Inequalities in non-communicable diseases and effective responses

MRC-HPA Centre for Environment and Health, Department of Epidemiology and Biostatistics, Imperial College London, London, UK.
The Lancet (Impact Factor: 45.22). 02/2013; 381(9866):585-97. DOI: 10.1016/S0140-6736(12)61851-0
Source: PubMed

ABSTRACT In most countries, people who have a low socioeconomic status and those who live in poor or marginalised communities have a higher risk of dying from non-communicable diseases (NCDs) than do more advantaged groups and communities. Smoking rates, blood pressure, and several other NCD risk factors are often higher in groups with low socioeconomic status than in those with high socioeconomic status; the social gradient also depends on the country's stage of economic development, cultural factors, and social and health policies. Social inequalities in risk factors account for more than half of inequalities in major NCDs, especially for cardiovascular diseases and lung cancer. People in low-income countries and those with low socioeconomic status also have worse access to health care for timely diagnosis and treatment of NCDs than do those in high-income countries or those with higher socioeconomic status. Reduction of NCDs in disadvantaged groups is necessary to achieve substantial decreases in the total NCD burden, making them mutually reinforcing priorities. Effective actions to reduce NCD inequalities include equitable early childhood development programmes and education; removal of barriers to secure employment in disadvantaged groups; comprehensive strategies for tobacco and alcohol control and for dietary salt reduction that target low socioeconomic status groups; universal, financially and physically accessible, high-quality primary care for delivery of preventive interventions and for early detection and treatment of NCDs; and universal insurance and other mechanisms to remove financial barriers to health care.

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    • "Non-communicable diseases (NCDs) are a growing burden on individuals and health systems globally (Di Cesare et al. 2013). While studies from high-income settings indicate that this burden disproportionately falls on individuals with lower socio-economic position (SEP), evidence from low and middle income (LMIC) settings is more mixed (Gupta et al. 2012; Zaman et al. 2012; Subramanian et al. 2013). "
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    ABSTRACT: To assess the prevalence of cardiometabolic risk factors by socio-economic position (SEP) in rural and peri-urban Indian population. Cross-sectional survey of 3,948 adults (1,154 households) from Telangana (2010-2012) was conducted to collect questionnaire-based data, physical measurements and fasting blood samples. We compared the prevalence of risk factors and their clustering by SEP adjusting for age using the Mantel Hansel test. Men and women with no education had higher prevalence of increased waist circumference (men: 8 vs. 6.4 %, P < 0.001; women: 20.9 vs. 12.0 %, P = 0.01), waist-hip ratio (men: 46.5 vs. 25.8 %, P = 0.003; women: 58.8 vs. 29.2 %, P = 0.04) and regular alcohol intake (61.7 vs. 32.5 %, P < 0.001; women: 25.7 vs. 3.8 %, P < 0.001) than educated participants. Unskilled participants had higher prevalence of regular alcohol intake (men: 57.7 vs. 38.7 %, P = 0.001; women: 28.3 vs. 7.3 %, P < 0.001). In contrast, participants with a higher standard of living index had higher prevalence of diabetes (top third vs. bottom third: men 5.2 vs. 3.5 %, P = 0.004; women 5.5 vs. 2.4 %, P = 0.003), hyperinsulinemia (men 29.5 vs. 16.3 %, P = 0.002; women 31.1 vs. 14.3 %, P < 0.001), obesity (men 23.3 vs. 10.6 %, P < 0.001; women 25.9 vs. 12.8 %, P < 0.001), and raised LDL (men 16.8 vs. 11.4 %, P = 0.001; women 21.3 vs. 14.0 %, P < 0.001). Cardiometabolic risk factors are common in rural India but do not show a consistent association with SEP except for higher prevalence of smoking and regular alcohol intake in lower SEP group. Strategies to address the growing burden of cardiometabolic diseases in urbanizing rural India should be assessed for their potential impact on social inequalities in health.
    Journal of Public Health 03/2015; 23(3). DOI:10.1007/s10389-015-0662-y · 2.06 Impact Factor
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    • "On the other hand, inverse association between EC incidence rate and SR in the current study is in line with previous individual and ecological studies (Brown et al., 2001; Singh et al., 2002; Weiderpass and Pukkala, 2006; Torres- Cintron et al., 2012; Jansson et al., 2005; Dar et al., 2013; Ljung et al., 2013). It is argued that risk factors of EC such as smoking, low consumption of fruit and vegetables and obesity are more prevalent among people and areas with low SR (Ellaway et al., 1997; Dubowitz et al., 2008; Hiscock et al., 2012; Di Cesare et al., 2013). Inverse associations between SR and these risk factors have been also reported in Iran (Dastgiri et al., 2006; Mehrabi et al., 2007; Kiadaliri, 2013). "
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    ABSTRACT: Background: Esophagus cancer (EC) is among the five most common cancers in both sexes in Iran, with an incidence rate well above world average. Social rank (SR) of individuals and regions are well-known independent predictors of EC incidence. The aim of current study was to assess gender and social disparities in EC incidence across Iran's provinces through 2003-2009. Materials and Methods: Data on distribution of population at province level were obtained from the Statistical Centre of Iran. Age-standardized incidence rates of EC were gathered from the National Cancer Registry. The Human Development Index (HDI) was used to assess the province social rank. Rate ratios and Kunst and Mackenbach relative indices of inequality (RIIKM) were used to assess gender and social inequalities, respectively. Annual percentage change (APC) was calculated using joinpoint regression. Results: EC incidence rate increased 4.6% and 6.5% per year among females and males, respectively. There were no gender disparities in EC incidence over the study period. There were substantial social disparities in favor of better-off provinces in Iran. These social disparities were generally the same between males and females and were stable over the study period. Conclusions: The results showed an inverse association between the provinces' social rank and EC incidence rate in Iran. In addition, I found that, in contrast with international trends, women are at the same risk of EC as men in Iran. Further investigations are needed to explain these disparities in EC incidence across the provinces.
    Asian Pacific journal of cancer prevention: APJCP 01/2014; 15(2):623-7. DOI:10.7314/APJCP.2014.15.2.623 · 2.51 Impact Factor
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    ABSTRACT: Introduction: Data on risk factors and prevalence of hypertension are extremely limited from tribal population in India. The objective of this study was to assess the magnitude of these risk factors among the Mishing tribal community living in the remote riverine islands of the Brahmaputra in Assam. Method: Using a multistage cluster sampling technique 332 adults (25-65 years, men 54%) of Mishing tribe were selected. Information on risk factors of hypertension was collected using World Health Organization (WHO) STEP -1 questionnaire. Physical measurements were done using WHO STEP-2 Guidelines. Data were analyzed using SPSS. Results: Current smoking was reported by 35.8% (CI: 30.8-41.1) and current smokeless tobacco use by 78.9% (CI: 74.2-82.9). Current alcohol use prevalence was 66.9 % (CI: 61.6-71.7). Less than five servings of fruit and vegetable consumption were reported by 44.9% (CI: 39.6-50.2). Vigorous physical activity (> = 3000 met minutes /week) was reported by 86.4% (CI: 82.3-89.7) and moderate physical activity by 13.6% (CI: 10.2-17.6) leaving none in the sedentary group. Abdominal obesity (WC > = 90 cm in men and > = 80 cm in women) was found in 11.4% (CI: 8.4-15.3). Overweight (body mass index of > = 25) was found among 15.7% (CI: 12.1-19.9) of respondents. Hypertension was found in 25.6% (CI: 21.2-30.5). Among them 24.7% were aware, 16.5% were on treatment and 2.4% achieved adequate control. Conclusion: Tobacco use, Alcohol use and vigorous physical activity were significantly higher among male compared to female. Awareness, treatment and adequate control of hypertension were very low.
    Journal of Hypertension 01/2012; 30:e8. DOI:10.1097/01.hjh.0000419851.14035.70 · 4.22 Impact Factor
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