Socio-Economic Inequality of Chronic Non-Communicable Diseases in Bangladesh

Abstract

IntroductionChronic non-communicable diseases (NCDs) are a major public health challenge, and undermine social and economic development in much of the developing world, including Bangladesh. Epidemiologic evidence on the socioeconomic status (SES)-related pattern of NCDs remains limited in Bangladesh. This study assessed the relationship between three chronic NCDs and SES among the Bangladeshi population, paying particular attention to the differences between urban and rural areas.Materials and MethodData from the 2011 Bangladesh Demographic and Health Survey were used for this study. Using a concentration index (CI), we measured relative inequality across pre-diabetes, diabetes, pre-hypertension, hypertension, and BMI (underweight, normal weight, and overweight/obese) in urban and rural areas in Bangladesh. A CI and its associated curve can be used to identify whether socioeconomic inequality exists for a given health variable. In addition, we estimated the health achievement index, integrating mean coverage and the distribution of coverage by rural and urban populations.ResultsSocioeconomic inequalities were observed across diseases and risk factors. Using CI, significant inequalities observed for pre-hypertension (CI = 0.09, p = 0.001), hypertension (CI = 0.10, p = 0.001), pre-diabetes (CI = -0.01, p = 0.005), diabetes (CI = 0.19, p<0.001), and overweight/obesity (CI = 0.45, p<0.001). In contrast to the high prevalence of the chronic health conditions among the urban richest, a significant difference in CI was observed for pre-hypertension (CI = -0.20, p = 0.001), hypertension (CI = -0.20, p = 0.005), pre-diabetes (CI = -0.15, p = 0.005), diabetes (CI = -0.26, p = 0.004) and overweight/obesity (CI = 0.25, p = 0.004) were observed more among the low wealth quintiles of rural population. In the same vein, the poorest rural households had more co-morbidities compared to the richest rural households (p = 0.003), and prevalence of co-morbidities was much higher for the richest urban households compared to the poorest urban households. On the other hand in rural the “disachievement” of health indicators is more noticeable than the urban ones.ConclusionThe findings indicate the high burden of selected NCDs among the low wealth quintile populations in rural areas and wealthy populations in urban areas. Particular attentions may be necessary to address the problem of NCDs among these groups.

The prevalence of underweight, overweight and obesity in Bangladeshi adults: Data from a national survey

“…The prevalence of overweight and obesity that we report in urban Bangladesh (37%) is double the previous report of 17% based on a hospital (icddr,b) population of adults (≥20 years of age) in 2011 [18]. We found the prevalence of overweight and obesity in the rural areas (17%) was also higher than the 10% reported in rural women of reproductive age in 2000–2004 [19], but was less than half the prevalence reported in a rural community (aged ≥20 years) in 2009 which indicated that ~18% were overweight and 26% were obese[20]. In part, the discrepancy is due to different cut-points used to define overweight and obesity, as well as differences in the age of the population studied.…”

Socioeconomic Inequalities in Hypertension in Kenya: A Decomposition Analysis of 2015 Kenya STEPwise Survey on Non-communicable Diseases Risk Factors

“…Similar to other studies in LMICs [8,23,37,38], our findings indicate the presence of inequalities in hypertension disfavouring the poor population. The magnitude of the inequalities in our study (C: -0.08) is lower compared to that of Iran (C: -0.15) [23,38] and among rural residents in Bangladesh (C: -0.20) [23,38] despite an almost similar hypertension prevalence reflecting the varying levels of inequalities. However, our findings differ from the pro-poor inequality in high blood pressure reported in a study among women of reproductive age in sub-Saharan Africa [13].…”

Increasing prevalence of overweight and obesity in Bangladeshi women of reproductive age: Findings from 2004 to 2014

“…As like as other developing country, Bangladesh is experiencing a rapid demographic and epidemiological transition [ 8 – 10 ]which has been associated with increases in overweight and obesity. In 2011, cross-sectional data indicated that the overall prevalence of overweight and obesity combined in women who had been or were married was 18%[ 11 ], approximately 1.5 times that reported in women aged 20 to 49 years of age in 2007[ 12 ].…”