Bayati Mohsen, Arkia Elham, Emadi Mehrnoosh
Health Human Resources Research Center, School of Health Management and Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran.
Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran.
J Health Popul Nutr. 2025 Jan 13;44(1):8. doi: 10.1186/s41043-025-00739-z.
Socioeconomic inequality in nutritional status as one of the main social determinants of health can lead to inequality in health outcomes. In the present study, the socioeconomic inequality in the burden of nutritional deficiencies among the countries of the world using Global Burden of Disease (GBD) data was investigated.
Burden data of nutritional deficiencies and its subsets including protein-energy malnutrition, iodine deficiency, vitamin A deficiency, and dietary iron deficiency form GBD study and Human Development Index (HDI), a proxy for the socio-economic status of countries, from united nations database were collected. After descriptive statistics, the concentration index (CI) curve was used to measure socioeconomic inequality. CI for nutritional deficiencies was estimated based on Disability Adjusted Life Years (DALY), Years Lived with Disability (YLD), Years of Life Lost (YLL), prevalence, incidence and death indices. Moreover, CI of DALY and prevalence was estimated and reported for four nutritional deficiencies subgroups.
CIs for DALY, YLD, YLL, prevalence, incidence and death rate show negative values and their, which indicates the concentration of nutritional deficiencies burden among lower HDI countries. The highest value of CI (lowest inequality) for DALY was related to iodine deficiency (-0.3401) and the lowest (highest inequality) was related to vitamin A deficiency (-0.5884). Also, the highest value of CI for prevalence was related to protein-energy malnutrition (-0.1403) and the lowest was related to vitamin A deficiency (-0.4308). Results also show the inequality in DALY was greater than the disparity in prevalence for all subgroups of nutritional deficiencies.
Inequality in burden of nutritional deficiencies and protein-energy malnutrition, iodine deficiency, vitamin A deficiency and dietary iron deficiency are concentrated in countries with low HDI, so there is pro- poor inequality. Findings indicate that although malnutrition occurs more in low-income countries, due to the weakness of health care systems in these countries, the inequality in the final consequences of malnutrition such as DALY becomes much deeper. More attention should be paid to the development of prevention and primary treatment measures in low HDI countries, such as improving nutrition-related health education, nutritional support and early aggressive treatment, and also eliminating hunger.
营养状况方面的社会经济不平等作为健康的主要社会决定因素之一，可能导致健康结果的不平等。在本研究中，利用全球疾病负担（GBD）数据调查了世界各国营养缺乏负担方面的社会经济不平等情况。
收集了来自GBD研究的营养缺乏及其子集（包括蛋白质 - 能量营养不良、碘缺乏、维生素A缺乏和膳食铁缺乏）的负担数据，以及来自联合国数据库的人类发展指数（HDI，作为各国社会经济地位的代理指标）。在进行描述性统计后，使用集中指数（CI）曲线来衡量社会经济不平等。基于伤残调整生命年（DALY）、带病生存年数（YLD）、生命损失年数（YLL）、患病率、发病率和死亡率指数估算营养缺乏的CI。此外，还估算并报告了四个营养缺乏亚组的DALY和患病率的CI。
DALY、YLD、YLL、患病率、发病率和死亡率的CI均显示为负值，这表明营养缺乏负担集中在低HDI国家。DALY的CI最高值（不平等程度最低）与碘缺乏相关（-0.3401），最低值（不平等程度最高）与维生素A缺乏相关（-0.5884）。同样，患病率的CI最高值与蛋白质 - 能量营养不良相关（-0.1403），最低值与维生素A缺乏相关（-0.4308）。结果还表明，所有营养缺乏亚组的DALY不平等程度均大于患病率的差异。
营养缺乏以及蛋白质 - 能量营养不良、碘缺乏、维生素A缺乏和膳食铁缺乏的负担不平等集中在低HDI国家，因此存在有利于穷人的不平等。研究结果表明，虽然营养不良在低收入国家更为普遍，但由于这些国家医疗保健系统薄弱，营养不良的最终后果（如DALY）的不平等程度变得更深。应更加关注低HDI国家预防和初级治疗措施的发展，如改善营养相关健康教育、营养支持和早期积极治疗，以及消除饥饿。
