Institute of Human Sciences, University of Oxford, Oxford, UK.
Medical Sciences Division, University of Oxford, Oxford, UK.
BMC Public Health. 2022 Aug 17;22(1):1567. doi: 10.1186/s12889-022-13905-3.
As the global burden of disease evolves, lower-resource countries like Nepal face a double burden of non-communicable and infectious disease. Rapid adaptation is required for Nepal's health system to provide life-long, person-centred care while simultaneously improving quality of infectious disease services. Social determinants of health be key in addressing health disparities and could direct policy decisions to promote health and manage the disease burden. Thus, we explore the association of social determinants with the double burden of disease in Nepal.
This is a retrospective, ecological, cross-sectional analysis of infectious and non-communicable disease outcome data (2017 to 2019) and data on social determinants of health (2011 to 2013) for 753 municipalities in Nepal. Multinomial logistic regression was conducted to evaluate the associations between social determinants and disease burden.
The 'high-burden' combined double burden (non-communicable and infectious disease) outcome was associated with more accessible municipalities, (adjOR3.94[95%CI2.94-5.28]), municipalities with higher proportions of vaccine coverage (adjOR12.49[95%CI3.05-51.09]) and malnutrition (adjOR9.19E103[95%CI19.68E42-8.72E164]), lower average number of people per household (adjOR0.32[95%CI0.22-0.47]) and lower indigenous population (adjOR0.20[95%CI0.06-0.65]) compared to the 'low-burden' category on multivariable analysis. 'High-burden' of non-communicable disease was associated with more accessible municipalities (adjOR1.93[95%CI1.45-2.57]), higher female proportion within the municipality (adjOR1.69E8[95%CI3227.74-8.82E12]), nutritional deficiency (adjOR1.39E17[95%CI11799.83-1.64E30]) and malnutrition (adjOR2.17E131[95%CI4.41E79-1.07E183]) and lower proportions of population under five years (adjOR1.05E-10[95%CI9.95E-18-0.001]), indigenous population (adjOR0.32[95%CI0.11-0.91]), average people per household (adjOR0.44[95%CI0.26-0.73]) and households with no piped water (adjOR0.21[95%CI0.09-0.49]), compared to the 'low-burden' category on adjusted analysis. 'High burden' of infectious disease was also associated with more accessible municipalities (adjOR4.29[95%CI3.05-6.05]), higher proportions of population under five years (adjOR3.78E9[95%CI9418.25-1.51E15]), vaccine coverage (adjOR25.42[95%CI7.85-82.29]) and malnutrition (adjOR4.29E41[95%CI12408.29-1.48E79]) and lower proportions of households using firewood as fuel (adjOR0.39[95%CI0.20-0.79]) ('moderate-burden' category only) compared to 'low-burden'.
While this study produced imprecise estimates and cannot be interpreted for individual risk, more accessible municipalities were consistently associated with higher disease burden than remote areas. Female sex, lower average number per household, non-indigenous population and poor nutrition were also associated with higher burden of disease and offer targets to direct interventions to reduce the burden of infectious and non-communicable disease and manage the double burden of disease in Nepal.
随着全球疾病负担的演变，尼泊尔等资源较少的国家面临着非传染性疾病和传染病的双重负担。尼泊尔的卫生系统需要迅速适应，既要提供终身、以人为本的护理，又要同时提高传染病服务质量。社会决定因素对于解决健康差距至关重要，并可以指导政策决策，以促进健康和管理疾病负担。因此，我们探讨了尼泊尔社会决定因素与双重疾病负担的关联。
这是一项回顾性、生态、横断面分析，分析了尼泊尔 753 个市的传染病和非传染性疾病结局数据（2017 年至 2019 年）以及社会决定因素健康数据（2011 年至 2013 年）。采用多变量逻辑回归评估社会决定因素与疾病负担之间的关联。
“高负担”的双重疾病负担（非传染性和传染性疾病）结局与更易到达的市有关（调整后的优势比 3.94[95%置信区间 2.94-5.28]），疫苗接种比例较高的市（调整后的优势比 12.49[95%置信区间 3.05-51.09]）和营养不良（调整后的优势比 9.19E103[95%置信区间 19.68E42-8.72E164]），平均每户人口较少（调整后的优势比 0.32[95%置信区间 0.22-0.47]）和土著人口较少（调整后的优势比 0.20[95%置信区间 0.06-0.65]），与多变量分析中的“低负担”类别相比。“高负担”的非传染性疾病与更易到达的市有关（调整后的优势比 1.93[95%置信区间 1.45-2.57]），市内部女性比例较高（调整后的优势比 1.69E8[95%置信区间 3227.74-8.82E12]），营养缺乏（调整后的优势比 1.39E17[95%置信区间 11799.83-1.64E30]）和营养不良（调整后的优势比 2.17E131[95%置信区间 4.41E79-1.07E183]），以及五岁以下人口比例较低（调整后的优势比 1.05E-10[95%置信区间 9.95E-18-0.001]），土著人口（调整后的优势比 0.32[95%置信区间 0.11-0.91]），平均每户人口（调整后的优势比 0.44[95%置信区间 0.26-0.73]）和没有管道供水的家庭（调整后的优势比 0.21[95%置信区间 0.09-0.49]），与调整后的“低负担”类别相比。“高负担”的传染病也与更易到达的市有关（调整后的优势比 4.29[95%置信区间 3.05-6.05]），五岁以下人口比例较高（调整后的优势比 3.78E9[95%置信区间 9418.25-1.51E15]），疫苗接种率（调整后的优势比 25.42[95%置信区间 7.85-82.29]）和营养不良（调整后的优势比 4.29E41[95%置信区间 12408.29-1.48E79]）以及较少使用薪柴作为燃料的家庭比例（调整后的优势比 0.39[95%置信区间 0.20-0.79]）（仅“中度负担”类别），与“低负担”类别相比。
尽管这项研究产生了不精确的估计，不能用于个体风险的解释，但与偏远地区相比，更易到达的市与更高的疾病负担始终相关。女性、每户平均人口较少、非土著人口和营养不良也与疾病负担较高有关，并为直接干预提供了目标，以减轻尼泊尔传染性和非传染性疾病的负担，并管理双重疾病负担。
