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 ◽  
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.

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.

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.

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