Socioeconomic inequality in the prevalence of noncommunicable diseases in low- and middle-income countries: results from the World Health Survey.
BACKGROUND
Noncommunicable diseases are an increasing health concern worldwide, but particularly in low- and middle-income countries. This study quantified and compared education- and wealth-based inequalities in the prevalence of five noncommunicable diseases (angina, arthritis, asthma, depression and diabetes) and comorbidity in low- and middle-income country groups.


METHODS
Using 2002-04 World Health Survey data from 41 low- and middle-income countries, the prevalence estimates of angina, arthritis, asthma, depression, diabetes and comorbidity in adults aged 18 years or above are presented for wealth quintiles and five education levels, by sex and country income group. Symptom-based classification was used to determine angina, arthritis, asthma and depression rates, and diabetes diagnoses were self-reported. Socioeconomic inequalities according to wealth and education were measured absolutely, using the slope index of inequality, and relatively, using the relative index of inequality.


RESULTS
Wealth and education inequalities were more pronounced in the low-income country group than the middle-income country group. Both wealth and education were inversely associated with angina, arthritis, asthma, depression and comorbidity prevalence, with strongest inequalities reported for angina, asthma and comorbidity. Diabetes prevalence was positively associated with wealth and, to a lesser extent, education. Adjustments for confounding variables tended to decrease the magnitude of the inequality.


CONCLUSIONS
Noncommunicable diseases are not necessarily diseases of the wealthy, and showed unequal distribution across socioeconomic groups in low- and middle-income country groups. Disaggregated research is warranted to assess the impact of individual noncommunicable diseases according to socioeconomic indicators.
Department of Health Statistics and Information Systems, World Health Organization, Geneva, Switzerland. hosseinpoora@who.int
Ahmad Reza
AR
Hosseinpoor
Nicole
N
Bergen
Shanthi
S
Mendis
Sam
S
Harper
Emese
E
Verdes
Anton
A
Kunst
Somnath
S
Chatterji
D000328:Adult; D000787:Angina Pectoris / Q000453:epidemiology*; D001168:Arthritis / Q000453:epidemiology*; D001249:Asthma / Q000453:epidemiology*; D003863:Depression / Q000453:epidemiology*; D003906:Developing Countries / Q000706:statistics & numerical data*; D003920:Diabetes Mellitus / Q000453:epidemiology*; D005260:Female; D014943:Global Health; D054624:Health Status Disparities; D006306:Health Surveys; D006801:Humans; D008297:Male; D015995:Prevalence; D017678:Sex Distribution; D012959:Socioeconomic Factors