off, especially in Tanzania and Zimbabwe (Erreygers Index (EI) 0.227 and 0.232). Harmful alcohol use is more concentrated among the better off in Nigeria (EI 0.127), while Chad, Rwanda and Togo show an unequal pro-poor distribution (EI respectively − 0.147, -0.210, -0.266). Cambodia exhibits the largest socioeconomic inequality in unhealthy household behaviour (EI -0.253). The multilevel analyses confirm that in LMICs, tobacco and alcohol use are largely concentrated among the poor, while overweight is concentrated among the better-off. The associations between the share of GDP spent on health and the socioeconomical distribution of lifestyle factors are multidirectional. Conclusions This study emphasizes the importance of lifestyle risk factors in LMICs and the socioeconomic variation therein. Given the different socioeconomic patterns in lifestyle risk factors - overweight patters in LMICs differ considerably from those in high income countries- tailored interventions towards specific high-risk populations are warranted to supplement nationwide policies.

Socioeconomic inequalities in unhealthy lifestyles in low- and middle-income countries

2020 ◽  
Author(s):  
Charlotte Dieteren ◽  
Igna Bonfrer
Keyword(s):  
Alcohol Use ◽  
Tobacco Use ◽  
Socioeconomic Inequalities ◽  
Individual Characteristics ◽  
Middle Income ◽  
The Sustainable Development ◽  
Middle Income Countries ◽  
The Poor ◽  
Harmful Alcohol ◽  
Low And Middle Income

Abstract Background: The heavy and ever rising burden of non-communicable diseases (NCDs) in low- and middle-income countries (LMICs) warrants interventions to reduce unhealthy lifestyles. To effectively target these interventions, it is important to know how unhealthy lifestyles vary with socioeconomic characteristics. This study quantifies prevalence and socioeconomic inequalities in unhealthy lifestyles in LMICs, to identify policy priorities conducive to the Sustainable Development Goal of a one third reduction in deaths from NCDs by 2030.Methods: Data from 1,278,624 adult respondents to Demographic & Health Surveys across 22 LMICs between 2013 and 2018 are used to estimate crude prevalence rates and socioeconomic inequalities in tobacco use, overweight, harmful alcohol use and the clustering of these three in a household. Inequalities are measured by a concentration index and correlated with the percentage of GDP spent on health. We estimate a multilevel model to examine associations of individual characteristics with different unhealthy lifestyles.Results: The prevalence of tobacco use among men ranges from 59.6% (Armenia) to 6.6% (Nigeria). The highest level of overweight among women is 83.7% (Egypt) while this is less than 12% in Burundi, Chad and Timor-Leste. 82.5% of women in Burundi report that their partner is “often or sometimes drunk” compared to 1.3% in Gambia. Tobacco use is concentrated among the poor, except for the low share of men smoking in Nigeria. Overweight, however, is concentrated among the better off, especially in Tanzania and Zimbabwe (Erreygers Index (EI) 0.227 and 0.232). Harmful alcohol use is more concentrated among the better off in Nigeria (EI 0.127), while Chad, Rwanda and Togo show an unequal pro-poor distribution (EI respectively -0.147, -0.210, -0.266). Cambodia exhibits the largest socioeconomic inequality in unhealthy household behaviour (EI -0.253). The multilevel analyses confirm that in LMICs, tobacco and alcohol use are largely concentrated among the poor, while overweight is concentrated among the better-off.Conclusions: This study emphasizes the importance of unhealthy lifestyles in LMICs and the socioeconomic variation therein. Given the different socioeconomic patterns in unhealthy lifestyles - overweight patters in LMICs differ considerably from those in high income countries- tailored interventions towards specific high-risk populations are warranted.

scholarly journals Socioeconomic inequalities in lifestyle risk factors across low- and middle-income countries

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Charlotte Dieteren ◽  
Igna Bonfrer
Keyword(s):  
Risk Factors ◽  
Alcohol Use ◽  
Tobacco Use ◽  
Socioeconomic Inequalities ◽  
Middle Income ◽  
Lifestyle Risk Factors ◽  
Middle Income Countries ◽  
The Poor ◽  
Harmful Alcohol ◽  
Lifestyle Risk

Abstract Background The heavy and ever rising burden of non-communicable diseases (NCDs) in low- and middle-income countries (LMICs) warrants interventions to reduce their underlying risk factors, which are often linked to lifestyles. To effectively supplement nationwide policies with targeted interventions, it is important to know how these risk factors are distributed across socioeconomic segments of populations in LMICs. This study quantifies the prevalence and socioeconomic inequalities in lifestyle risk factors in LMICs, to identify policy priorities conducive to the Sustainable Development Goal of a one third reduction in deaths from NCDs by 2030. Methods Data from 1,278,624 adult respondents to Demographic & Health Surveys across 22 LMICs between 2013 and 2018 are used to estimate crude prevalence rates and socioeconomic inequalities in tobacco use, overweight, harmful alcohol use and the clustering of these three in a household. Inequalities are measured by a concentration index and correlated with the percentage of GDP spent on health. We estimate a multilevel model to examine associations of individual characteristics with the different lifestyle risk factors. Results The prevalence of tobacco use among men ranges from 59.6% (Armenia) to 6.6% (Nigeria). The highest level of overweight among women is 83.7% (Egypt) while this is less than 12% in Burundi, Chad and Timor-Leste. 82.5% of women in Burundi report that their partner is “often or sometimes drunk” compared to 1.3% in Gambia. Tobacco use is concentrated among the poor, except for the low share of men smoking in Nigeria. Overweight, however, is concentrated among the better off, especially in Tanzania and Zimbabwe (Erreygers Index (EI) 0.227 and 0.232). Harmful alcohol use is more concentrated among the better off in Nigeria (EI 0.127), while Chad, Rwanda and Togo show an unequal pro-poor distribution (EI respectively − 0.147, − 0.210, − 0.266). Cambodia exhibits the largest socioeconomic inequality in unhealthy household behaviour (EI − 0.253). The multilevel analyses confirm that in LMICs, tobacco and alcohol use are largely concentrated among the poor, while overweight is concentrated among the better-off. The associations between the share of GDP spent on health and the socioeconomical distribution of lifestyle factors are multidirectional. Conclusions This study emphasizes the importance of lifestyle risk factors in LMICs and the socioeconomic variation therein. Given the different socioeconomic patterns in lifestyle risk factors - overweight patters in LMICs differ considerably from those in high income countries- tailored interventions towards specific high-risk populations are warranted to supplement nationwide policies.

Educational and wealth inequalities in tobacco use among men and women in 54 low-income and middle-income countries

2016 ◽  
Vol 27 (1) ◽  
pp. 26-34 ◽  
Author(s):  
Chandrashekhar T Sreeramareddy ◽  
Sam Harper ◽  
Linda Ernstsen
Keyword(s):  
Tobacco Use ◽  
Smokeless Tobacco ◽  
Low Income ◽  
Socioeconomic Inequalities ◽  
Educational Inequalities ◽  
Middle Income ◽  
Men And Women ◽  
Middle Income Countries ◽  
Index Of Inequality ◽  
Wealth Inequalities

BackgroundSocioeconomic differentials of tobacco smoking in high-income countries are well described. However, studies to support health policies and place monitoring systems to tackle socioeconomic inequalities in smoking and smokeless tobacco use common in low-and-middle-income countries (LMICs) are seldom reported. We aimed to describe, sex-wise, educational and wealth-related inequalities in tobacco use in LMICs.MethodsWe analysed Demographic and Health Survey data on tobacco use collected from large nationally representative samples of men and women in 54 LMICs. We estimated the weighted prevalence of any current tobacco use (including smokeless tobacco) in each country for 4 educational groups and 4 wealth groups. We calculated absolute and relative measures of inequality, that is, the slope index of inequality (SII) and relative index of inequality (RII), which take into account the distribution of prevalence across all education and wealth groups and account for population size. We also calculated the aggregate SII and RII for low-income (LIC), lower-middle-income (lMIC) and upper-middle-income (uMIC) countries as per World Bank classification.FindingsMale tobacco use was highest in Bangladesh (70.3%) and lowest in Sao Tome (7.4%), whereas female tobacco use was highest in Madagascar (21%) and lowest in Tajikistan (0.22%). Among men, educational inequalities varied widely between countries, but aggregate RII and SII showed an inverse trend by country wealth groups. RII was 3.61 (95% CI 2.83 to 4.61) in LICs, 1.99 (95% CI 1.66 to 2.38) in lMIC and 1.82 (95% CI 1.24 to 2.67) in uMIC. Wealth inequalities among men varied less between countries, but RII and SII showed an inverse pattern where RII was 2.43 (95% CI 2.05 to 2.88) in LICs, 1.84 (95% CI 1.54 to 2.21) in lMICs and 1.67 (95% CI 1.15 to 2.42) in uMICs. For educational inequalities among women, the RII varied much more than SII varied between the countries, and the aggregate RII was 14.49 (95% CI 8.87 to 23.68) in LICs, 3.05 (95% CI 1.44 to 6.47) in lMIC and 1.58 (95% CI 0.33 to 7.56) in uMIC. Wealth inequalities among women showed a pattern similar to that of men: the RII was 5.88 (95% CI 3.91 to 8.85) in LICs, 1.76 (95% CI 0.80 to 3.85) in lMIC and 0.39 (95% CI 0.09 to 1.64) in uMIC. In contrast to men, among women, the SII was pro-rich (higher smoking among the more advantaged) in 13 of the 52 countries (7 of 23 lMIC and 5 of 7 uMIC).InterpretationOur results confirm that socioeconomic inequalities tobacco use exist in LMIC, varied widely between the countries and were much wider in the lowest income countries. These findings are important for better understanding and tackling of socioeconomic inequalities in health in LMIC.

Smoking portrayal in Ethiopian movies: a theory-based content analysis

2018 ◽  
Vol 34 (4) ◽  
pp. 687-696
Author(s):  
Mesfin Awoke Bekalu ◽  
K Viswanath
Keyword(s):  
Content Analysis ◽  
Tobacco Use ◽  
Average Length ◽  
High Income ◽  
Health Consequences ◽  
Middle Income ◽  
Middle Income Countries ◽  
Considerable Research ◽  
Keyword Searches ◽  
Low And Middle Income

Abstract Considerable research from high-income countries has characterized the amount, nature and effects of movie smoking depiction. However, in low- and middle-income countries (LMICs) where tobacco use and tobacco-related diseases are growing, little research has investigated smoking imagery in movies. This study examined the extent and nature of smoking portrayal in locally produced Ethiopian movies, and estimated the number of tobacco impressions movies delivered. Sample movies were taken from YouTube. Keyword searches were conducted using ‘Ethiopian movies’ and ‘Ethiopian drama’ on 18 September 2016. In each search, the first 100 most viewed movies were examined. Excluding repeated results, a total of 123 movies were selected for content analysis. Three coders participated. Results indicated that 86 (69.9%, 95% CI 63–78%) of the 123 most viewed movies contain at least one tobacco incident (TI). The movies depict a total of 403 TIs, with an average of 4.7 (95% CI 3.7–5.6) TIs in each movie. The average length of TIs is 1 min and 11 s. On average, the movies were viewed more than half a million times by September 2016, and received more ‘likes’ than ‘dislikes’, z = −8.05, p = 0.00. They delivered over 194 million tobacco impressions via YouTube alone from July 2012 through September 2016. Most TIs portray smoking as a socially acceptable behavior with no negative health consequences. The findings suggest that as with transnational Western movies, locally produced movies in LMICs should be scrutinized for compliance with national and international regulatory efforts.

scholarly journals Socioeconomic Status and Its Relation to Hypertension in Rural Nepal

2021 ◽  
Vol 2021 ◽  
pp. 1-9
Author(s):  
Sanju Bhattarai ◽  
Birgit Tandstad ◽  
Archana Shrestha ◽  
Biraj Karmacharya ◽  
Abhijit Sen
Keyword(s):  
Blood Pressure ◽  
Socioeconomic Status ◽  
Socioeconomic Factors ◽  
Low Income ◽  
Lifestyle Factors ◽  
High Income ◽  
Middle Income ◽  
Middle Income Countries ◽  
Rural Nepal ◽  
Low And Middle Income

Introduction. Hypertension and its association with socioeconomic positions are well established. However, the gradient of these relationships and the mediating role of lifestyle factors among rural population in low- and middle-income countries such as Nepal are not fully understood. We sought to assess the association between socioeconomic factors (education, income, and employment status) and hypertension. Also, we assessed whether the effect of education and income level on hypertension was mediated by lifestyle factors. Methods. This cross-sectional study was conducted among 260 participants aged ≥18 years attending a rural health center in Dolakha, Nepal. Self-reported data on demographic, socioeconomic, and lifestyle factors were collected, and blood pressure, weight, and height were measured for all study participants. Those with systolic blood pressure ≥140 mm Hg or diastolic blood pressure ≥90 mm Hg or administrating high blood pressure-lowering medicines were regarded as hypertensives. Poisson regression models were used to estimate the prevalence ratios and corresponding 95% confidence intervals to assess the association between socioeconomic factors and hypertension. We explored mediation, using the medeff command in Stata for causal mediation analysis of nonlinear models. Results. Of the 50 hypertensive participants, sixty percent were aware of their status. The age-standardized prevalence of hypertension was two times higher for those with higher education or high-income category. Compared to low-income and unemployed groups, the prevalence ratio of hypertension was 1.33 and 2.26 times more for those belonging to the high-income and employed groups, respectively. No evidence of mediation by lifestyle factors was observed between socioeconomic status and hypertension. Conclusions. Socioeconomic positions were positively associated with hypertension prevalence in rural Nepal. Further studies using longitudinal settings are necessary to validate our findings especially in low- and middle-income countries such as Nepal.

Delivering Drugs to the Poor: Will the TRIPS Amendment Help?

2008 ◽  
Vol 34 (2-3) ◽  
pp. 107-124 ◽  
Author(s):  
Graham Dutfield
Keyword(s):  
Respiratory Infections ◽  
High Income ◽  
Sub Saharan Africa ◽  
Middle Income ◽  
Neonatal Deaths ◽  
Vaccine Preventable Diseases ◽  
Middle Income Countries ◽  
The Poor ◽  
Low And Middle Income ◽  
Hiv Aids

Many of the diseases and health conditions that account for a large part of the disease burden in low- and middle-income countries are far less common in high-income countries. These burdens are primarily associated with infectious diseases, reproductive health, and childhood illnesses. Just eight diseases and conditions account for 29 percent of all deaths in low- and middle-income countries: TB, HIV/AIDS, diarrheal diseases, vaccine-preventable diseases of childhood, malaria, respiratory infections, maternal conditions, and neonatal deaths.Approximately 17.6 million people in low- and middle-income countries die each year from communicable diseases and maternal and neonatal conditions. Both the occurrence of and the death rates from such diseases and conditions are far lower in all high-income countries.Millions of people in developing countries die of diseases for which treatments exist that can relieve suffering and save, or at least prolong, people’s lives. High-profile pandemics like HIV/AIDS understandably attract considerable attention. Millions of people have died of this terrible disease - 2.6 million in 2003 and 2.8 million in 2005, of which Sub-Saharan Africa contributed 1.9 million and 2.0 million respectively. As the above quote makes clear, there are a whole host of diseases that have particularly devastating impacts on the poor.

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