Dataset Information

Socioeconomic inequalities in smoking in low and mid income countries: positive gradients among women?

ABSTRACT:

Background

In Southern Europe, smoking among older women was more prevalent among the high educated than the lower educated, we call this a positive gradient. This is dominant in the early stages of the smoking epidemic model, later replaced by a negative gradient. The aim of this study is to assess if a positive gradient in smoking can also be observed in low and middle income countries in other regions of the world.

Methods

We used data of the World Health Survey from 49 countries and a total of 233,917 respondents. Multilevel logistic regression was used to model associations between individual level smoking and both individual level and country level determinants. We stratified results by education, occupation, sex and generation (younger vs. older than 45). Countries were grouped based on GDP and region.

Results

In Eastern Europe and the Eastern Mediterranean, we observed a positive gradient in smoking among older women and a negative gradient among younger women. In Sub-Saharan Africa and Latin America no clear gradient was observed: inequalities were relatively small. In South-East Asia and East Asia a strong negative gradient was observed. Among men, no positive gradients were observed, and like women the strongest negative gradients were seen in South-East Asia and East Asia.

Conclusions

A positive socio-economic gradient in smoking was found among older women in two regions, but not among younger women. But contrary to predictions derived from the smoking epidemic model, from a worldwide perspective the positive gradients are the exception rather than the rule.

SUBMITTER: Bosdriesz JR

PROVIDER: S-EPMC3922442 | biostudies-literature | 2014 Feb

REPOSITORIES: biostudies-literature

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Publications

Socioeconomic inequalities in smoking in low and mid income countries: positive gradients among women?

Bosdriesz Jizzo R JR Mehmedovic Selma S Witvliet Margot I MI Kunst Anton E AE

International journal for equity in health 20140206

<h4>Background</h4>In Southern Europe, smoking among older women was more prevalent among the high educated than the lower educated, we call this a positive gradient. This is dominant in the early stages of the smoking epidemic model, later replaced by a negative gradient. The aim of this study is to assess if a positive gradient in smoking can also be observed in low and middle income countries in other regions of the world.<h4>Methods</h4>We used data of the World Health Survey from 49 countri ...[more]

PMID: 24502335

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Project description:ImportanceAnemia remains a major challenge for women's and children's health in low- and middle-income countries (LMICs).ObjectiveTo assess the socioeconomic inequalities and prevalence of anemia among children and nonpregnant girls and women in LMICs over time.Design, setting, and participantsThis cross-sectional and repeated cross-sectional analysis used data from the Demographic and Health Surveys collected from January 1, 2000, through December 31, 2014. Initial cross-sectional data sets constructed from the most recent surveys included 163?419 children aged 6 to 59 months and 304?202 nonpregnant girls and women aged 15 to 49 years (hereinafter referred to as nonpregnant women) from 45 LMICs. Repeated cross-sectional data sets from the most recent and the earliest surveys consisted of 322?088 nonpregnant women from 25 LMICs and 182?273 children from 24 LMICs. Analyses were conducted from June 1, 2016, through July 3, 2018.Main outcomes and measuresTotal and severe anemia for children aged 6 to 59 months (hemoglobin level, <11 and <7 g/dL, respectively) and nonpregnant women aged 15 to 49 years (<12 and <8 g/dL, respectively) were defined according to the World Health Organization hemoglobin cutoff levels. The slope index of inequality (SII) and the relative index of inequality (RII) were calculated to determine anemia inequalities.ResultsAmong the 163?419 children aged 6 to 59 months and the 304?202 nonpregnant women aged 15 to 49 years in the initial cross-sectional data sets, 34 of 45 countries had anemia prevalence levels for children greater than 40% and 37 of 45 had anemia prevalence levels greater than 20% for nonpregnant women. Among the 182?273 children from 24 LMICs and 322?088 nonpregnant women from 25 LMICs in the repeated cross-sectional data sets, the annualized absolute decreases in the prevalence of anemia ranged from 0.67 to 3.98 percentage points in 16 of the 24 LMICs; for cases of severe anemia, the decrease was 0.03 to 0.82 percentage points in 15 LMICs. Among 322?088 nonpregnant women from 25 LMICs in the repeated cross-sectional data sets, the annualized absolute decreases in the prevalence of anemia ranged from 0.49 to 2.59 percentage points in 17 of 25 LMICs; for severe anemia, the decrease was 0.03 to 0.29 percentage points in 15 LMICs. The SII was significantly negative and the RII was significantly less than 1 in 37 of the 45 LMICs among children and in 26 of the 45 LMICs for nonpregnant women. The annualized changes in the SII approached 0 in 16 of the 24 LMICs among children and in 11 of 25 LMICs among nonpregnant women.Conclusions and relevanceMost LMICs continue to exhibit a high prevalence of anemia among children and nonpregnant women, although the prevalence of total and severe anemia have decreased in many LMICs. Anemia inequalities among children and nonpregnant women persist in most LMICs.

Project description:ObjectiveTo analyze socioeconomic inequalities in the prevalence of underweight and overweight or obesity in women from low and middle-income countries (LMICs).MethodsUsing the last available Demographic Health Survey between 2010 and 2016 from 49 LMICs, we estimated the prevalence of underweight (BMI < 18.5 kg/m2) and overweight or obesity combined (BMI ≥ 25 kg/m2) for women aged 20-49 years. We used linear regression to explore the associations between the two outcomes and gross national income (GNI). We assess within-country socioeconomic inequalities using wealth deciles. The slope index of inequality (SII) and the inequality pattern index (IPI) were calculated for each outcome. Negative values of the latter express bottom inequality (when inequality is driven by the poorest deciles) while positive values express top inequality (driven by the richest deciles).ResultsIn total, 931,145 women were studied. The median prevalence of underweight, overweight or obesity combined, and obesity were 7.3% (range 0.2-20.5%), 31.5% (8.8-85.3%), and 10.2% (1.9-48.8%), respectively. Pearson correlation coefficients with log GNI were -0.33 (p = 0.006) for underweight, 0.72 (p < 0.001) for overweight or obesity, and 0.66 (p < 0.001) for obesity. For underweight, the SII was significantly negative in 38 of the 49 countries indicating a higher burden among poor women. There was no evidence of top or bottom inequality. Overweight or obesity increased significantly with wealth in 44 of the 49 countries. Top inequality was observed in low-prevalence countries, and bottom inequality in high-prevalence countries.ConclusionUnderweight remains a problem among the poorest women in poor countries, but overweight and obesity are the prevailing problem as national income increases. In low-prevalence countries, overweight or obesity levels are driven by the higher prevalence among the richest women; as national prevalence increases, only the poorest women are relatively preserved from the epidemic.

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Dataset Information

Socioeconomic inequalities in smoking in low and mid income countries: positive gradients among women?

Background

Methods

Results

Conclusions

Publications

Socioeconomic inequalities in smoking in low and mid income countries: positive gradients among women?

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