Socioeconomic inequalities in non-communicable disease risk factors in a middle-income country

Background: Epidemiological evidence suggests earlier adoption of non-communicable disease (NCD) risk factors by advantaged socioeconomic (SES) groups which, with development, is followed by increased prevalence among disadvantaged groups. Yet, it is unclear whether the magnitude and direction of these inequalities are consistent across various risk factors. We investigated this issue by examining patterns of associations between SES and four NCD risk behaviors.

Methods: Data are derived from the national Nutrition and Non-Communicable Disease Survey of 2279 individuals (1046 men and 1233 women), aged 25 years or more, in Lebanon, a small middle-income country in the MENA region. SES was assessed through education, car ownership, presence of full-time domestic worker and crowding index.

Results: Physical inactivity and cigarettes smoking were the most common behavioral risk factors (46.2% and 44.7%, respectively), followed by low fruit/vegetable consumption (36.8%) and episodic alcohol drinking (12.3%). Higher education and car ownership were associated with reduced odds of cigarette smoking and low fruit/vegetable consumption. Odds ratios were all statistically significant and in the range of 0.42 to 0.84. In contrast, car ownership and the presence of a full-time domestic worker were significantly associated with increased odds of physical inactivity and heavy episodic alcohol drinking (range 1.29 to 1.88). Mixed patterns were found for crowding index.

Conclusions: The disaggregated analysis demonstrated different patterns of SES inequalities in NCD risk factors within the country. This highlights the need to account for a diverse range of high-risk populations in designing NCD health promotion policies and programs.