title: Associations between life conditions and multi-morbidity in marginalized populations: the case of Palestinian refugees.
abstract: BACKGROUND
  Evidence suggests that higher multi-morbidity rates among people with low socioeconomic status produces and maintains poverty. Our research explores the relationship between socioeconomic deprivation and multi-morbidity among Palestinian refugees in Lebanon, a marginalized and impoverished population.
  
  
  METHODS
  A representative sample of Palestinian refugees in Lebanon was surveyed, interviewing 2501 respondents (97% response rate). Multi-morbidity was measured by mental health, chronic and acute illnesses and disability. Multinomial logistic regression models assessed the association between indicators of poverty and multi-morbidities.
  
  
  RESULTS
  Findings showed that 14% of respondents never went to school, 41% of households reported water leakage and 10% suffered from severe food insecurity. Participants with an elementary education or less and those completing intermediate school were more than twice as likely to report two health problems than those with secondary education or more (OR: 2.60, CI: 1.73-3.91; OR: 2.47, CI: 1.62-3.77, respectively). Those living in households with water leakage were nearly twice as likely to have three or more health reports (OR = 1.88, CI = 1.45-2.44); this pattern was more pronounced for severely food insecure households (OR = 3.41, CI = 1.83-6.35).
  
  
  CONCLUSIONS
  We identified a positive gradient between socioeconomic status and multi-morbidity within a refugee population. These findings reflect inequalities produced by the health and social systems in Lebanon, a problem expected to worsen following the massive influx of refugees from Syria. Ending legal discrimination and funding infrastructural, housing and health service improvements may counteract the effects of deprivation. Addressing this problem requires providing a decent livelihood for refugees in Lebanon.
authors.affiliation: Department of Environmental Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon rima.habib@aub.edu.lb.
authors.forename: Rima R
authors.initials: RR
authors.lastname: Habib
authors.affiliation: Department of Environmental Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon.
authors.forename: Safa
authors.initials: S
authors.lastname: Hojeij
authors.affiliation: Department of Environmental Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon.
authors.forename: Kareem
authors.initials: K
authors.lastname: Elzein
authors.affiliation: Department of Environmental Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon.
authors.forename: Jad
authors.initials: J
authors.lastname: Chaaban
authors.affiliation: Department of Environmental Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon.
authors.forename: Karin
authors.initials: K
authors.lastname: Seyfert
mesh_terms: D000208:Acute Disease / Q000453:epidemiology; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018912:Arabs / Q000208:ethnology / Q000706:statistics & numerical data*; D002908:Chronic Disease / Q000453:epidemiology; D003430:Cross-Sectional Studies; D006233:Persons with Disabilities / Q000706:statistics & numerical data*; D004522:Educational Status; D005260:Female; D005523:Food Supply / Q000706:statistics & numerical data; D006304:Health Status; D006798:Housing; D006801:Humans; D007861:Lebanon / Q000453:epidemiology; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology*; D008875:Middle Aged; D011203:Poverty / Q000208:ethnology / Q000706:statistics & numerical data*; D012036:Refugees / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D013593:Syria / Q000208:ethnology; D055815:Young Adult