The social patterning of risk factors for noncommunicable diseases in five countries: evidence from the modeling the epidemiologic transition study (METS).
Associations between socioeconomic status (SES) and risk factors for noncommunicable diseases (NCD-RFs) may differ in populations at different stages of the epidemiological transition. We assessed the social patterning of NCD-RFs in a study including populations with different levels of socioeconomic development.



Data on SES, smoking, physical activity, body mass index, blood pressure, cholesterol and glucose were available from the Modeling the Epidemiologic Transition Study (METS), with about 500 participants aged 25-45 in each of five sites (Ghana, South Africa, Jamaica, Seychelles, United States).



The prevalence of NCD-RFs differed between these populations from five countries (e.g., lower prevalence of smoking, obesity and hypertension in rural Ghana) and by sex (e.g., higher prevalence of smoking and physical activity in men and of obesity in women in most populations). Smoking and physical activity were associated with low SES in most populations. The associations of SES with obesity, hypertension, cholesterol and elevated blood glucose differed by population, sex, and SES indicator. For example, the prevalence of elevated blood glucose tended to be associated with low education, but not with wealth, in Seychelles and USA. The association of SES with obesity and cholesterol was direct in some populations but inverse in others.



In conclusion, the distribution of NCD-RFs was socially patterned in these populations at different stages of the epidemiological transition, but associations between SES and NCD-RFs differed substantially according to risk factor, population, sex, and SES indicator. These findings emphasize the need to assess and integrate the social patterning of NCD-RFs in NCD prevention and control programs in LMICs.
University Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, Biopôle 2, Route de la Corniche 10, 1010, Lausanne, Switzerland. silvia.stringhini@chuv.ch.
Silvia
S
Stringhini
Tropical Medicine Research Institute, University of the West Indies, Mona, Kingston, Jamaica.
Terrence E
TE
Forrester
Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
Jacob
J
Plange-Rhule
Research Unit for Exercise Science and Sports Medicine, University of Cape Town, Cape Town, South Africa.
Estelle V
EV
Lambert
Ministry of Health, Victoria, Republic of Seychelles.
Bharathi
B
Viswanathan
Center for Laboratory Medicine, Canton Hospital, St. Gallen, Switzerland.
Walter
W
Riesen
Center for Laboratory Medicine, Canton Hospital, St. Gallen, Switzerland.
Wolfgang
W
Korte
Chronic Disease Initiative in Africa, Department of Medicine, University of CapeTown, Cape Town, South Africa.
Naomi
N
Levitt
Stritch School of Medicine, Loyola University Chicago, Maywood, IL, USA.
Liping
L
Tong
Stritch School of Medicine, Loyola University Chicago, Maywood, IL, USA.
Lara R
LR
Dugas
Stritch School of Medicine, Loyola University Chicago, Maywood, IL, USA.
David
D
Shoham
Stritch School of Medicine, Loyola University Chicago, Maywood, IL, USA.
Ramon A
RA
Durazo-Arvizu
Stritch School of Medicine, Loyola University Chicago, Maywood, IL, USA.
Amy
A
Luke
University Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, Biopôle 2, Route de la Corniche 10, 1010, Lausanne, Switzerland.|Ministry of Health, Victoria, Republic of Seychelles.
Pascal
P
Bovet
D000328:Adult; D001794:Blood Pressure; D002784:Cholesterol / Q000097:blood; D002908:Chronic Disease / Q000453:epidemiology*; D003906:Developing Countries / Q000706:statistics & numerical data; D016021:Epidemiologic Studies; D015444:Exercise; D005260:Female; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000453:epidemiology; D015995:Prevalence; D012307:Risk Factors; D012424:Rural Population; D012907:Smoking / Q000453:epidemiology; D012923:Social Class; D012959:Socioeconomic Factors; D014481:United States / Q000453:epidemiology
D002784:Cholesterol
Hypertension; Low and middle income countries; Noncommunicable diseases; Obesity; Physical activity; Risk factors; Smoking; Socioeconomic status