Erasmus University Rotterdam, Erasmus School of Health Policy & Management, P.O. Box 1738, 3000 DR, Rotterdam, The Netherlands.
BMC Public Health. 2021 May 20;21(1):951. doi: 10.1186/s12889-021-11014-1.
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.
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.
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.
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.
在中低收入国家（LMICs），非传染性疾病（NCDs）的负担沉重且不断增加，因此有必要采取干预措施来降低其潜在的风险因素，这些风险因素通常与生活方式有关。为了有效地用有针对性的干预措施补充国家政策，了解这些风险因素在 LMICs 人口的社会经济阶层中的分布情况非常重要。本研究量化了 LMICs 中生活方式风险因素的流行程度和社会经济不平等，以确定有利于到 2030 年实现非传染性疾病死亡人数减少三分之一的可持续发展目标的政策重点。
本研究使用了 2013 年至 2018 年间 22 个 LMIC 中 1278624 名成年受访者的人口与健康调查数据，以估计烟草使用、超重、有害饮酒以及这三种因素在家庭中的聚集程度的粗患病率和社会经济不平等。不平等程度通过集中指数进行衡量，并与用于卫生保健的国内生产总值（GDP）的百分比相关联。我们还估计了一个多水平模型，以检验个体特征与不同生活方式风险因素之间的关联。
男性的吸烟率从亚美尼亚的 59.6%（亚美尼亚）到尼日利亚的 6.6%（尼日利亚）不等。女性超重率最高的是埃及，为 83.7%，而布隆迪、乍得和东帝汶的这一比例则低于 12%。在布隆迪，82.5%的女性报告说她们的伴侣“经常或有时喝醉”，而在冈比亚，这一比例仅为 1.3%。烟草使用主要集中在贫困人口中，但尼日利亚男性吸烟比例较低，情况除外。然而，超重主要集中在较富裕的人群中，特别是在坦桑尼亚和津巴布韦（Erreygers 指数（EI）分别为 0.227 和 0.232）。在尼日利亚，有害饮酒更多地集中在较富裕的人群中（EI 为 0.127），而乍得、卢旺达和多哥则显示出有利于穷人的不平等分布（EI 分别为-0.147、-0.210、-0.266）。柬埔寨在不健康的家庭行为方面表现出最大的社会经济不平等（EI -0.253）。多水平分析证实，在 LMICs 中，烟草和酒精的使用主要集中在贫困人口中，而超重则集中在较富裕的人群中。用于卫生保健的国内生产总值（GDP）的比例与生活方式因素的社会经济分布之间的关联是多方向的。
本研究强调了 LMICs 中生活方式风险因素的重要性及其社会经济差异。鉴于生活方式风险因素的社会经济模式存在差异——LMICs 中的超重模式与高收入国家有很大不同——有必要针对特定的高危人群制定有针对性的干预措施，以补充国家政策。
