Centre for Population-based Approaches for Non-Communicable Disease Prevention, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
Secretariat of the WHO Global Coordination Mechanisms on the Prevention and Control of Non-communicable diseases, World Health Organization, Geneva, Switzerland.
J Glob Health. 2018 Dec;8(2):020409. doi: 10.7189/jogh.08.020409.
Non-communicable diseases (NCDs) are the leading cause of death globally. Eighty-two percent of premature NCD deaths occur within low- and lower middle-income countries (LLMICs). Research to date, largely drawn from high-income countries, suggests that disadvantaged and marginalized groups have a higher NCD burden, but there has been a dearth of research studying this relationship within LLMICs. The purpose of this systematic review is to map the literature on evidence from LLMICs on the socio-economic status (SES) gradient of four particular NCDs: cardiovascular disease, cancer, diabetes, and chronic respiratory diseases.
We conducted a comprehensive literature search for primary research published between 1 January 1990 and 27 April 2015 using six bibliographic databases and web resources. We included studies that reported SES and morbidity or mortality from cardiovascular disease, cancer, diabetes and chronic respiratory diseases within LLMICs.
Fifty-seven studies from 17 LLMICs met our inclusion criteria. Fourteen of the 18 papers that reported significant associations between cancer and SES suggested that low SES groups had the highest cancer risk. Eleven of 15 papers reporting significant relationships between CVD and SES suggested that low SES groups have higher risk. In contrast, seven of 12 papers reporting significant findings related to diabetes found that higher SES groups had higher diabetes risk. We identified just three studies on the relationship between chronic respiratory diseases and SES; none of them reported significant findings.
Only 17 of the 84 LLMICs were represented, highlighting the need for more research on NCDs within these countries. The majority of studies were medium to high quality cross-sectional studies. When we restricted our analyses to high quality studies only, for both cancer and cardiovascular disease more than half of studies found a significantly higher risk for those of lower SES. The opposite was true for diabetes, whilst there was a paucity of high quality research on chronic respiratory disease. Development programmes must consider health alongside other aims and NCD prevention interventions must target all members of the population.
Prospero: CRD42015020169.
非传染性疾病（NCDs）是全球死亡的主要原因。82%的过早 NCD 死亡发生在低收入和中低收入国家（LMICs）。迄今为止的研究主要来自高收入国家，表明弱势群体和边缘群体的 NCD 负担更高，但在 LLMICs 中，几乎没有研究研究这种关系。本系统评价的目的是绘制 LLMICs 中关于四个特定 NCD（心血管疾病、癌症、糖尿病和慢性呼吸道疾病）的社会经济地位（SES）梯度的文献。
我们对 1990 年 1 月 1 日至 2015 年 4 月 27 日期间发表的原始研究进行了全面的文献检索，使用了六个书目数据库和网络资源。我们纳入了在 LLMICs 中报告 SES 与心血管疾病、癌症、糖尿病和慢性呼吸道疾病发病率或死亡率的研究。
来自 17 个 LLMICs 的 57 项研究符合我们的纳入标准。在报告癌症与 SES 之间存在显著关联的 18 篇论文中，有 14 篇表明低 SES 群体的癌症风险最高。在报告 CVD 与 SES 之间存在显著关系的 15 篇论文中，有 11 篇表明低 SES 群体的风险更高。相反，在报告与糖尿病相关的显著发现的 12 篇论文中，有 7 篇发现 SES 较高的群体糖尿病风险较高。我们只发现了三项关于慢性呼吸道疾病与 SES 之间关系的研究；它们都没有报告显著的结果。
只有 84 个 LLMICs 中的 17 个得到了代表，这突出表明需要在这些国家开展更多关于 NCDs 的研究。大多数研究都是中高质量的横断面研究。当我们将分析仅限于高质量研究时，对于癌症和心血管疾病，超过一半的研究发现 SES 较低的人风险显著更高。糖尿病则相反，而关于慢性呼吸道疾病的高质量研究却很少。发展计划必须将健康与其他目标结合起来考虑，NCD 预防干预措施必须针对所有人群。
Prospéro：CRD42015020169。
