Journal of Preventive Medicine and Public Health

The Korean Society for Preventive Medicine (대한예방의학회)
권호 표지
DOI QR코드

DOI QR Code

Decomposition of Socioeconomic Inequality in Cardiovascular Disease Prevalence in the Adult Population: A Cohort-based Cross-sectional Study in Northwest Iran

  • Pourfarzi, Farhad (Digestive Disease Research Center, Ardabil University of Medical Sciences) ;
  • Moghadam, Telma Zahirian (Social Determinants of Health Research Center, Ardabil University of Medical Sciences) ;
  • Zandian, Hamed (Social Determinants of Health Research Center, Ardabil University of Medical Sciences)
  • Received : 2022.01.29
  • Accepted : 2022.03.29
  • Published : 2022.05.31
Download PDF
⟨ Previous Next ⟩

Abstract

Objectives: The incidence of cardiovascular disease (CVD) mortality is increasing in developing countries. This study aimed to decompose the socioeconomic inequality of CVD in Iran. Methods: This cross-sectional population-based study was conducted on 20 519 adults who enrolled in the Ardabil Non-Communicable Disease cohort study. Principal component analysis and multivariable logistic regression were used, respectively, to estimate socioeconomic status and to describe the relationships between CVD prevalence and the explanatory variables. The relative concentration index, concentration curve, and Blinder-Oaxaca decomposition model were used to measure and decompose the socioeconomic inequality. Results: The overall age-adjusted prevalence of CVD was 8.4% in northwest Iran. Multivariable logistic regression showed that older adults, overweight or obese adults, and people with hypertension and diabetes were more likely to have CVD. Moreover, people with low economic status were 38% more likely to have CVD than people with high economic status. The prevalence of CVD was mainly concentrated among the poor (concentration index, -0.077: 95% confidence interval, -0.103 to -0.060), and 78.66% of the gap between the poorest and richest groups was attributed to differences in the distribution of the explanatory variables included in the model. Conclusions: The most important factors affecting inequality in CVD were old age, chronic illness (hypertension and diabetes), marital status, and socioeconomic status. This study documented stark inequality in the prevalence of CVD, wherein the poor were more affected than the rich. Therefore, it is necessary to implement policies to monitor, screen, and control CVD in poor people living in northwest Iran.

Keywords

Acknowledgement

This project was financially supported by the National Institute for Medical Research Development (NIMAD: 962249). In addition, a part of this work was funded by the Ardabil University of Medical Sciences (ARUMS).

References

  1. Ruan Y, Guo Y, Zheng Y, Huang Z, Sun S, Kowal P, et al. Cardiovascular disease (CVD) and associated risk factors among older adults in six low-and middle-income countries: results from SAGE Wave 1. BMC Public Health 2018;18(1):778. https://doi.org/10.1186/s12889-018-5653-9
  2. de Mestral C, Stringhini S. Socioeconomic status and cardiovascular disease: an update. Curr Cardiol Rep 2017;19(11):115. https://doi.org/10.1007/s11886-017-0917-z
  3. Lopez AD, Adair T. Is the long-term decline in cardiovasculardisease mortality in high-income countries over? Evidence from national vital statistics. Int J Epidemiol 2019;48(6):1815-1823. https://doi.org/10.1093/ije/dyz143
  4. Davari M, Maracy MR, Khorasani E. Socioeconomic status, cardiac risk factors, and cardiovascular disease: a novel approach to determination of this association. ARYA Atheroscler 2019;15(6):260-266.
  5. Stewart J, Manmathan G, Wilkinson P. Primary prevention of cardiovascular disease: a review of contemporary guidance and literature. JRSM Cardiovasc Dis 2017;6:2048004016687211.
  6. Sadeghi M, Haghdoost AA, Bahrampour A, Dehghani M. Modeling the burden of cardiovascular diseases in Iran from 2005 to 2025: the impact of demographic changes. Iran J Public Health 2017;46(4):506-516.
  7. Alizadeh G, Gholipour K, Khosravi MF, Khodayari-Zarnaq R. Preventive community-based strategies of cardiovascular diseases in Iran: a multi-method study. Soc Work Public Health 2020;35(4):177-186 https://doi.org/10.1080/19371918.2020.1764432
  8. Soltani S, Saraf-Bank S, Basirat R, Salehi-Abargouei A, Mohammadifard N, Sadeghi M, et al. Community-based cardiovascular disease prevention programmes and cardiovascular risk factors: a systematic review and meta-analysis. Public Health 2021;200:59-70. https://doi.org/10.1016/j.puhe.2021.09.006
  9. Rezaei S, Hajizadeh M. Measuring and decomposing socioeconomic inequality in catastrophic healthcare expenditures in Iran. J Prev Med Public Health 2019;52(4):214-223. https://doi.org/10.3961/jpmph.19.046
  10. Rahmanian K, Shojaie M. The prevalence of pre-hypertension and its association to established cardiovascular risk factors in south of Iran. BMC Res Notes 2012;5:386. https://doi.org/10.1186/1756-0500-5-386
  11. Veronesi G, Ferrario MM, Kuulasmaa K, Bobak M, Chambless LE, Salomaa V, et al. Educational class inequalities in the incidence of coronary heart disease in Europe. Heart 2016;102(12):958-965. https://doi.org/10.1136/heartjnl-2015-308909
  12. Rose G, Marmot MG. Social class and coronary heart disease. Br Heart J 1981;45(1):13-19. https://doi.org/10.1136/hrt.45.1.13
  13. Najafi F, Pasdar Y, Hamzeh B, Rezaei S, Moradi Nazar M, Soofi M. Measuring and decomposing socioeconomic inequalities in adult obesity in Western Iran. J Prev Med Public Health 2018;51(6):289-297. https://doi.org/10.3961/jpmph.18.062
  14. Franks P, Tancredi DJ, Winters P, Fiscella K. Including socioeconomic status in coronary heart disease risk estimation. Ann Fam Med 2010;8(5):447-453. https://doi.org/10.1370/afm.1167
  15. Braveman PA, Cubbin C, Egerter S, Chideya S, Marchi KS, Metzler M, et al. Socioeconomic status in health research: one size does not fit all. JAMA 2005;294(22):2879-2888. https://doi.org/10.1001/jama.294.22.2879
  16. Orkaby AR, Onuma O, Qazi S, Gaziano JM, Driver JA. Preventing cardiovascular disease in older adults: one size does not fit all. Cleve Clin J Med 2018;85(1):55-64. https://doi.org/10.3949/ccjm.85a.16119
  17. Zahirian Moghadam T, Zandian H, Pourfarzi F, Poustchi H. Environmental and economics-related factors of smoking among Iranian adults aged 35-70: a PERSIAN cohort-based cross-sectional study. Environ Sci Pollut Res Int 2021;28(33):45365-45374. https://doi.org/10.1007/s11356-021-13941-3
  18. Mahdavi-Roshan M, Rezazadeh A, Joukar F, Naghipour M, Hassanipour S, Mansour-Ghanaei F. Comparison of anthropometric indices as predictors of the risk factors for cardiovascular disease in Iran: the PERSIAN Guilan Cohort Study. Anatol J Cardiol 2021;25(2):120-128.
  19. Alipour V, Zandian H, Yazdi-Feyzabadi V, Avesta L, Moghadam TZ. Economic burden of cardiovascular diseases before and after Iran's health transformation plan: evidence from a referral hospital of Iran. Cost Eff Resour Alloc 2021;19(1):1. https://doi.org/10.1186/s12962-020-00250-8
  20. Poustchi H, Eghtesad S, Kamangar F, Etemadi A, Keshtkar AA, Hekmatdoost A, et al. Prospective epidemiological research studies in Iran (the PERSIAN Cohort Study): rationale, objectives, and design. Am J Epidemiol 2018;187(4):647-655. https://doi.org/10.1093/aje/kwx314
  21. Kolenikov S, Angeles G. Socioeconomic status measurement with discrete proxy variables: is principal component analysis a reliable answer? Rev Income Wealth 209;55(1):128-165. https://doi.org/10.1111/j.1475-4991.2008.00309.x
  22. Filmer D, Pritchett LH. Estimating wealth effects without expenditure data--or tears: an application to educational enrollments in states of India. Demography 2001;38(1):115-132. https://doi.org/10.2307/3088292
  23. Wagstaff A, Paci P, van Doorslaer E. On the measurement of inequalities in health. Soc Sci Med 1991;33(5):545-557. https://doi.org/10.1016/0277-9536(91)90212-U
  24. Monteiro CN, Beenackers MA, Goldbaum M, de Azevedo Barros MB, Gianini RJ, Cesar CL, et al. Socioeconomic inequalities in dental health services in Sao Paulo, Brazil, 2003-2008. BMC Health Serv Res 2016;16(1):683. https://doi.org/10.1186/s12913-016-1928-y
  25. World Health Organization. Closing the gap in a generation: health equity through action on the social determinants of health - final report of the commission on social determinants of health; 2008 [cited 2021 Dec 1]. Available from: https://www.who.int/publications/i/item/WHO-IER-CSDH-08.1
  26. Zandian H, Takian A, Rashidian A, Bayati M, Zahirian Moghadam T, Rezaei S, et al. Effects of Iranian economic reforms on equity in social and healthcare financing: a segmented regression analysis. J Prev Med Public Health 2018;51(2):83-91. https://doi.org/10.3961/jpmph.17.050
  27. Yusuf S, Joseph P, Rangarajan S, Islam S, Mente A, Hystad P, et al. Modifiable risk factors, cardiovascular disease, and mortality in 155 722 individuals from 21 high-income, middle-income, and low-income countries (PURE): a prospective cohort study. Lancet 2020;395(10226):795-808. https://doi.org/10.1016/s0140-6736(19)32008-2
  28. Emadi M, Delavari S, Bayati M. Global socioeconomic inequality in the burden of communicable and non-communicable diseases and injuries: an analysis on global burden of disease study 2019. BMC Public Health 2021;21(1):1771. https://doi.org/10.1186/s12889-021-11793-7
  29. Malyutina S, Bobak M, Simonova G, Gafarov V, Nikitin Y, Marmot M. Education, marital status, and total and cardiovascular mortality in Novosibirsk, Russia: a prospective cohort study. Ann Epidemiol 2004;14(4):244-249. https://doi.org/10.1016/S1047-2797(03)00133-9
  30. Koch E, Romero T, Romero CX, Akel C, Manriquez L, Paredes M, et al. Impact of education, income and chronic disease risk factors on mortality of adults: does 'a pauper-rich paradox' exist in Latin American societies? Public Health 2010;124(1):39-48. https://doi.org/10.1016/j.puhe.2009.11.008
  31. Chang WC, Kaul P, Westerhout CM, Graham MM, Armstrong PW. Effects of socioeconomic status on mortality after acute myocardial infarction. Am J Med 2007;120(1):33-39. https://doi.org/10.1016/j.amjmed.2006.05.056
  32. McFadden E, Luben R, Wareham N, Bingham S, Khaw KT. Occupational social class, risk factors and cardiovascular disease incidence in men and women: a prospective study in the European Prospective Investigation of Cancer and Nutrition in Norfolk (EPIC-Norfolk) cohort. Eur J Epidemiol 2008;23(7):449-458. https://doi.org/10.1007/s10654-008-9262-2
  33. Verdonk P, Benschop YW, de Haes HC, Lagro-Janssen TL. From gender bias to gender awareness in medical education. Adv Health Sci Educ Theory Pract 2009;14(1):135-152. https://doi.org/10.1007/s10459-008-9100-z
  34. Regitz-Zagrosek V, Lehmkuhl E, Weickert MO. Gender differences in the metabolic syndrome and their role for cardiovascular disease. Clin Res Cardiol 2006;95(3):136-147. https://doi.org/10.1007/s00392-006-0351-5
  35. Mehramiri A, Parand S, Haghpanah S, Karimi M. Attitudes of haemophilic patients towards their health and socio-economic problems in Iran. Haemophilia 2012;18(1):122-128. https://doi.org/10.1111/j.1365-2516.2011.02586.x
  36. Ramahi T, Khawaja M, Abu-Rmeileh N, Abdulrahim S. Socioeconomic disparities in heart disease in the Republic of Lebanon: findings from a population-based study. Heart Asia 2010;2(1):67-72. https://doi.org/10.1136/ha.2009.000851
  37. Psaltopoulou T, Hatzis G, Papageorgiou N, Androulakis E, Briasoulis A, Tousoulis D. Socioeconomic status and risk factors for cardiovascular disease: Impact of dietary mediators. Hellenic J Cardiol 2017;58(1):32-42. https://doi.org/10.1016/j.hjc.2017.01.022
  38. Williams CT, Latkin CA. Neighborhood socioeconomic status, personal network attributes, and use of heroin and cocaine. Am J Prev Med 2007;32(6 Suppl):S203-S210. https://doi.org/10.1016/j.amepre.2007.02.006
  39. Kanitz MG, Giovannucci SJ, Jones JS, Mott M. Myocardial infarction in young adults: risk factors and clinical features. J Emerg Med 1996;14(2):139-145. https://doi.org/10.1016/0736-4679(95)02089-6
  40. Pourreza A, Barat A, Hosseini M, Akbari Sari A, Oghbaie H. Relationship between socioeconomic factors and coronary artery disease among under-45 year-old individuals in Shahid Rajaee Hospital, Tehran, Iran: a case-control study. J Sch Public Health Inst Public Health Res 2010;7(4): 25-32 (Persian).