Socioeconomic status and prevalence of chronic non-communicable diseases in Chinese women: a structural equation modelling approach

Beyond Numbers: Decoding the Gendered Tapestry of Non-Communicable Diseases in India

INTRODUCTION

Non-communicable diseases (NCDs) represent a major global health challenge, particularly in low- and middle-income countries like India, with significant gender disparities in mortality and disease burden. This study aims to investigate these disparities, using data from national health surveys, to inform gender-specific public health strategies and align with global health goals.

METHODOLOGY

The study uses data from the Longitudinal Aging Study in India (LASI) and National Family Health Surveys (NFHS-4 and NFHS-5).

RESULT

The results from the Longitudinal Ageing Study in India (LASI) and National Family Health Surveys (NFHS-4 and NFHS-5) indicate significant demographic and health-related variations among 65,562 participants. Key findings show gender disparities in lifestyle habits such as alcohol and tobacco use, and differences in health outcomes across age, education, and socioeconomic status. Notably, an increase in NCD prevalence, particularly hypertension and diabetes, was observed from NFHS-4 to NFHS-5, highlighting evolving health challenges in India.

CONCLUSIONS

The study emphasizes the importance of gender in the prevalence and management of non-communicable diseases (NCDs) in India, advocating for public health strategies that address gender differences, socio-economic factors, and urban-rural disparities to achieve health equity.

Food consumption score and predictors among pregnant women attending antenatal care services in health centers of Addis Ababa, Ethiopia: Using ordinal logistic regression model

BACKGROUND

Poor maternal nutrition during pregnancy creates a stressful environment that can lead to long-term effects on tissue development. Understanding the food consumption score can be used to prevent problems associated with poor dietary intake of pregnant mothers. In Ethiopia, the food consumption score ranges from 54% to 81.5%, which is far below the World Food Program (WFP) recommendation. Thus, this study aimed to assess food consumption score and associated factors among pregnant women attending antenatal care services in health centers of Addis Ababa, Ethiopia.

METHODS

This study has used institution based cross sectional study. Overall, 999 pregnant women were selected for this study. A multistage sampling technique followed by systematic random sampling was used to include pregnant women coming for antenatal care services in the selected health centers of Addis Ababa from June 07 to July 08, 2022. We used interviewer administered questionnaire using the Kobo toolbox. Food consumption score (FCS) was assessed after collecting data on frequency of eight food groups consumed over the previous seven days, which were weighted according to their relative nutritional value. STATA 14 was used to analyse the data. Ordinal logistic regression was used to identify independent predictors of food consumption score. Those variables having p value < 0.25 in the bivariable ordinal logistic regression were considered for the final model. Crude and Adjusted Odds Ratio were used to assess the strength of the association. In the final model, p value < 0.05 at 95% confidence interval was used to declare statistical significance.

RESULT

From the total of 949 pregnant women a little over half (51.20% (95%CI: 48.00%-54.40%) had acceptable food consumption score, while just over two fifth (42.60% (95% CI: 39.40%-45.70%)) and a small proportion (6.2% (95%CI: 4.84%-7.94%)) of the study participants had borderline and poor food consumption score, respectively. No meal skip (AOR = 1.37, 95% CI:1.03-1.81), able to read and write (AOR = 3.99, 95% CI: 1.33-11.96), poorest wealth status (AOR = 0.52, 95% CI: 0.34-0.78), positive attitude towards consumption of a diversified diet (AOR = 1.52,95% CI: 1.17-1.98) were independent predictors of acceptable food consumption score.

CONCLUSION

In this study, considerably low level of acceptable food consumption score among the study participants was observed. Besides, not skipping meal, having better educational status, wealth status and attitude towards consumption of a diversified diet were associated with acceptable food consumption score. Therefore, nutritional education considering important dietary modifications should be intensified targeting vulnerable groups.

Epidemiological characteristics of chronic non-communicable diseases in Dongfang, China, 2021: a cross-sectional survey

OBJECTIVES

The study aimed to understand the composition, epidemiological characteristics and disease burden of chronic non-communicable diseases and to evaluate the association between sociodemographic factors and chronic non-communicable diseases.

DESIGN

A cross-sectional study.

SETTING AND PARTICIPANTS

Medical records of 196 761 residents were collected from Dongfang disease surveillance system from January to December 2021.

PRIMARY OUTCOME

Prevalence and disability burden were recorded. Logistic regression was used to investigate the relationship between sociodemography factors and diseases.

RESULTS

Cardiovascular diseases, chronic lower respiratory diseases and other upper respiratory tract diseases were the main chronic non-communicable diseases. In multivariable analysis, men were associated with increased risk of cardiovascular diseases (OR=1.210, 95% CI 1.162 to 1.261) and chronic lower respiratory diseases (OR=1.128, 95% CI 1.079 to 1.180). Older age was associated with increased risk of cardiovascular diseases (OR=83.952, 95% CI 58.954 to 119.550), whereas was associated with decreased risk of chronic lower respiratory diseases (OR=0.442, 95% CI 0.415 to 0.471) and other upper respiratory tract diseases (OR=0.450, 95% CI 0.411 to 0.493). The unemployed and poor household were associated with decreased risk of cardiovascular diseases (OR=0.463, 95% CI 0.412 to 0.521 and OR=0.390, 95% CI 0.342 to 0.444, respectively), whereas were associated with increased risk of chronic lower respiratory diseases (OR=12.219, 95% CI 6.343 to 23.539 and OR=10.954, 95% CI 5.666 to 21.177, respectively) and other upper respiratory tract diseases (OR=2.246, 95% CI 1.719 to 2.936 and OR=3.035, 95% CI 2.308 to 3.991, respectively). Gender and age moderated the association between personnel category and major diseases.

CONCLUSIONS

The spectrum and epidemiological characteristics of chronic diseases observed in Dongfang is good evidence for developing prevention guides and health policies for region.

Health Disparities Among Family Decision-Makers in China: An Ordered Probit Analysis of the China Family Panel Studies

Purpose

The family decision-makers serve as the backbone of the family, and their health status warrants consideration. This study aims to explore how the health status of this group of people, namely the family decision-making group, is affected, and to delve into the mechanisms of influence based on this. The goal is to provide reliable evidence and strategies for the health management of the family decision-makers group, contributing to the achievement of the "Healthy China 2030" Planning Outline.

Patients and Methods

Drawing on data from the China Family Panel Studies (CFPS), this study utilizes an Ordered Probit Model to analyze and compare the health status of family decision-makers and non-decision-makers.

Results

The findings indicate that decision-makers tend to experience poorer health outcomes than other family members, with increased pressure related to decision-making identified as a significant contributor to their declining health. Heterogeneity analysis reveals that the negative effect is less pronounced in households with higher net worth but more pronounced in those with more significant housing, education, and medical spending pressures. Moreover, this study analysis highlights that enhancing individual or family socioeconomic status can alleviate the adverse health effects experienced by family decision-makers.

Conclusion

The study reveals the presence of certain health adverse effects among family decision-makers. The implications drawn from this research hold significance for the health management of this demographic, underscoring the necessity for tailored interventions aimed at addressing the distinctive challenges confronted by this group.

Socioeconomic Inequalities in Chronic Disease in Kharameh Cohort Study: A Population-Based Cross- Sectional Study in Southern Iran

BACKGROUND

The trend of chronic diseases is increasing globally. Socioeconomic status (SES) is a major factor underlying many chronic diseases. This study was conducted to investigate the socioeconomic inequalities in distribution of chronic diseases in Iran, as a middle-income country.

METHODS

This cross-sectional study was conducted using the baseline data of the Kharameh cohort study, that were collected between 2014 and 2016. The number of participants in this study was 10663 people in the age range of 35 to 70 years. Principal component analysis was used for calculating the SES of the people under study. In addition, we used concentration index and concentration curve to measure socioeconomic inequality in chronic disease.

RESULTS

The mean age of 10,663 participants in our study was 52.15±8.22 years and the male to female ratio was 1.26. Recurrent headache (25.8%( and hypertension (23.5%) were the most prevalent diseases. The concentration index showed that the distribution of movement disorder, recurrent headaches and gastroesophageal reflux diseases is significantly concentrated among people with low SES, and obesity among people with high SES. The results of the analysis by gender were similar to the results seen in all participants.

CONCLUSION

The findings of this study show that socioeconomic inequality is the cause of the concentration of non-communicable diseases among people with low socio-economic status. Therefore, health policy makers should pay special attention to identifying vulnerable subgroups and formulate strategic plans to reduce inequalities.

Socio-economic inequalities in diabetes and prediabetes among Bangladeshi adults

Diabetes and prediabetes are overwhelming public health concerns in Bangladesh. However, there is a paucity of the literature examining and measuring socioeconomic inequalities in the prevalence of diabetes in Bangladesh. To provide reliable data and contribute to a nationwide scenario analysis, this study aims to estimate the inequality in prevalence of diabetes and prediabetes and to identify factors potentially contributing to socioeconomic inequalities in Bangladesh. This study used data from the latest Bangladesh Demographic and Health Survey (BDHS) 2017-18, a nationally representative survey. A regression-based decomposition method was applied to assess the socioeconomic contributors to inequality. The prevalence of diabetes and prediabetes were about 10 and 15% among Bangladeshi adults, respectively. Both diabetes and prediabetes were significantly associated with age, wealth status, suffering from overweight or obesity and administrative divisions of the respondents (p < 0.001). Respondents' household wealth status accounted for about 74 and 81% of the total inequality in diabetes and prediabetes in Bangladesh, respectively. Administrative region contributed 24.85% of the inequality in prediabetes and 12.26% of the inequality in diabetes. In addition, overweight or obesity status contributed 11.37% and exposure to television contributed 5.17% of the inequality in diabetes. Diabetes and prediabetes affect a substantial proportion of the Bangladeshi adult population. Therefore, these findings should be considered in the context of current and proposed policy decision making and for tracking its progression with economic development in Bangladesh.

Impact of Sociodemographic Characteristics, Lifestyle, and Obesity on Coexistence of Diabetes and Hypertension: A Structural Equation Model Analysis amongst Chinese Adults

Background

In general, given the insufficient sample size, considerable literature has been found on single studies of diabetes and hypertension and few studies have been found on the coexistence of diabetes and hypertension (CDH) and its influencing factors with a large range of samples. This study aimed to establish a structural equation model for exploring the direct and indirect relationships amongst sociodemographic characteristics, lifestyle, obesity, and CDH amongst Chinese adults.

Methods

A cross-sectional study was conducted in a representative sample of 25356 adults between June 1, 2015, and September 30, 2018, in Hubei province, China. Confirmatory factor analysis was initially conducted to test the latent variables. A structural equation model was then performed to analyse the association between latent variables and CDH.

Results

The total prevalence of CDH was 2.8%. The model paths indicated that sociodemographic characteristics, lifestyle, and obesity were directly associated with CDH, and the effects were 0.187, 0.739, and 0.353, respectively. Sociodemographic characteristics and lifestyle were also indirectly associated with CDH, and the effects were 0.128 and 0.045, respectively. Lifestyle had the strongest effect on CDH (β = 0.784, P < 0.001), followed by obesity (β = 0.353, P < 0.001) and sociodemographic characteristics (β = 0.315, P < 0.001). All paths of the model were significant (P < 0.001).

Conclusion

CDH was significantly associated with sociodemographic characteristics, lifestyle, and obesity amongst Chinese adults. The dominant predictor of CDH was lifestyle. Targeting these results might develop lifestyle and weight loss intervention to prevent CDH according to the characteristics of the population.

Socioeconomic determinants and inequalities in the prevalence of non-communicable diseases in Saudi Arabia

BACKGROUND

Non-communicable diseases (NCDs) are increasingly becoming a challenge worldwide, causing high mortality and morbidity. Saudi Arabia has one of the highest rates of NCDs globally and the highest in the Arabian Gulf region. Epidemiological data indicate that NCDs are responsible for 70 % of all deaths in Saudi Arabia. The aim of this study was to examine the socioeconomic determinants and inequalities in the prevalence of NCDs in Saudi Arabia.

METHODS

Data from the Saudi Family Health Survey conducted in 2018 by the General Authority for Statistics were used for this study. Univariate, bivariate, and multivariate logistic regression analyses were employed to examine the socioeconomic factors associated with the prevalence of NCDs. Moreover, the concentration curve and concentration indices were used to assess inequalities in the prevalence of NCDs.

RESULTS

Among the 11,527 respondents, the prevalence of NCDs was 32.15 %. The prevalence of NCDs was higher among women and among elderly respondents aged ≥ 60 years. With respect to the determinants of the prevalence of NCDs, the logistic regression results showed that the likelihood of reporting NCDs was lower among people with a higher education (OR: 0.599, 95 % CI: 0.497-0.723, p < 0.01) compared with that of people with an education below the primary school level. Other factors significantly associated with the prevalence of NCDs were age, marital status, nationality, and region of residence. The inequality analysis showed that at the national level, the prevalence of NCDs was concentrated among less educated people (concentration index = - 0.338, p < 0.01), but with significant regional variations. Gender disaggregation showed that both income-based and education-based concentration indices were significantly negative among women, indicating that the prevalence of NCDs is concentrated among women with a lower income level and with less education.

CONCLUSIONS

The findings of this study are important for policymakers to combat both the increasing prevalence of and socio-economic inequalities in NCDs. The government should develop targeted intervention strategies to control NCDs and achieve health equality considering socio-economic status. Future policies should target women and the lower educated population in Saudi Arabia.

The contribution of physical inactivity and socioeconomic factors to type 2 diabetes in Nepal: A structural equation modelling analysis

BACKGROUND AND AIM

Type 2 diabetes mellitus (T2DM) is emerging as a significant public health challenge in Nepal. Behavioural, social and economic changes are likely to play a part in the rise of this chronic disease, as they are in many developing countries. A better understanding of the relationship between physical activity (PA), socioeconomic factors and T2DM can inform the design of prevention programs. This study aimed to identify the path relationships between PA, socioeconomic position, anthropometric and metabolic variables and T2DM.

METHODS AND RESULTS

This study analysed data from 1977 Nepalese adults aged 40-69 years from the cross-sectional WHO STEPS survey undertaken in 2013. The latent variable "PA" was created using the information on domains of PA while the latent variable "socioeconomic position" was created using the variables education, occupation and ethnicity. Participants' fasting blood glucose was used to determine their diabetes status. Structural equation modelling was conducted, and correlations and adjusted regression coefficients are reported. Individuals with higher education, in paid employment and from advantaged ethnic groups were more likely to have T2DM. Waist circumference, triglycerides and hypertension were found to have a statistically significant positive direct effect on T2DM. PA had indirect effects on T2DM, mediated by waist circumference. The indirect effects of socioeconomic position on T2DM were mediated by body mass index, waist circumference, triglycerides and total cholesterol.

CONCLUSION

Among Nepalese adults, higher socioeconomic position had a significant direct effect on T2DM, while both PA and higher socioeconomic position had significant indirect effects. Policies and programs to address T2DM in Nepal should address the factors contributing to unhealthy weight status, particularly among those of higher socioeconomic status.

Socioeconomic and demographic predictors of high blood pressure, diabetes, asthma and heart disease among adults engaged in various occupations: evidence from India

In India, non-communicable diseases (NCDs) accounted for nearly 62% of all deaths in 2016. Four NCDs - high blood pressure, diabetes, asthma and heart disease - together accounted for over 34% of these deaths. Using data from two rounds of the India Human Development Surveys (IHDSs), levels and changes in the prevalence rates of the four NCDs (based on diagnosed cases) among adults aged 15-69 years in India between 2004-05 and 2011-12 were examined by socioeconomic and demographic factors and for five broad occupation categories. The socioeconomic and demographic risk factors for each of these NCDs were determined using multiple linear logistic regression analysis of pooled data from two rounds of the IHDS. The results showed that while urban residence, age, female sex and education were associated with higher odds of high blood pressure, diabetes and heart disease, household economic status was associated with higher odds for all four NCDs. Furthermore, increased higher odds of high blood pressure, diabetes and heart disease were found for the legislator/senior official/professional occupation group compared with non-workers. Skilled agricultural/elementary workers had lower odds of high blood pressure, diabetes, asthma and heart disease. Craft/machine-related trade workers had higher odds of high blood pressure and diabetes, and reduced odds of asthma and heart disease. Compared with non-workers, the odds ratios for asthma were lower for all other occupational categories. During the two study decades, the Government of India implemented several programmes designed to improve the health and well-being of its people. However, more focused attention on the adult population is needed, and special attention should be paid to the issue of the occupational health of the working population through the strict implementation of work place safety protocols and the removal of potential health hazards.

Association between socioeconomic status and prognosis after ischemic stroke in South China

Background: Previous studies have conflicting results on the association between socioeconomic status and stroke outcomes. Thus, this study aimed to investigate whether socioeconomic status is associated with the prognosis of ischemic stroke in Guangzhou, South China. Methods: A total of 622 patients with ischemic stroke who were admitted in the neurology department of five general hospitals in Guangzhou from May 2014 to October 2014 were included in the study. Socioeconomic status was measured based on education, income, caregiver, and insurance. The modified Rankin scale was used to evaluate the two years prognosis of patients with stroke. A multivariate logistic regression model was performed to determine the association between socioeconomic status and ischemic stroke prognosis. Results: In 2 years follow-up, 542 ischemic stroke patients were interviewed by telephone. Age ranged from 31 to 96 years, 65.5% of the patients were male. 33.9% of patients with ischemic stroke had a poor prognosis. After adjustment for age, sex, cardiovascular disease, behavior lifestyle, and severity of stroke, odds ratio for poor prognosis in patients with low income was 1.84 (95%CI 1.05-3.22), family caregiver 3.19 (95%CI 1.05-9.70), and no insurance 1.68 (95%CI 1.02-2.77). Conclusions: Patients with low income, family caregiver, and no insurance have a poorer prognosis after ischemic stroke that can be partly explained by intermediate variable in the patients' demographic characteristics, cardiovascular disease, behavior lifestyle, and stroke severity. Abbreviations: DALYs: disability-adjusted life years; SES: socioeconomic status; FMC: free medical care; MIUR: medical insurance for urban residents; MIUE: medical insurance for urban employees; NCMS: new rural cooperative medical scheme ; NIHSS: National Institute of Health Stroke Scale ; mRS: modified Rankin scale; OR: odds ratios; CI: confidence interval.

Sino-Australian University Partnership in Health Management Education

This paper outlines a successful partnership program between La Trobe University in Melbourne Australia, and Harbin Medical University in Harbin, China. These two universities have been collaborating for more than 15 years to provide a comprehensive Master of Health Administration program that adapts the Australian curriculum to meet the rapidly increasing need for qualified health services managers throughout China. This paper describes the mechanisms by which the joint programs were developed and how the two universities work together in partnership to continually improve the program components and outcomes, taking into account the significant differences in context and cultures. Since 2001, La Trobe University has enrolled about 1000 Chinese health services managers, with 721 completing a Master's degree, who are now having increasing influence on the reforms of the Chinese health care system. The partnership has enriched Australian knowledge of Chinese culture and values, as well as the Chinese health system and health policies, as evidenced by the large volume of joint publications. The profession of health management has been substantially strengthened in China, and working together, Chinese and Australian academics have had demonstrated impact on enhancing the reforms of the Chinese public health system. Further studies, with sufficient funds for data collection, are needed to evaluate the long-term impacts of transnational programs on academic and health system development in China.