A systematic review of associations between non-communicable diseases and socioeconomic status within low- and lower-middle-income countries

Noncommunicable disease syndemic among the general population in Iran: a cross-sectional study

Objectives

This study aims to investigate the status of the NCD syndemic among individuals over 25 in all provinces of Iran.

Methods

This study was based on a national survey. Using a systematic cluster random sampling framework, 26,707 participants were selected from all 31 Iranian provinces. The data were analyzed for descriptive statistics by gender and age, followed by principal component analysis and logistic regression, using R software for the statistical analysis.

Results

There was an interaction between diabetes mellitus and cardiovascular diseases, in their association with healthy life lost due to disability in the Iranian adult population. Additionally, there was a clustering of diabetes mellitus and cardiovascular diseases, partly due to the shared specific causes such as obesity, hypertension, shared baseline features, and poverty.

Conclusions

The syndemic analysis showed that social inequalities in diabetes and cardiovascular disease arise not only from exposure levels but also from varying vulnerabilities and disease outcomes. Iran's health policy should prioritize reducing these health inequalities.

Improving the agronomic performance of high-amylose durum wheat

High-amylose wheat has garnered significant attention from the food industry for its potential to produce low-glycaemic food products. It is well-established that there is a direct correlation between the amylose content in flour and the amount of resistant starch (RS) in foods. Recently, some research initiatives have successfully produced high-amylose durum wheat by targeting key enzymes in the amylopectin biosynthesis pathway, though this has resulted in a reduction in seed weight. This study aimed to develop durum wheat genotypes with enhanced nutritional and agronomic traits by pyramiding mutations in the SSIIa genes and the GW2-A1 null allele. A cross between Svevo SSIIa- and Kronos GW2-A1- was performed, and marker-assisted selection (MAS) strategies were employed to identify ten sister lines (GW2-A1-/SSIIa-). Biochemical analyses revealed that the GW2-A1-/SSIIa- genotypes exhibited significantly higher amylose and resistant starch (5-10-fold) levels compared to Svevo and GW2-A1- controls. Phenotypic analyses highlighted that GW2-A1-/SSIIa- lines showed a 50 % increase in hundred-grain weight (HGW) and improved grain size parameters compared to Svevo SSIIa-, though these values remained lower than Svevo and Kronos GW2-A1-. Yield per plot increased by 67 % compared to Svevo SSIIa- but was 30-40 % lower than Svevo and Kronos GW2-A1-. Gene expression analysis revealed upregulation of key starch biosynthesis genes (Susy2, UGPase) in GW2-A1-/SSIIa- lines, suggesting compensatory mechanisms for reduced starch content. Downregulation of TPS7 indicated potential limitations in trehalose-6-phosphate biosynthesis, which may influence starch accumulation. This study demonstrates that combining SSIIa and GW2-A1 null mutations can mitigate yield losses associated with high-amylose genotypes while maintaining elevated levels of resistant starch and dietary fiber.

Global burden and national health inequity of ischemic heart disease attributed to kidney dysfunction from 1990 to 2021: Findings from the global burden of disease study 2021

BACKGROUND AND AIMS

To estimate the global disease burden and cross-national inequalities in the distribution of ischemic heart disease attributable to kidney dysfunction (KI-IHD) from 1990 to 2021.

METHODS

The estimates for age-standardized death rates (ASDR) and age-standardized disability-adjusted life-years rates (ASDAR) of KI-IHD were obtained from the Global Burden of Disease Study (GBD) 2021. Data for gross domestic product (GDP) and GDP growth rates were extracted from World Bank database. The average annual percent change (AAPC) was calculated to analyze temporal trends of ASDR and ASDAR by Joinpoint regression model. Slope index of inequality and concentration index were generated to quantify the cross-national socioeconomic inequality of KI-IHD burden.

RESULTS

From 1990 to 2021, the ASDR and ASDAR of KI-IHD has shown downward trend globally; with AAPC values of -1.384 % and -1.204 %. The ASDR and ASDAR of KI-IHD was higher in males than females, with increasing age, the burden gradually increased. The concentration index showed 0.02 (95%CI: 0.02, 0.06) in 1990 and -0.11 (95%CI: 0.15, -0.07) in 2021. The slope index of inequality showed that an excess of 170 ASDR per 100,000 existed between countries with the lowest and the highest SDI in 1990, however, in 2021, the results are reversed, a reduction of 159 per 100,000. GDP growth rate and GDP per capita might be associated with the health inequality of KI-IHD.

CONCLUSION

The burden of KI-IHD has decreased in almost 70 % of countries over the past three decades. Disproportional distribution of health inequalities was concentrated in poor countries.

Conceptualizing the effects of COVID-19 on eating and physical activity in people with type 2 diabetes and hypertension in Ecuador using the social ecological model

BACKGROUND

Our aim was to explore patients' perceptions of changes in diet and physical activity in people with type 2 diabetes mellitus and/or arterial hypertension in two low-income districts of Ecuador.

METHODS

We carried out a qualitative study of 19 telephone interviews in August-September 2020 with people with type 2 diabetes mellitus and/or arterial hypertension. Interviews were recorded, anonymized and transcribed verbatim for analysis using the social ecological model.

RESULTS

Within the context of poor access to the health services, participants identified a lack of social policies to address food insecurity and income stability. Food insecurity was related to mobility restrictions and loss of income, particularly among vulnerable populations, such as migrants and women. Changing work environments influenced physical activity patterns and food availability. Family support was crucial to overcome economic shortfalls allowing for better eating habits. Despite recognizing overeating as detrimental to disease management, participants reported increased desire to binge eat due to emotional distress and anxiety.

CONCLUSIONS

The lack of social policies dealing with poverty and food insecurity during the pandemic made non-communicable disease self-care with physical activity and diet challenging for vulnerable populations.

Evaluation of quality of life and eating behavior in outpatients with type 2 diabetes mellitus and/or systemic arterial hypertension: a cross-sectional study

To evaluate the quality of life and eating behavior of patients with type 2 diabetes mellitus and/or systemic arterial hypertension treated at a specialized outpatient service in southern Brazil. The cross-sectional study included adults and elderly individuals previously diagnosed with type 2 diabetes mellitus and/or systemic arterial hypertension. The WHOQOL-bref instrument was used to obtain quality of life. Eating behavior was assessed using the Three-factor Eating Questionnaire-R21. Multiple linear regression and Spearman's correlation were used to examine the relationship between quality of life and eating behavior. And the Mann-Whitney U-test, Kruskal-Wallis and multiple linear regression to verify the relationship between quality of life, behavior, sociodemographic and clinical. E o Spearman's correlation coefficient was used to examine the relationship between quality of life and eating behavior. A significance level of 5% was adopted for all analyses. A total of 326 participants were included, with a mean age of 57.0 ± 12.2 years, the majority of whom were females (70.9%) and adults (53.4%). Females exhibited worse quality of life, as observed in the domains of 'psychological' (p = 0.000), 'environmental' (p = 0.033), and general quality of life (p = 0.017). In addition, associations were also observed between quality of life and age, education level, and sleep duration. Sleeping less than 8 hours/day was the predictor that most contributed to the decrease in quality of life scores. Cognitive restriction was the dimension of eating behavior with the highest score (44.4); however, only uncontrolled eating (p = 0.000) and emotional eating (p = 0.000) were associated with age. Self-perception of quality of life changed according to gender, age group, sleep duration and eating behavior. The quality of life was inversely correlated with emotional eating and uncontrolled eating.

Evaluation of intervention systematic reviews on chronic non-communicable diseases and lifestyle risk factors in low-middle income countries: meta-research

BACKGROUND

Systematic Reviews (SRs) rigorously synthesize findings on a theme, but some articles with this design are redundant due to errors and conflicts. Meta-research aims to rigorously analyze research, assessing SRs' methodological quality and result reliability. This study evaluates SRs' overall quality in low- and middle-income countries (LMICs) on chronic non-communicable Diseases (NCDs) and key modifiable risk factors, using assessment tools.

METHODS

A search strategy was conducted in the following databases: MEDLINE (via PubMed), Embase, (via Elsevier), Cochrane Library, and Grey Literature for published studies from January 1, 2014 - April 5, 2024. SRs addressing the association between at least one of the four most important modifiable behavioral risk factors (tobacco use, inadequate diet, alcohol consumption, and physical inactivity) and chronic NCDs in populations classified as LMICs according to the 'World Bank list of countries' were included. The selected studies were imported into the EndNote 20 software and analyzed using a form for the extraction of their main data and four tools were chosen to assess each of the most important domains of scientific evidence: Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) for article writing; Template for Intervention Description and Replication (TIDieR) for intervention description; A Measurement Tool for Evaluating Systematic Reviews (AMSTAR-2) for methodological assessment; and Grading of Recommendations, Assessment, Development and Evaluation (GRADE) for certainty of evidence.

RESULTS

Nine studies were included in this analysis. The average Overall Score on the PRISMA 2020 checklist was 13.5 for articles published before 2020 and 25.67 for those published after 2020. TIDieR analysis revealed complete correspondence (100%) for item 'Brief Name', while other items, like 'Why' (89%), and 'What', 'Who Provided', and 'How' (78%), were partially met but significantly so. Regarding AMSTAR-2 criteria, only one study fulfilled all critical items, meeting item 7 by providing a detailed list of excluded studies and justifying each exclusion motive. Additionally, among critical items applicable to multiple articles, only item 11 was consistently fulfilled by all studies. In the final classification, one article achieved a moderate quality rating, three were critically low quality, and five had low quality among the nine evaluated articles. In the GRADE tool evaluation, limitations resulted in estimations for only 19 outcomes and 8 intervention-exposure sets.

CONCLUSION

The results demonstrated that the writing of recent scientific articles meets most of the PRISMA 2020 criteria, with a checklist being the most used tool. Interventions and exposure were also very well reported, with the TIDieR checklist not being cited in any study as a guiding tool. AMSTAR-2 revealed a methodological approach of varied quality, mainly low and critically low. The GRADE approach classified the certainty of the evidence as generally very low. Therefore, it is necessary to encourage adherence to these approaches to improve the methodological quality in SR studies on chronic NCDs and behavioral factors in LMICs.

Socioeconomic Status, Modifiable Factors, and Risk of Microvascular Complications in Individuals With Type 2 Diabetes: A Cohort Study From the UK Biobank

BACKGROUND

To investigate whether lower socioeconomic status (SES) was associated with an increased risk of diabetic microvascular complications and to analyze the potential mediating role of several modifiable factors.

METHODS

The study included 11 309 patients with type 2 diabetes at baseline from the UK Biobank cohort. SES was grouped based on income, education, and employment status by using latent class analysis. Microvascular complications of diabetes were identified through electronic health records. Cox regression models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for microvascular complications across SES groups. Mediation analysis was applied to explore potential mediators in these associations.

RESULTS

During a median follow-up of 12.2 years, 262, 764, and 1017 participants in the high, medium, and low SES groups were diagnosed with microvascular complications. Compared to participants with high SES, those with low SES had a HR of 1.75 (95% CI: 1.53, 2.01) for total microvascular complications, a HR of 2.11 (95% CI: 1.74, 2.55) for nephropathy, a HR of 1.40 (95% CI: 1.14, 1.72) for retinopathy, and a HR of 1.79 (95% CI: 1.32, 2.43) for neuropathy. Mediation analysis indicated that alcohol consumption, body mass index, triglycerides, high density lipoprotein cholesterol, and glycated hemoglobin mediated the association between SES and microvascular complications, with mediation percentages of 1.3%, 12.2%, 4.4%, 10.9%, and 10.8%, respectively.

CONCLUSIONS

Lower SES may be associated with a higher risk of diabetic microvascular complications, and obesity-related indicators and glycated hemoglobin may play important mediating roles in the association.

Association of objective and subjective socioeconomic status with intrinsic capacity deficits among community-dwelling middle-aged and older adults in China: A cross-sectional study

BACKGROUND

Intrinsic capacity (IC), representing an individual's full range of physical and mental abilities, is influenced by objective socioeconomic status (SES); however, the impact of subjective SES remains unclear.

OBJECTIVES

This study aims to assess IC and investigate the relationship between SES and IC deficits, with a particular focus on the role of subjective SES.

DESIGN

Cross-sectional study SETTING: 45 communities in two provinces in China PARTICIPANTS: Community-dwelling middle-aged and older adults aged 50 and above MEASUREMENTS: IC was assessed following the Integrated Care for Older People guideline. SES was measured through objective SES (education and occupation) and subjective SES (measured by MacArthur Scale). Ordinal logistic regression models were performed to estimate the association between SES and IC.

RESULTS

Among 3,058 participants (61.3 ± 8.05 years, 54.8 % women), 2,333 (76.3 %) showed deficits in at least one IC subdomain, particularly sensory (63.5 %), vitality (25.8 %) and cognition (18.4 %). A dose-response association was observed between SES and IC deficits. Individuals with high subjective SES (OR: 0.72, 0.60-0.87), high education (OR: 0.54, 0.38-0.75), and high occupation (OR: 0.64 0.50-0.81) exhibited lower IC deficits risk compared with counterparts. Individuals with high education and middle subjective SES or high occupation and middle subjective SES had 67 % (OR: 0.33, 0.18-0.60) and 49 % (OR: 0.51, 0.35-0.74) lower risk than those with low SES.

CONCLUSIONS

These findings suggest that individuals with low SES may be more vulnerable to IC deficits. Addressing social inequalities in the early assessment of IC is crucial for reducing health disparities and promoting healthy ageing.

Interpersonal violence-related physical injury in low- and middle-income countries and its association with markers of socioeconomic status: a systematic review

BACKGROUND

Interpersonal violence-related physical injury (IPVRPI) is a leading cause of death in low- and middle-income countries (LMICs), yet reliable data relating socioeconomic status (SES) and IPVRPI in these settings are lacking. We analyzed existing literature on associations between SES and IPVRPI in LMICs to understand how SES is measured in these contexts and synthesize data relating markers of SES to IPVRPI at the individual-level in order to inform future hospital-based IPVRPI prevention efforts.

METHODS

We searched Ovid MEDLINE, EMBASE, and Global Health databases in January 2022 for analytical studies from LMICs that explored individual-level associations between IPVRPI and markers of SES. Studies about intimate partner violence, suicide, or children < 12 years old were excluded, as were population-level studies. Markers of SES considered were educational attainment, employment, and household wealth. Collated data relating these SES indicators with IPVRPI were presented in forest plots.

RESULTS

A total of 34 studies from 20 LMICs were included. Brazil, Mexico, and South Africa were the most represented countries. Studies were mostly cross-sectional (n = 23), and data were typically from patient hospital records (n = 17) or population surveys (n = 12). Included studies explored associations between IPVRPI and education (n = 26), employment (n = 26), and household wealth (n = 19). Categorizations, particularly for employment and wealth, were highly variable between studies. Among the studies that performed multivariable analyses, IPVRPI was found to be significantly associated with lower educational attainment (n = 6), unemployment (n = 4), and lower household wealth (n = 6).

CONCLUSIONS

Numerous studies have explored individual-level associations between IPVRPI and markers of SES among LMIC populations. Across a variety of LMIC contexts, we found that IPVRPI tended to be associated with markers of lower SES. Further conclusions were limited by the heterogeneity of SES measure categorizations, varied IPVRPI case definitions, and lack of adjusted analyses. Future research should ensure SES measures utilized in LMICs are comprehensive and comparable, focus more specifically on IPVRPI from community violence, and consider hospital-based interventions to reduce risk of IPVRPI in LMIC settings.

Nanomanaging Chronic Wounds with Targeted Exosome Therapeutics

Chronic wounds pose a significant healthcare challenge, impacting millions of patients worldwide and burdening healthcare systems substantially. These wounds often occur as comorbidities and are prone to infections. Such infections hinder the healing process, complicating clinical management and proving recalcitrant to therapy. The environment within the wound itself poses challenges such as lack of oxygen, restricted blood flow, oxidative stress, ongoing inflammation, and bacterial presence. Traditional systemic treatment for such chronic peripheral wounds may not be effective due to inadequate blood supply, resulting in unintended side effects. Furthermore, topical applications are often impervious to persistent biofilm infections. A growing clinical concern is the lack of effective therapeutic modalities for treating chronic wounds. Additionally, the chemically harsh wound microenvironment can reduce the effectiveness of treatments, highlighting the need for drug delivery systems that can deliver therapies precisely where needed with optimal dosages. Compared to cell-based therapies, exosome-based therapies offer distinct advantages as a cell-free approach for chronic wound treatment. Exosomes are of endosomal origin and enable cell-to-cell communications, and they possess benefits, including biocompatibility and decreased immunogenicity, making them ideal vehicles for efficient targeting and minimizing off-target damage. However, exosomes are rapidly cleared from the body, making it difficult to maintain optimal therapeutic concentrations at wound sites. The hydrogel-based approach and development of biocompatible scaffolds for exosome-based therapies can be beneficial for sustained release and prolong the presence of these therapeutic exosomes at chronic wound sites. Engineered exosomes have been shown to possess stability and effectiveness in promoting wound healing compared to their unmodified counterparts. Significant progress has been made in this field, but further research is essential to unlock their clinical potential. This review seeks to explore the benefits and opportunities of exosome-based therapies in chronic wounds, ensuring sustained efficacy and precise delivery despite the obstacles posed by the wound environment.

Multimorbid life expectancy across race, socio-economic status, and sex in South Africa

Multimorbidity is increasing globally as populations age. However, it is unclear how long individuals live with multimorbidity and how it varies by social and economic factors. We investigate this in South Africa, whose apartheid history further complicates race, socio-economic, and sex inequalities. We introduce the term 'multimorbid life expectancy' (MMLE) to describe the years lived with multimorbidity. Using data from the South African National Income Dynamics Study (2008-17) and incidence-based multistate Markov modelling, we find that females experience higher MMLE than males (17.3 vs 9.8 years), and this disparity is consistent across all race and education groups. MMLE is highest among Asian/Indian people and the post-secondary educated relative to other groups and lowest among African people. These findings suggest there are associations between structural inequalities and MMLE, highlighting the need for health-system and educational policies to be implemented in a way proportional to each group's level of need.

The association between 24-h movement behaviours and adiposity among Australian preschoolers: a compositional data analysis

INTRODUCTION

The relationship between 24-h movement behaviours (i.e. sleep, sedentary behaviour and physical activity) and adiposity in preschoolers remains unclear. Therefore, this study aims to investigate the associations between 24-h movement behaviours and adiposity in preschoolers making use of compositional data analysis (CoDA).

METHODS

Australian preschoolers (3-5 years) from the Early Start Baseline Study wore an ActiGraph accelerometer to assess sedentary behaviour (SB), light physical activity (LPA) and moderate-to-vigorous physical activity (MVPA). Their weight and height were measured using standardized protocols and converted to Body Mass Index (BMI) z-scores using the World Health Organisation growth references. Their parents completed a questionnaire to assess their level of education and the child's sleep duration, age and sex. CoDA was employed to investigate the association between 24-h movement behaviours and adiposity in R.

RESULTS

This study included 169 preschoolers and their overall 24-h movement behaviour composition was associated with BMI z-scores (F = 5.02, p = 0.002). When examining the association between each movement behaviour relative to the others and BMI z-scores, we observed a statistically significant favourable association for sleep (p = 0.025) and unfavourable association for MVPA (p = 0.010), but not for the other behaviours. As such, reallocating 10 min from sleep or from MVPA, proportionally to all other behaviours was associated with a difference of + 0.031 (95%CI = 0.004,0.06) and -0.085 (95%CI = -0.15,-0.02) in BMI z-score, respectively.

CONCLUSION

Despite the association between more time spent in MVPA and higher BMI z-scores, promoting a balanced amount of time in each 24-h movement behaviour-more MVPA, less sedentary time, and sufficient sleep-remains important for overall health. Future studies should address methodological challenges (e.g. recruitment bias that may exist in the parents/children willing to participate versus the general population, recall bias in parent reported sleep duration, or other confounding variables such as diet), use larger and more diverse samples, and consider longitudinal designs. Additionally, focusing on other adiposity indicators, such as waist-to-height ratio or fat percentage, could enhance understanding of these relationships.

Bridging the Gap: Reducing Health Inequities in Access to Preventive Health Care Services in Rural Communities in the Philippines

INTRODUCTION

We used an implementation science framework to investigate perceived health inequities in preventive health care initiatives in rural communities in the Philippines. We also identified health equity-focused quality improvement strategies.

METHODS

Three health care providers and 12 barangay clinic patients were interviewed.

RESULTS

Patient interviews showed that social determinants of health, respect, and attitudes toward health care providers affected patient empowerment to engage in self-management for noncommunicable diseases (NCDs). Health care providers identified six challenges in managing NCDs: (a) inefficient work processes; (b) staffing shortages; (c) insufficient access to low-cost medications; (d) inadequate primary preventive health education from the schools; (e) health care not considered a priority; and (f) lack of local government support.

DISCUSSION

Inadequate preventive health care and education intensify health access and resource inequities in rural communities in the Philippines. A multi-sectoral plan may improve rural health infrastructure and education toward improving health care access and decreasing care disparities.

Prevalence of Self-Reported Chronic Non-Communicable Diseases among Adults in Addis Health and Demographic Surveillance System (Addis-HDSS), Addis Ababa, Ethiopia

Background

Chronic non-communicable diseases (NCDs) are a global health challenge, causing millions of deaths annually and contributing significantly to the global disease burden. Despite their prevalence in low- and middle-income countries (LMICs), NCDs receive limited global health financing. Ethiopia, like other LMICs, is experiencing a rising burden of NCDs. This study aimed to assess the self-reported prevalence of chronic NCDs and identify associated sociodemographic factors.

Methods

A population-based cross-sectional study was conducted at the Addis Health Demographic Surveillance System (Addis-HDSS) site in Addis Ababa, Ethiopia. All adults (≥18 years) living in the Addis-HDSS sites were included. Data were collected using a structured electronic questionnaire on self-reported NCDs and sociodemographic variables. Binomial regression model was used to identify sociodemographic factors associated with self-reported NCDs.

Results

Overall, 11.5% (95% CI: 11.3%-11.7%) of adults reported at least one NCD. The most prevalent conditions were hypertension (5.9%; 95% CI: 5.7%-6.1%) and diabetes mellitus (3.4%; 95% CI: 3.3%-3.5%). Older age (Adjusted Incidence Rate Ratio (AIRR): 5.47; 95% CI: 5.17-5.79), no formal education (AIRR: 1.58; 95% CI: 1.45-1.72), being formerly married (AIRR: 2.68; 95% CI: 2.47-2.91), and higher wealth quintiles (AOR: 1.16; 95% CI: 1.07-1.26) were statistically significant risk factors associated with NCDs.

Conclusion

This study highlights the high burden of chronic NCDs among adults in Addis Ababa. The findings highlight the importance of addressing NCDs as a significant public health challenge. Expanding access to early prevention, diagnosis, and care is critical in urban settings.

Education, urbanicity of residence, and cardiometabolic biomarkers among middle-aged and older populations in the US, Mexico, China, and India

Background

The relationship between education and cardiometabolic biomarkers is contextually dependent on both inter-country and intra-country factors. This study aimed to examine educational differences in cardiometabolic biomarkers among middle-aged and older adults in the US, Mexico, China, and India, and whether this relationship is modified by urbanicity of residence.

Methods

Data were from contemporary cross-sectional waves of the US Health and Retirement Study (HRS; 2016/17, n = 19,608), the Mexican Health and Aging Study (MHAS; 2015, n = 12,356), the China Health and Retirement Longitudinal Study (CHARLS; 2015/16, n = 13,268), and the Longitudinal Aging Study in India (LASI; 2017/19, n = 47,838). To account for substantial variations in educational distribution across the four countries, we measured education attainment in two ways: by categorizing education levels into binary classifications ('lower education: lower secondary education or below' vs. 'higher education: upper secondary education or above') to assess absolute education attainment, and by using within-country percentile ranks to capture relative education attainment. We assessed educational differences in four cardiometabolic biomarkers: body mass index (BMI), systolic blood pressure (SBP), glycated haemoglobin (HbA1c), and total cholesterol. We tested whether urbanicity of residence modified the relationship between education and these cardiometabolic biomarkers.

Results

The proportion of individuals with higher education was 82.6% in the US, 15.6% in Mexico, 10.6% in China, and 16.8% in India. In the US, higher education was associated with lower SBP (-2.74 mmHg, 95% CI: -3.62, -1.86) and HbA1c (-0.14%, 95% CI: -0.20, -0.08), but higher total cholesterol (3.33 mg/dL, 95% CI: 1.41, 5.25). In Mexico, higher education was associated with lower BMI only (-0.51 kg/m2, 95% CI: -0.76, -0.26). In China, higher education was not associated with any biomarker. In India, higher education was associated with higher BMI (1.61 kg/m2, 95% CI: 1.49, 1.73), SBP (1.67 mmHg, 95% CI: 1.16, 2.18), and HbA1c (0.35%, 95% CI: 0.19, 0.51). The association between education and cardiometabolic biomarkers was modified by urbanicity in China and India but not in the US or Mexico. In both China and India, relationships between education and cardiometabolic biomarkers were stronger among rural residents compared to those among urban residents. Results based on relative education attainment showed similar patterns in terms of the direction of the effect estimates, despite some discrepancies in statistical significance.

Interpretation

There is a complex relationship between education and cardiometabolic biomarkers across countries and by urbanicity of residence. This complexity underscores the importance of accounting for contextual factors when devising strategies to enhance cardiometabolic health in various settings.

Economic and healthcare influences on circulatory diseases in Kazakhstan: a retrospective ecological study

BACKGROUND

Health is a key driver of the United Nations Sustainable Development Goals. This study examined the relationships between economic indicators, demographic metrics, and health system factors and morbidity due to non-communicable diseases, such as diseases of the circulatory system, in Kazakhstan.

METHODS

This retrospective ecological study utilized regionally aggregated data from 2010 to 2020 for all 14 regions in Kazakhstan. Data on incidence rates of diseases of the circulatory system (DCS) and socioeconomic, demographic, and healthcare variables were sourced from the Bureau of National Statistics and the Ministry of Health. Variables included gross regional product per capita, population density, living wage, unemployment rates, average monthly salary, Gini coefficient, income below subsistence level, housing space per capita, average monthly wage in healthcare, doctor and nurse densities per 10,000 population, and number of hospital beds. A correlation analysis was performed followed by stepwise regression to identify significant predictors.

RESULTS

The analysis identified that higher living wages (β = 0.7), population density (β = 0.275), nurse density (β = 0.212), and average monthly salary (β = 0.502) were positively associated with higher DCS incidence rates. Conversely, gross regional product per capita (β = -0.68), housing space per capita (β = -0.441), and income below the subsistence level (β = -0.161) were negatively associated with DCS incidence. The model explained approximately 63.7% of variance in DCS incidence.

CONCLUSIONS

Socioeconomic and healthcare factors significantly influence the incidence of circulatory diseases in Kazakhstan. Policies aimed at improving economic conditions such as increasing living wages and reducing unemployment may help lower DCS morbidity. Additionally, equitable distribution of healthcare resources like nurses could enhance early detection and management of circulatory diseases, contributing to better public health outcomes in a middle-income country setting.

Prevention and control of cardiovascular disease in "real-world" settings: sustainable implementation of effective policies

Global progress in addressing cardiovascular diseases (CVD) has been insufficient to attain the nine WHO non-communicable disease (NCD) targets and the Sustainable Development Goal (SDG) target of reducing premature NCD mortality by one-third by 2030. Progress has been slowest in low- and middle-income countries (LMIC) where addressing the CVD burden is a foremost development imperative. This review examines the reasons for this situation to propose a way forward. First, we review policy instruments to address behavioral and metabolic risk factors of CVD and health system interventions to improve cardiovascular outcomes. Second, we illustrate the financial, health workforce, health system challenges, and weak national capacity that impede the implementation of these policy instruments. Third, we discuss how LMIC might move forward despite these challenges by (a) giving due consideration to contextual and other factors that determine the success of policy implementation (b) including affordable, high-impact interventions as the core of the universal health coverage health benefit package with primary health care as the foundation and (c) by taking note of the WHO guidance provided in the 2023-2030 implementation roadmap for the Global Action Plan for prevention and control of NCD.

The case for investment in nutritional interventions to prevent and reduce childhood and adolescent overweight and obesity in Peru: a modelling study

BACKGROUND

Between 2006 and 2016 the prevalence of overweight and obesity among children and adolescents aged 5-19 years in Peru increased from 22.7 to 27.0%. This investment case quantifies the economic impacts of childhood and adolescent overweight and obesity in Peru. It identifies and quantifies the potential impact of a set of new or expanded interventions that can strengthen current national efforts to prevent and reduce child and adolescent overweight and obesity.

METHODS

A deterministic Markov cohort model with a societal cost perspective estimated reductions in mortality and morbidity from implementing interventions to prevent and reduce child and adolescent overweight and obesity and the impact in savings in healthcare costs and gains in wages and productivity. Interventions identified through a review of published literature includes a school-based social marketing campaign, exclusive breastfeeding promotion and support, a healthy food and drink policy for school premises, and a 20% subsidy on fruits and vegetables for people living below the national poverty line. The return on investment (ROI) was calculated along with the estimated cost savings associated with the interventions. Analysis was conducted to test ROI sensitivity to changes in the key parameters and assumptions.

RESULTS

Between 2025 and 2092, the expected combined direct and indirect healthcare costs attributable to child and adolescent overweight and obesity in Peru are 210.6 billion USD. The direct healthcare costs are 1.8 billion USD, and the indirect costs are 208.8 billion USD. Expected savings for all interventions combined is 13.9 billion USD with a per-person savings of 12,089.8 USD. The expected ROI of the four interventions combined is 39.3 USD (30-years), 64.6 USD (50-years), and 164.1 USD (66-years) per one USD invested.

CONCLUSIONS

The overweight and obesity epidemic among children and adolescents in Peru requires wide-ranging and expanded implementation of policies to achieve long-term reductions in prevalence. This study's findings show that the four priority interventions have high ROIs and can be used to guide policy to address the complex interplay of factors that contribute to the obesogenic environment.

Chronic diseases among women of reproductive age in primary care: prevalence and associated factors

OBJECTIVE

To analyze the prevalence and associated factors with chronic diseases among women of reproductive age in primary health care.

METHOD

Cross-sectional study conducted with 397 women of reproductive age living in northern Paraná, Brazil. Data were collected from July 2019 to September 2020. The Women's Clinical Record was used to collect sociodemographic data, risk behaviors, diagnosis of chronic diseases and medication use. Chi-Square test was performed for association analysis, and Logistic Regression estimating Odds Ratio and 95% confidence intervals.

RESULTS

The prevalence of chronic diseases among women of reproductive age was 38.53% and the associated factors were: age group from 31 to 40 years old (OR=3.67; p=0.001) and from 41 to 49 years (OR =9.7; p=0.001), incomplete high school education (OR= 2.7; p=0.001), obesity (OR= 2.25; p=0.001) and smoking (OR=2.23; p=0.001).

CONCLUSION

Age at the end of the reproductive phase, obesity and smoking were associated with the presence of chronic diseases. Knowledge of these factors can assist in screening, monitoring and health education actions provided to women of childbearing age.

Lower Socioeconomic Status Predicts Increased Proinflammatory Signaling in Late Pregnancy: Evidence From a Filipino Cohort

OBJECTIVES

Maternal socioeconomic status (SES) is an important predictor of adverse birth outcomes and postnatal health across global populations. Chronic inflammation is implicated in cardiometabolic disease risk in high-income contexts and is a potential pathway linking maternal adversity to offspring health trajectories. To clarify how socioeconomic inequality shapes pregnancy inflammation in middle-income settings, we investigated SES as a predictor of inflammatory cytokines in late gestation in a sample from the Cebu Longitudinal Health Nutrition Survey in Cebu, Philippines.

METHODS

We used multiple regression to evaluate maternal SES, reflected in household assets, as a predictor of general inflammation (C-reactive protein), inflammatory cytokines (interleukin-6, interleukin-10), and inflammatory balance (n = 407). Inflammatory markers were measured at 29.9 weeks gestation in dried blood spots, and a measure reflecting relative balance of IL6 and IL10 was calculated to capture pro- versus anti-inflammatory skewed immune profiles.

RESULTS

Greater household assets significantly predicted lower IL6 concentration (p <  0.001), with a trend toward lower IL6 relative to IL10 (p = 0.084). C-reactive protein and IL10 were not individually related to SES.

CONCLUSIONS

The inverse relationship between SES and pregnancy inflammation in Cebu is consistent with results from high-income settings. These findings further highlight the influence of socioeconomic conditions on immune regulation during pregnancy. Given the evidence that gestational inflammation impacts offspring fetal growth, our results suggest that social and economic effects on immune function may be an important pathway for the intergenerational transmission of health disparities.

Standardized Wound Care: Patchwork Practices?

Standardized care is crucial in health care for ensuring consistent, safe, high-quality, efficient, and evidence-based practices. Care pathways that standardize procedures promote adherence to best practices, reduce variability in treatment, and encourage collaboration among health care teams. This approach ultimately improves patient outcomes, enhances safety, and boosts the overall effectiveness of health care services. However, despite these benefits being widespread across most of the U.S. health care system, wound care stands out as an area where standards can vary significantly. The inconsistency in wound care standards in the United States can be traced to several factors. These include limited structured clinical wound care education, the discretion of health care providers in different business environments, differences in wound care settings, varying access to advanced treatments and technology, patient demographics and socioeconomic status, as well as differences in state laws and regional or institutional practices. Addressing these disparities requires a comprehensive approach that considers the complex interplay of the abovementioned factors. Active measures are needed to improve access, equity, and the quality of wound care services for all patients, regardless of where they live, their socioeconomic status, their health care coverage, or the business interests of providers and their institutions as well as of vendors marketing wound care products inconsistent with evidence-based practice. By understanding and actively addressing these factors, we can work toward achieving more standardized, evidence-based, and patient-centered practices in wound care across the nation.

Prognosis and risk factor assessment of patients with advanced lung cancer with low socioeconomic status: model development and validation

BACKGROUND

Lung cancer, a major global health concern, disproportionately impacts low socioeconomic status (SES) patients, who face suboptimal care and reduced survival. This study aimed to evaluate the prognostic performance of traditional Cox proportional hazards (CoxPH) regression and machine learning models, specifically Decision Tree (DT), Random Forest (RF), Support Vector Machine (SVM), and Extreme Gradient Boosting (XGBoost), in patients with advanced lung cancer with low SES.

DESIGN

A retrospective study.

METHOD

The 949 patients with advanced lung cancer with low SES who entered the hospice ward of a tertiary hospital in Wuhan, China, from January 2012 to December 2021 were randomized into training and testing groups in a 3:1 ratio. CoxPH regression methods and four machine learning algorithms (DT, RF, SVM, and XGBoost) were used to construct prognostic risk prediction models.

RESULTS

The CoxPH regression-based nomogram demonstrated reliable predictive accuracy for survival at 60, 90, and 120 days. Among the machine learning models, XGBoost showed the best performance, whereas RF had the lowest accuracy at 60 days, DT at 90 days, and SVM at 120 days. Key predictors across all models included Karnofsky Performance Status (KPS) score, quality of life (QOL) score, and cough symptoms.

CONCLUSIONS

CoxPH, DT, RF, SVM, and XGBoost models are effective in predicting mortality risk over 60-120 days in patients with advanced lung cancer with low SES. Monitoring KPS, QOL, and cough symptoms is crucial for identifying high-risk patients who may require intensified care. Clinicians should select models tailored to individual patient needs and preferences due to varying prediction accuracies.

REPORTING METHOD

This study was reported in strict compliance with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guideline.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

Quantitative Definition of Low-Health-Interest Populations by Using Regression Trees: A Nationwide Internet Survey in Japan

BACKGROUND

Reducing health disparities is a public health issue. Identification of low-health-interest populations is important, but a definition of people with low health interest has not yet been established. We aimed to quantitatively define low-health-interest populations.

METHODS

A nationwide cross-sectional internet survey was conducted in 2022. We compiled regression tree (RT) analyses with/without adjustment for age, sex, and socioeconomic status with the 12-item Interest in Health Scale (IHS, score range 12-48) as an explanatory variable and the 10 composite health behaviors as a dependent variable. We defined the first IHS branching condition from the root node as a lower-health-interest group and the terminal node with the lowest health behaviors as the lowest-health-interest group.

RESULTS

The mean IHS value of 22,263 analyzed participants was 32.1 ± 5.6; it was higher in females and in those who were aged over 45 years, had a high education, a high income, or a spouse. The first branching condition was IHS 31.5, and the terminal node branched at 24.5, before/after adjustment for covariates.

CONCLUSIONS

We determined the cutoff values of the IHS as <32 for a lower-health-interest group and <25 for the lowest-health-interest group. Using these cutoffs might enable us to reveal the characteristics of low-health-interest populations.

Association between socioeconomic status and risk of chronic obstructive pulmonary disease in China: a prospective cohort study

OBJECTIVE

Socioeconomic status (SES) has been proven to be associated with chronic obstructive pulmonary disease (COPD) in Western populations, but the evidence is very limited in China. This study aimed to investigate the association between SES and the risk of COPD incident.

METHODS

This study was based on the China Kadoorie Biobank (CKB) project in Wuzhong District, Suzhou. A total of 45,484 adults aged 30-79 were included in the analysis during 2004-2008. We used Cox proportional hazard models to investigate the association between SES and the risk of COPD. Household income, education, private property and consumption potential was used to measure SES. Incident COPD cases were ascertained using hospitalization records, death certificates, and active follow-up.

RESULTS

A total of 524 COPD cases were identified during a median follow-up of 11.2 years. Household income was inversely associated with the risk of COPD (Ptrend<0.005). The adjusted hazard ratios (95% confidence intervals) for incident COPD were 0.88 (0.69-1.14), 0.77 (0.60-0.99), and 0.42 (0.31-0.57) for participants with annual household income of 10,000 ~ 19,999 yuan, 20,000 ~ 34,999 yuan and ≥ 35,000 yuan respectively, in comparison to participants with an annual household income < 10,000 yuan. Furthermore, we found that education level, refrigerator use, private toilet, private phone, and motor vehicle were adversely associated with COPD risk, while ownership of newly renovated flats was positively correlated with COPD incident.

CONCLUSIONS

This prospective study suggests that SES is associated with the risk of COPD in Chinese adults. Population-based COPD prevention strategies tailored for people with different SES could help reduce the burden of COPD in Chinese.

Molecular Morbidity Score-Can MicroRNAs Assess the Burden of Disease?

Multimorbidity refers to the presence of two or more chronic diseases and is associated with adverse outcomes for patients. Factors such as an ageing population have contributed to a rise in prevalence of multimorbidity globally; however, multimorbidity is often neglected in clinical guidelines. This is largely because patients with multimorbidity are systematically excluded from clinical trials. Accordingly, there is an urgent need to develop novel biomarkers and methods of prognostication for this cohort of patients. The hallmarks of ageing are now thought to potentiate the pathogenesis of multimorbidity. MicroRNAs are small, regulatory, noncoding RNAs which have been implicated in the pathogenesis and prognostication of numerous chronic diseases; there is a substantial body of evidence now implicating microRNA dysregulation with the different hallmarks of ageing in the aetiology of chronic diseases. This article proposes using the hallmarks of ageing as a framework to develop a panel of microRNAs to assess the prognostic burden of multimorbidity. This putative molecular morbidity score would have many potential applications, including assessing the efficacy of clinical interventions, informing clinical decision making and facilitating wider inclusion of patients with multimorbidity in clinical trials.

Impact of population ageing on cancer-related disability-adjusted life years: A global decomposition analysis

Background

As the global population ages, the burden of cancer is increasing. We aimed to assess the impact of population ageing on cancer-related disability-adjusted life years (DALYs).

Methods

We used the decomposition method to estimate the impact of ageing, population growth, and epidemiological change on cancer-related DALYs from 1990 to 2019, stratified by 204 countries/territories and by their sociodemographic index (SDI). This approach separates the net effect of population ageing from population growth and change in age-specific DALY rates.

Results

Cancer-related DALYs among individuals aged ≥65 years increased by 95.14% between 1990 (52.25 million) and 2019 (101.96 million). Population growth was the main contributor to cancer-related DALYs (92.38 million, attributed proportion: 60.91%), followed by population ageing (41.38 million, 27.28%). Cancer-related DALYs attributed to population ageing followed a bell-shaped pattern when stratified by SDI, meaning they peaked in middle-SDI countries. Cancer-related DALYs attributed to ageing increased in 171 and decreased in 33 countries/territories. The top three cancer types with the highest increase in the absolute number of cancer-related DALYs associated with ageing were tracheal, bronchus, and lung (8.72 million); stomach (5.06 million); and colorectal (4.28 million) cancers, while the attributed proportion of DALYs was the highest in prostate (44.75%), pancreatic (40.93%), and non-melanoma skin (38.03%) cancers.

Conclusions

Population ageing contributed to global cancer-related DALYs, revealing a bell-shaped pattern when stratified by socioeconomic development, affecting middle-SDI countries the most. To respond to the growing ageing population and reduce cancer-related DALYs, it is necessary to allocate health care resources and prioritize interventions for older adults.

Determinants of mortality status and population attributable risk fractions of the North West Province, South African site of the international PURE study

BACKGROUND

Mortality data and comparative risk assessments from sub-Saharan Africa are limited. There is an urgent need for high quality population health surveys to be conducted, to improve the national health surveillance system. Our aim was to perform a comparative risk assesment and report on the mortality status and cause of death data of participants from a South African site of the international Prospective Urban Rural Epidemiology study.

METHODS

1 921 Black participants were included, with a median observational time of 13 years resulting in 21 525 person-years. We performed a comparative risk assessment considering four health status domains: locality (rural vs. urban), socio-economic status (SES) (education and employment), lifestyle factors (physical activity, smoking and alcohol consumption) and prevalent diseases (human immunodeficiency virus (HIV), type 2 diabetes mellitus and hypertension). Next, population-attributable fractions (PAFs) were calculated to determine the mortality risk attributable to modifiable determinants.

RESULTS

577 all-cause deaths occurred. Infectious diseases (28.1% of all deaths) were the most frequent cause of death, followed by cardiovascular disease (CVD) (22.4%), respiratory diseases (11.6%) and cancer (11.1%). The three main contributors to all-cause mortality were HIV infection, high SES and being underweight. HIV infection and underweight were the main contributors to infectious disease mortality and hypertension, the urban environment, and physical inactivity to CVD mortality. HIV had the highest PAF, followed by physical inactivity, alcohol and tobacco use and hypertension (for CVD mortality).

CONCLUSION

This African population suffers from a quadruple burden of disease. Urban locality, high SES, prevalent disease (HIV and hypertension) and lifestyle factors (physical inactivity, tobacco and alcohol use) all contributed in varying degrees to all-cause and cause-specific mortalities. Our data confirm the public health importance of addressing HIV and hypertension, but also highlights the importance of physical inactivity, tobacco use and alcohol consumption as focal points for public health strategies to produce the most efficient mortality reduction outcomes.

Impacts of Poverty and Lifestyles on Mortality: A Cohort Study in Predominantly Low-Income Americans

INTRODUCTION

Low socioeconomic status has been linked to increased mortality. However, the impacts of poverty, alone or combined with health behaviors, on mortality and life expectancy have not been adequately investigated.

METHODS

Data from the Southern Community Cohort Study was used, including nearly 86,000 participants recruited during 2002-2009 across 12 US southeastern states. Analysis was conducted from February 2022 to January 2023.

RESULTS

During a median follow-up of 12.1 years, 19,749 deaths were identified. A strong dose-response relationship was found between household incomes and mortality, with a 3.3-fold (95%CI=3.1-3.6) increased all-cause mortality observed for individuals in the lowest income group (<$15,000/year) compared with those in the highest group (≥$50,000/year). Within each income group, mortality monotonically increased with declining healthy lifestyle score. Risk was significantly lower among those in the lowest income but healthiest lifestyle group, compared to those with the highest income but unhealthiest lifestyle (HR=0.82, 95%CI=0.69-0.97). Poor White participants appeared to experience higher all-cause mortality than poor Black participants. Life expectancy was more than 10.0 years shorter for those in the lowest income group compared with those in the highest income group.

CONCLUSIONS

Poverty is strongly associated with increased risk of death, but the risks could be modestly abated by a healthier lifestyle. These findings call for a comprehensive strategy for enhancing a healthy lifestyle and improving income equality to reduce death risks, particularly among those experiencing health disparities due to poverty.

Effects of Garlic on Glucose Parameters and Lipid Profile: A Systematic Review and Meta-Analysis on Randomized Controlled Trials

(1) Background: The effect of garlic on glucose and lipid metabolism in humans remains controversial. The aim of this study was to investigate the effects of garlic on blood lipid levels and glucose levels in humans through a systematic review and meta-analysis. (2) Methods: We extensively searched four databases, including PubMed, Web of Science, Embase, and the Cochrane Library, up to February 2024. To assess the collective impact of garlic and its supplements on fasting blood glucose (FBG), glycosylated hemoglobin (HbA1c), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and triglycerides (TG), an analysis was conducted using a random effects model. Subgroup analyses were performed when I2 < 50%. (3) Result: We found that the garlic intervention was effective in controlling FBG (mean difference = -7.01; 95% CI: -8.53, -5.49, p < 0.001), HbA1c (mean deviation = -0.66; 95% CI: -0.76, -0.55, p < 0.001, I2 = 62.9%), TC (mean difference = -14.17; 95% CI: -19.31, -9.03, p < 0.001), and LDL-C (mean difference = -8.20; 95% CI: -15.58, -0.81, p = 0.03); moreover, it also increased the level of HDL-C in humans (mean difference = 2.06; 95% CI: 1.54, 2.59; p < 0.001). Nonetheless, the intervention involving garlic did not yield a substantial impact on triglyceride (TG) levels. (4) Conclusion: The intervention of garlic is beneficial to control blood glucose and blood lipids in humans.

The effect of socioeconomic status, depression, and diabetes symptoms severity on diabetes patient's life satisfaction in India

Evidence suggests that diabetes is on the rise in India, affecting many people's life satisfaction. Comprehensive estimation of life satisfaction among diabetes patients does not exist in the country. This study examined the effects of socioeconomic status, depression, and diabetes symptoms severity on the life satisfaction of diabetes patients by controlling various demographic variables. It was a cross-sectional study comprising 583 diabetes patients from Punjab, India. Patients were interviewed using a multi-stage purposeful random sampling method. Descriptive analysis and partial least squares structural equation modelling were used in the study to test the hypotheses. Results revealed that socioeconomic status, depression and diabetes symptoms severity significantly influence the life satisfaction of diabetes patients. A 1% drop in diabetes symptoms severity corresponds to a 0.849% increase in life satisfaction, whereas a 1% decrease in depression results in a 0.898% increase in life satisfaction. Patients with higher diabetes symptoms severity were coping with common mental disorders. Women reported higher diabetes symptoms severity and depression than men, resulting in lower life satisfaction. An experimental evaluation of the effects of socioeconomic status, depression and diabetes symptoms severity, and numerous demographic factors on life satisfaction was reported. The findings will help policymakers understand the problem associated with life satisfaction among diabetes patients in the country.

Investigating the role of the built environment, socio-economic status, and lifestyle factors in the prevalence of chronic diseases in Mashhad: PLS-SEM model

Background

Chronic diseases remain a significant contributor to both mortality and disability in our modern world. Physical inactivity and an unhealthy diet are recognized as significant behavioral risk factors for chronic diseases, which can be influenced by the built environment and socio-economic status (SES). This study aims to investigate the relationship between the built environment, SES, and lifestyle factors with chronic diseases.

Methods

The current study was conducted in Mashhad's Persian cohort, which included employees from Mashhad University of Medical Sciences (MUMS). In the study, 5,357 participants from the cohort were included. To assess the state of the built environment in Mashhad, a Geographic Information System (GIS) map was created for the city and participants in the Persian Mashhad study. Food intake and physical exercise were used to assess lifestyle. A food frequency questionnaire (FFQ) was used to assess food intake. To assess food intake, the diet quality index was computed. To assess the link between variables, the structural model was created in accordance with the study's objectives, and partial least square structural equation modeling (PLS-SEM) was utilized.

Results

The chronic diseases were positively associated with male sex (p < 0.001), married (p < 0.001), and higher age (p < 0.001). The chronic diseases were negatively associated with larger family size (p < 0.05), higher SES (p < 0.001), and higher diet quality index (DQI) (p < 0.001). No significant relationship was found between chronic disease and physical activity.

Conclusion

Food intake and socioeconomic status have a direct impact on the prevalence of chronic diseases. It seems that in order to reduce the prevalence of chronic diseases, increasing economic access, reducing the class gap and increasing literacy and awareness should be emphasized, and in the next step, emphasis should be placed on the built environment.

The prevalence of cardiovascular disease risk factors among adults living in extreme poverty

Evidence on cardiovascular disease (CVD) risk factor prevalence among adults living below the World Bank's international line for extreme poverty (those with income <$1.90 per day) globally is sparse. Here we pooled individual-level data from 105 nationally representative household surveys across 78 countries, representing 85% of people living in extreme poverty globally, and sorted individuals by country-specific measures of household income or wealth to identify those in extreme poverty. CVD risk factors (hypertension, diabetes, smoking, obesity and dyslipidaemia) were present among 17.5% (95% confidence interval (CI) 16.7-18.3%), 4.0% (95% CI 3.6-4.5%), 10.6% (95% CI 9.0-12.3%), 3.1% (95% CI 2.8-3.3%) and 1.4% (95% CI 0.9-1.9%) of adults in extreme poverty, respectively. Most were not treated for CVD-related conditions (for example, among those with hypertension earning <$1.90 per day, 15.2% (95% CI 13.3-17.1%) reported taking blood pressure-lowering medication). The main limitation of the study is likely measurement error of poverty level and CVD risk factors that could have led to an overestimation of CVD risk factor prevalence among adults in extreme poverty. Nonetheless, our results could inform equity discussions for resource allocation and design of effective interventions.

Social determinants of chronic diseases reporting among slum dwellers in Egypt

The high prevalence of chronic diseases in urban slums poses increasing challenges to future social and economic development for these disadvantaged areas. Assessing the health status of slum residents offers guidance for formulating appropriate policies and interventions to improve slum residents' health outcomes. This research aimed to identify the social determinants of chronic diseases reporting among slum dwellers in Egypt. A cross-sectional survey was conducted from March to December 2021 in three slum areas in Giza governorate, Egypt, including 3,500 individuals. We constructed an asset index and a welfare index to measure the economic status and living conditions of slum residents, respectively. We used these indices, along with demographic and socio-economic factors, as independent variables in the analysis. We modeled factors associated with health status using a two-level mixed logistic model to control the effects of slum areas and the potential correlation between household members. The study contributed significantly to a better understanding of the context in which slum dwellers live and the interlinkages among poor living conditions, low economic status, and health outcomes. The results showed a high rate of self-reported chronic diseases among adults aged 18 and older, reaching more than 22%, while it did not exceed 2.0% among children in the slum areas. Therefore, measuring the determinants of chronic diseases was limited to adults. The sample size was 2530 adults after excluding 970 children. The prevalence of chronic diseases among adults ranged between 16.3% in Zenin and 22.6% in Bein El Sarayat. Our findings indicated that low socio-economic status was significantly associated with reporting chronic diseases. Future policies should be dedicated to improving living conditions and providing necessary healthcare services for these vulnerable areas.

Prevalence of Diabetes and the Relationship Between Wealth and Social Demographic Characteristics Across 6 Low-and-Middle Income Countries

Background

As the global burden of diabetes persists, research is needed to understand the role of wealth and correlates of diabetes across regions of the world. The purpose of this study is to examine the prevalence and role of wealth and diabetes across 6 low- and middle- income countries while also accounting for independent correlates of diabetes by country.

Methods

Data from the Study on Global Ageing and Adult Health (SAGE), SAGE Wave 1 was used. Self-reported diabetes status was the primary dependent variable and wealth quintile, number of dwelling characteristics and possession of a set of assets, was the independent variable. Logistic regression models examined the relationship between wealth and presence of diabetes across 6 countries with the highest wealth quintile, quintile 1, serving as the reference group.

Results

Sample size by country included Ghana N = 5573, South Africa N = 4227, Russia N = 4947, Mexico N = 5448, India N = 12198, and China N = 15050. Average age across country ranged from 49 to 63 years of age. Prevalence of diabetes across country included 3.4% and 9.2% for Ghana and South Africa, respectively. In Russia, 8.3%; Mexico, 18.1%; India, 4.9%; and China, 5.9% of the sample reported having diabetes. In the adjusted logistic model, wealth was associated with higher odds of diabetes in Ghana (OR 2.26; CI 1.28; 4.13), South Africa (OR 4.57; CI 2.25; 10.32), Mexico (OR 2.00; CI 1.14; 3.60), India (OR 2.45; CI 1.60; 3.86), and China (OR 2.16; CI 1.62, 2.93).

Conclusions

These findings add to the growing body of evidence in our understanding between wealth and diabetes. As diabetes persists as a leading cause of death globally, future work should focus on mechanisms underlying the relationship between wealth and diabetes while also developing interventions to mitigate his burgeoning disease affecting communities across low- and middle-income countries.

Factors associated with happiness among community-dwelling older adults: a systematic review

OBJECTIVES

To identify factors associated with self-reported happiness among community-dwelling older adults.

METHODS

A systematic review of the literature was conducted. Searches were conducted in the PsycInfo, Web of Science, Scopus and Pubmed databases for relevant articles published in English, Spanish or Portuguese using the following search strategy and Boolean operators: (happiness*) AND (elder* OR (old adult*)). No restriction was imposed with regards to year of publication. This review was registered in PROSPERO (CRD42018107302).

RESULTS

Forty-six articles met the eligibility criteria and were included in the review. Economic, social and health-related factors were associated with happiness among community-dwelling older adults. The sociodemographic characteristics of older adults, such as the female sex, being married, an older age, a higher level of schooling and having a religion, were also associated with happiness.

CONCLUSIONS

The articles included in the present systematic review demonstrate that social, economic and health-related aspects have an association with happiness in community-dwelling older adults.

Social Determinants of Health and Disparities in Hypertension and Cardiovascular Diseases

High blood pressure causes over 10 million preventable deaths annually globally. Populations in low- and middle-income countries suffer the most, experiencing increased uncontrolled blood pressure and cardiovascular disease (CVD) deaths. Despite improvements in high-income countries, disparities persist, notably in the United States, where Black individuals face up to 4× higher CVD mortality than White individuals. Social determinants of health encompass complex, multidimensional factors linked to an individual's birthplace, upbringing, activities, residence, workplaces, socioeconomic and environmental structures, and significantly affect health outcomes, including hypertension and CVD. This review explored how social determinants of health drive disparities in hypertension and related CVD morbidity from a socioecological and life course perspective. We present evidence-based strategies, emphasizing interventions tailored to specific community needs and cross-sector collaboration to address health inequalities rooted in social factors, which are key elements toward achieving the United Nations' Sustainable Development Goal 3.4 for reducing premature CVD mortality by 30% by 2030.

A drink equals how many cigarettes? Equating mortality risks from alcohol and tobacco use in Canada

Objective

To quantify and communicate risk equivalencies for alcohol-and tobacco-attributable mortality by comparing per standard drinks consumed to per number of cigarettes smoked in Canada.

Methods

Alcohol-and tobacco-attributable premature deaths (≤75 years of age) and years of life lost (YLL) were estimated using a lifetime risk modeling approach. Alcohol-attributable death statistics were obtained from the 2023 Canadian Guidance on Alcohol and Health data source. Tobacco-attributable death statistics were derived from the Mortality Population Risk Tool (MPoRT) model.

Results

The risk of alcohol use on premature death and YLL increased non-linearly with the number of drinks consumed, while the risk for tobacco use on these two measures increased linearly with the number of cigarettes smoked. Males who consumed 5 drinks/day-a standard drink contains 13.45 grams of alcohol in Canada-had an equivalent risk as smoking 4.9 cigarettes/day (when modeling for premature death) and 5.1 cigarettes/day (when modeling for YLL). Females who consumed 5 drinks/day experienced an equivalent risk as smoking 4.2 cigarettes/day for premature deaths and YLL. At all levels of alcohol consumption females and males who consumed <5 drinks/day have less risks from consuming a standard drink than from smoking a cigarette. For males who consumed 5 drinks/day, the increased risks of death from per drink consumed and per cigarette smoked were equal.

Conclusion

Risk equivalencies comparing alcohol use to tobacco use could help people who drink improve their knowledge and understanding of the mortality risks associated with increased number of drinks consumed per day.

The effect of PFAS exposure on glucolipid metabolism in children and adolescents: a meta-analysis

Background

Previous studies showed that per- and polyfluoroalkyl substances (PFAS), which are widely found in the environment, can disrupt endocrine homeostasis when they enter the human body. This meta-analysis aimed to evaluate current human epidemiological evidence on the relationship between PFAS exposure and glucolipid metabolism in childhood and adolescence.

Methods

We searched PubMed, Web of Science, Embase, and Cochrane Library databases, and identified population-based epidemiological studies related to PFAS and glucolipid metabolism indexes that were published before 30 December 2022. The heterogeneity of the included literature was assessed using the I-square (I2) test and statistics Q. Random-effects and fixed-effects models were used to combine the effect size. Subgroup analysis based on age and sex of the study participants was performed. A sensitivity analysis was used to evaluate the robustness and reliability of the combined results. Egger's and Begg's tests were used to analyze publication bias.

Results

A total of 12 studies were included in this analysis. There was a positive association between PFAS and TC (β = 1.110, 95% CI: 0.601, 1.610) and LDL (β = 1.900, 95% CI: 1.030, 2.770), and a negative association between PFAS and HOMA-IR in children and adolescents (β = -0.130, 95% CI: -0. 200, -0.059). PFOS was significant positive associated with TC (β = 8.22, 95% CI: 3.93, 12.51), LDL (β = (12.04, 95% CI: 5.08, 18.99), and HOMA-IR (β = -0.165, 95% CI: -0.292, -0.038). Subgroup analysis showed that exposure to PFAS in the adolescent group was positively associated with TC and LDL levels, and the relationship was stronger in females.

Conclusion

PFAS exposure is associated with glucolipid metabolism in children and adolescents. Among them, PFOS may play an important role. Recognition of environmental PFAS exposure is critical for stabilizing the glycolipid metabolism relationship during the growth and development of children and adolescents.

Assessing the effects of air pollution and residential greenness on frailty in older adults: a prospective cohort study from China

Many studies have established a correlation between air pollution and green space with age-related diseases, yet the relationship between air pollution, green space, and frailty among older adults is not fully understood. The primary objective of this investigation is to examine the longitudinal association among air pollution, green space, and frailty in older adults, as well as the potential interaction and mediating effect. Analyzed data were obtained from the multi-wave CLHLS investigation (2008-2018). The participants' environmental exposure was evaluated using six air pollutants (PM1, PM2.5, PM10, PM10-2.5, O3, and NO2), and normalized difference vegetation index (NDVI). Annual ambient air pollutants were estimated using satellite-based spatiotemporal models. Time-varying Cox proportional risk models were employed to investigate the longitudinal relationships between air pollutants, greenness, and the onset of frailty in the elderly population. We conducted a variety of subgroup analyses, sensitivity analyses, and assessed potential interaction and causal mediating effects. A total of 6953 eligible elderly individuals were enrolled in our study. In the fully adjusted model, per IQR uptick in levels of PM1, PM2.5, PM10, PM10-2.5, O3, and NO2 corresponded to a 17% (95% CI 1.10-1.24), 25% (95% CI 1.17-1.34), 29% (95% CI 1.20-1.39), 35% (95% CI 1.24-1.47), 12% (95% CI 1.04-1.20), and 11% (95% CI 1.05-1.18) increase in frailty risk, respectively. For NDVI, increased IQR was significantly negatively associated with the risk of frailty (aHR 0.82, 95% CI 0.77-0.87). Our results revealed a significant interaction effect among O3, NO2, and residential greenness. PM1, PM2.5, PM10, and PM10-2.5 play a mediating role in the estimated relationship between residential greenness and frailty. In summary, our study reveals that PM1, PM2.5, PM10, PM10-2.5, O3, and NO2 correspond to elevated risks of frailty in the elderly. Residential greenness is associated with a lower risk of frailty in the elderly. Residential greenness can exert a positive impact on frailty by reducing particulate matter concentrations.

Overadjustment bias in systematic reviews and meta-analyses of socio-economic inequalities in health: a meta-research scoping review

BACKGROUND

Overadjustment bias occurs when researchers adjust for an explanatory variable on the causal pathway from exposure to outcome, which leads to biased estimates of the causal effect of the exposure. This meta-research review aimed to examine how previous systematic reviews and meta-analyses of socio-economic inequalities in health have managed overadjustment bias.

METHODS

We searched Medline and Embase until 16 April 2021 for systematic reviews and meta-analyses of observational studies on associations between individual-level socio-economic position and health outcomes in any population. A set of criteria were developed to examine methodological approaches to overadjustment bias adopted by included reviews (rated Yes/No/Somewhat/Unclear).

RESULTS

Eighty-four reviews were eligible (47 systematic reviews, 37 meta-analyses). Regarding approaches to overadjustment, whereas 73% of the 84 reviews were rated as Yes for clearly defining exposures and outcomes, all other approaches were rated as Yes for <55% of reviews; for instance, 5% clearly defined confounders and mediators, 2% constructed causal diagrams and 35% reported adjusted variables for included studies. Whereas only 2% included overadjustment in risk of bias assessment, 54% included confounding. Of the 37 meta-analyses, 16% conducted sensitivity analyses related to overadjustment.

CONCLUSIONS

Our findings suggest that overadjustment bias has received insufficient consideration in systematic reviews and meta-analyses of socio-economic inequalities in health. This is a critical issue given that overadjustment bias is likely to result in biased estimates of health inequalities and accurate estimates are needed to inform public health interventions. There is a need to highlight overadjustment bias in review guidelines.

Socioeconomic status is negatively associated with immunosenescence but positively associated with inflammation among middle-aged women in Cebu, Philippines

BACKGROUND

Socioeconomic status (SES) gradients in health are well-documented, and while biological pathways are incompletely understood, chronic inflammation and accelerated immune aging (immunosenescence) among lower SES individuals have been implicated. However, previous findings have come from samples in higher income countries, and it is unclear how generalizable they are to lower- and middle-income countries (LMIC) with different infectious exposures and where adiposity-an important contributor to chronic inflammation-might show different SES patterning. To address this gap, we explored associations between SES and inflammation and immunosenescence in a sample of women in Cebu, Philippines.

METHODS

Data came from the mothers of the Cebu Longitudinal Health and Nutrition Survey birth cohort (mean age: 47.7, range: 35-69 years). SES was measured as a combination of annual household income, education level, and assets. Chronic inflammation was measured using C-reactive protein (CRP) in plasma samples from 1,834 women. Immunosenescence was measured by the abundance of exhausted CD8T (CD8 + CD28-CD45RA-) and naïve CD8T and CD4T cells, estimated from DNA methylation in whole blood in a random subsample of 1,028. Possible mediators included waist circumference and a collection of proxy measures of pathogen exposure.

RESULTS

SES was negatively associated with the measures of immunosenescence, with slight evidence for mediation by a proxy measure for pathogen exposure from the household's drinking water source. In contrast, SES was positively associated with CRP, which was explained by the positive association with waist circumference.

CONCLUSIONS

Similar to higher income populations, in Cebu there is an SES-gradient in pathogen exposures and immunosenescence. However, lifestyle changes occurring more rapidly among higher SES individuals is contributing to a positive association between SES and adiposity and inflammation. Our results suggest more studies are needed to clarify the relationship between SES and inflammation and immunosenescence across LMIC.

Lower regional urbanicity and socioeconomic status attenuate associations of green spaces with hypertension and diabetes mellitus: a national representative cross-sectional study in China

BACKGROUND

High blood pressure (HBP) and diabetes mellitus (DM) are two of the most prevalent cardiometabolic disorders globally, especially among individuals with lower socio-economic status (SES). Studies have linked residential greenness to decreased risks of HBP and DM. However, there has been limited evidence on whether SES may modify the associations of residential greenness with HBP and DM.

METHODS

Based on a national representative cross-sectional study among 44,876 adults, we generated the normalized difference vegetation index (NDVI) at 1 km spatial resolution to characterize individuals' residential greenness level. Administrative classification (urban/rural), nighttime light index (NLI), individual income, and educational levels were used to characterize regional urbanicity and individual SES levels.

RESULTS

We observed weaker inverse associations of NDVI with HBP and DM in rural regions compared to urban regions. For instance, along with per interquartile range (IQR, 0.26) increment in residential NDVI at 0∼5 year moving averages, the ORs of HBP were 1.04 (95%CI: 0.94, 1.15) in rural regions and 0.85 (95%CI: 0.79, 0.93) in urban regions (P = 0.003). Along with the decrease in NLI levels, there were continuously decreasing inverse associations of NDVI with DM prevalence (P for interaction <0.001). In addition, weaker inverse associations of residential NDVI with HBP and DM prevalence were found among individuals with lower income and lower education levels compared to their counterparts.

CONCLUSIONS

Lower regional urbanicity and individual SES could attenuate the associations of residential greenness with odds of HBP and DM prevalence.

Area-level deprivation and individual-level socioeconomic correlates of the diabetes care cascade among black south africans in uMgungundlovu, KwaZulu-Natal, South Africa

South Africa is experiencing a rapidly growing diabetes epidemic that threatens its healthcare system. Research on the determinants of diabetes in South Africa receives considerable attention due to the lifestyle changes accompanying South Africa's rapid urbanization since the fall of Apartheid. However, few studies have investigated how segments of the Black South African population, who continue to endure Apartheid's institutional discriminatory legacy, experience this transition. This paper explores the association between individual and area-level socioeconomic status and diabetes prevalence, awareness, treatment, and control within a sample of Black South Africans aged 45 years or older in three municipalities in KwaZulu-Natal. Cross-sectional data were collected on 3,685 participants from February 2017 to February 2018. Individual-level socioeconomic status was assessed with employment status and educational attainment. Area-level deprivation was measured using the most recent South African Multidimensional Poverty Index scores. Covariates included age, sex, BMI, and hypertension diagnosis. The prevalence of diabetes was 23% (n = 830). Of those, 769 were aware of their diagnosis, 629 were receiving treatment, and 404 had their diabetes controlled. Compared to those with no formal education, Black South Africans with some high school education had increased diabetes prevalence, and those who had completed high school had lower prevalence of treatment receipt. Employment status was negatively associated with diabetes prevalence. Black South Africans living in more deprived wards had lower diabetes prevalence, and those residing in wards that became more deprived from 2001 to 2011 had a higher prevalence diabetes, as well as diabetic control. Results from this study can assist policymakers and practitioners in identifying modifiable risk factors for diabetes among Black South Africans to intervene on. Potential community-based interventions include those focused on patient empowerment and linkages to care. Such interventions should act in concert with policy changes, such as expanding the existing sugar-sweetened beverage tax.

State of cancer care in India and opportunities for innovation

Cancer is one of the leading causes of morbidity and mortality in India. Despite recent medical and technological advances, the cancer burden in India remains high and continues to rise. Moreover, substantial regional disparities in cancer incidence and access to essential medical resources exist throughout the country. While innovative and effective cancer therapies hold promise for improving patient outcomes, several barriers hinder their development and utilization in India. Here we provide an overview of these barriers, including challenges related to patient awareness, inadequate infrastructure, scarcity of trained oncology professionals, and the high cost of cancer care. Furthermore, we discuss the limited availability of cancer clinical trials in the country, along with an examination of potential avenues to enhance cancer care in India. By confronting these hurdles head-on and implementing innovative, pragmatic solutions, we take an indispensable step toward a future where every cancer patient in the country can access quality care.

Socioeconomic inequalities in physical, psychological, and cognitive multimorbidity in middle-aged and older adults in 33 countries: a cross-sectional study

BACKGROUND

Many physical, psychological, and cognitive disorders are highly clustered among populations with low socioeconomic status. However, the extent to which socioeconomic status is associated with different combinations of these disorders is unclear, particularly outside high-income countries. We aimed to evaluate these associations in 33 countries including high-income countries, upper-middle-income countries, and one lower-middle-income country.

METHODS

This cross-sectional multi-region study pooled individual-level data from seven studies on ageing between 2017 and 2020. Education and total household wealth were used to measure socioeconomic status. Physical disorder was defined as having one or more of the self-reported chronic conditions. Psychological and cognitive disorders were measured by study-specific instruments. The outcome included eight categories: no disorders, physical disorder, psychological disorder, cognitive disorder, and their four combinations. Multivariable-adjusted logistic regression models were used to estimate odds ratios (ORs) and 95% CIs for the associations of socioeconomic status with these outcomes separately for high-income countries, upper-middle-income countries, and the lower-middle-income country.

FINDINGS

Among 167 376 individuals aged 45 years and older, the prevalence of multimorbidity was 24·5% in high-income countries, 33·9% in upper-middle-income countries, and 8·1% in the lower-middle-income country (India). Lower levels of education, household wealth, and a combined socioeconomic status score were strongly associated with physical, psychological, and cognitive multimorbidity in high-income countries and upper-middle-income countries, with ORs (low vs high socioeconomic status) for physical-psychological-cognitive multimorbidity of 12·36 (95% CI 10·29-14·85; p<0·0001) in high-income countries and of 23·84 (18·85-30·14; p<0·0001) in upper-middle-income countries. The associations in the lower-middle-income country were mixed. Participants with both a low level of education and low household wealth had the highest odds of multimorbidity (eg, OR for physical-psychological-cognitive multimorbidity 21·21 [15·95-28·19; p<0·0001] in high-income countries, 37·07 [25·66-53·56; p<0·0001] in upper-middle-income countries, and 54·96 [7·66-394·38; p<0·0001] in the lower-middle-income country).

INTERPRETATION

In study populations from high-income countries, upper-middle-income countries, and the lower-middle-income country, the odds of multimorbidity, which included physical, psychological, and cognitive disorders, were more than ten times greater in individuals with low socioeconomic status. Equity-oriented policies and programmes that reduce social inequalities in multimorbidity are urgently needed to achieve Sustainable Development Goals.

FUNDING

Zhejiang University, Fundamental Research Funds for the Central Universities, The Key Laboratory of Intelligent Preventive Medicine of Zhejiang Province, Wellcome Trust, Medical Research Council, National Institute on Aging, and Academy of Finland.

TRANSLATION

For the Chinese translation of the abstract see Supplementary Materials section.

Inequality of opportunity in outpatient expenditure among the elderly with multimorbidity: evidence from China

BACKGROUND

Inequality of opportunity (IOp) stemming from social circumstances exists in outpatient service utilization for the multimorbid elderly in China. However, little is known regarding the magnitude of the IOp and its composition. Therefore, this study aims to measure the IOp in outpatient expenditure and provide potential pathways for policy reform by assessing the contribution of each circumstance.

METHODS

This study included 3527 elderly aged ≥ 65 years with multimorbidity from the Chinese Longitudinal Healthy Longevity Study conducted in 2017-2018. An ordinary least squares regression model was used to analyze the circumstance-influencing factors of outpatient expenditure. The parametric approach was performed to quantify the IOp in outpatient expenditure and the Shapley value decomposition method was employed to determine the contribution of each circumstance. By extracting heterogeneity in the residual of the circumstance-dependent equation of outpatient expenditure across circumstance groups divided based on cluster analysis, we captured the effect of unobserved circumstances.

RESULTS

Except for pension and distance to health facilities, all the associations between circumstance and outpatient expenditure were statistically significant. The inequality caused by circumstances accounted for 25.18% of the total inequality. The decomposition results revealed that the reimbursement rate contributed 82.92% of the IOp, followed by education duration (4.55%), household registration (3.21%), household income (3.18%), pension (1.49%), medical insurance (1.26%), physical labor (0.99%), unobserved circumstances (0.86%), distance to health facilities (0.83%) and region (0.71%).

CONCLUSIONS

The priority of policy enhancement is to effectively improve the outpatient reimbursement benefit for treating chronic diseases. Additional crucial actions include enhancing the health literacy of the multimorbid elderly to promote the shift from medical needs to demands and accelerating the construction of rural capacity for providing high-quality healthcare to the elderly with multimorbidity.

The Relationship between Whole-Milk Dairy Foods and Metabolic Health Highlights an Opportunity for Dietary Fat Recommendations to Evolve with the State of the Science

The science of dietary fats has evolved, and a body of evidence indicates they are complex bioactive nutrients that have different effects on health depending on their food source, chain length, degree of saturation, and other factors that can be affected by food processing, handling, and storage. As such, it is becoming increasingly clear that the effects of foods on obesity and metabolic health cannot be predicted simply with their fat content. The aim of this opinion article is to provide a brief overview of select recent research on the effects of whole-milk dairy foods on body composition and indicators of metabolic health across the lifespan to show the gap between current knowledge and dietary guidance. As the state of the science on dietary fats and human health evolves to consider the complexity of food matrices, the total nutrient package they deliver, and the health impacts associated with dietary patterns, so too must guidelines for dietary fat.

"Academia da Saúde" program: mapping evidence from the largest health promotion community program in Brazil

The aim of this scoping review was to map the literature related to the "Academia da Saúde" Program, including the objective and rationale of the studies, activities carried out in the program's centers, as well as the actors involved in these actions. The search for evidence was conducted in the MEDLINE, LILACS, Web of Science, Scopus, COCHRANE, and SciELO databases. Additional evidence was investigated in the Catalog of Theses and Dissertations of the Coordination of Improvement of Higher Education Personnel (CAPES-Brazil) and in the Brazilian Digital Library of Theses and Dissertations, in addition to manual searches in the references of the studies/documents. Out of 642 initial records, the information synthesis was composed of 74 studies/documents (n = 54; 73.0% scientific articles, n = 48; 64.9% with cross-sectional design, n = 45; 60.8% quantitative analysis). Nutrition (n = 24; 32.2%) and evaluation of the Program (n = 27; 36.5%) were the main themes analyzed. Regarding the participant/object analyzed in each study, users (n = 39; 52.6%) were the main actors investigated. Future studies should consider investigating the effectiveness of the actions developed in the program centers, especially physical activity and healthy eating practices.

Patterns of Non-Communicable Disease, Multimorbidity, and Population Awareness in Bahir Dar, Northwest Ethiopia: A Cross-Sectional Study

Objective

Ethiopia, like other developing countries, is going through an epidemiological transition, and high rates of non-communicable diseases (NCDs) are having a significant impact on the health system; however, there is limited evidence about community level NCD prevalence, multimorbidity, and population awareness that could inform targeted interventions and policy responses. This study aimed to identify factors associated with NCD prevalence, multimorbidity, and population awareness of NCDs in Bahir Dar, Northwest Ethiopia.

Methods

A community-based cross-sectional survey was conducted with 417 randomly sampled adults. We performed descriptive and logistic regression analyses to evaluate associations between NCD prevalence (cardiovascular diseases, diabetes, cancer, chronic respiratory diseases, chronic kidney disease, and hypertension) multimorbidity (2 or more NCDs) and demographic, socioeconomic, individual risk factors, anthropometrics, knowledge, and attitude.

Results

This study reveals that 24% of participating adults have an NCD, and 8% have multimorbidity. One-third (34.5%) have some NCD knowledge, and 75% consider NCDs more dangerous than communicable diseases. We find low NCD prevalence in participants: younger than 40 years of age (AOR 0.17, 95% CI 0.07 to 0.39); with normal body mass index (AOR 0.27, 0.10 to 0.77) and; with a family history of NCD (AOR 7.7, 4.2 to 14.1). Multimorbidity is lower in young adults (AOR 0.08, 0.03 to 0.26). NCD knowledge is higher in men (AOR 1.76, 1.06 to 2.93) and employed adults (AOR 2.91, 1.52 to 5.57), and NCD attitude in normal-weight adults (AOR 3.23, 1.42 to 7.39).

Conclusion

This study reveals a high prevalence of NCD and overall low NCD awareness in the population. Age above 40 years, family history of NCD, and weight in the obese category are significant predictors of NCD prevalence. These findings can help health professionals, health offices, and concerned stakeholders to plan targeted health interventions to reduce NCDs in the population.