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Income-based inequalities in risk factors of NCDs and inequities of preventive care services amongst 202,682 adults: a cross-sectional study of South Asia Biobank
Journal article   Open access   Peer reviewed

Income-based inequalities in risk factors of NCDs and inequities of preventive care services amongst 202,682 adults: a cross-sectional study of South Asia Biobank

Bernardo Andretti, Petya Atanasova, Zoey Verdun, Nalinda Tharanga Wellappuli, Rajendra Pradeepa, Sudha Vasudevan, Akansha Tyagi, Ali Ahsan, Md Mokbul Hossain, Abu Ahmed Shamim, …
BMC medicine, Vol.23, 504 (2025)
2025
DOI: https://doi.org/10.1186/s12916-025-04308-3
PMID: 40877943
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Published1.81 MBDownloadView
Open Access CC BY V4.0

Abstract

Adult Aged Asia, Southern Biological Specimen Banks Cross-Sectional Studies Diet Female Healthcare Disparities - statistics & numerical data Humans Income - statistics & numerical data India - epidemiology Male Middle Aged Noncommunicable Diseases - epidemiology Noncommunicable Diseases - prevention & control Pakistan - epidemiology Preventive Health Services - statistics & numerical data Risk Factors Socioeconomic Factors Sri Lanka - epidemiology Young Adult
There is scant research examining income-based inequalities in risk factors of non-communicable diseases (NCDs) and inequities of preventive care services across the South Asian population. We conducted a cross-sectional study of 202,682 adults aged 18 or above in four South Asian countries: Bangladesh, India, Pakistan, and Sri Lanka. We combined South Asia Biobank (SAB) surveillance data with environmental mapping exposure and 24-h dietary recall to estimate income-based inequalities using concentration curves and concentration indices (CI) that measure the magnitude and directional inequality effects. We also computed the horizontal inequity index (HII) for need-standardised healthcare utilisation and advice by measuring the extent to which the distribution of health promotion advice matches the distribution of diet-related risk factor variables across the income distribution. We reported concentration index coefficients and standard errors. Inequalities in exposure and diet-related risk factors of NCDs were observed. Underweight was concentrated amongst the poor (CI = - 0.16, SE = 0.005, p < 0.001), while overweight and obesity were concentrated amongst the rich (CI = 0.11, SE = 0.003, p < 0.001). Non-recommended intake of fats (CI = 0.04, SE = 0.003, p < 0.001) and carbohydrates were concentrated amongst the rich (CI = 0.05, SE = 0.003, p < 0.001), while non-recommended intake of free sugars (CI = - 0.05, SE = 0.004, p < 0.001) and fruits and vegetables amongst the poor (CI = - 0.07, SE = 0.005, p < 0.001). Exposure to unhealthy outlets was concentrated amongst the rich (CI = 0.02, SE = 0.002, p < 0.001). There were persistent and pro-rich inequities in healthcare utilisation (HII = 0.02, SE = 0.002, p < 0.001) and advice for salt reduction (HII = 0.02, SE = 0.004, p < 0.001), fat reduction (HII = 0.02, SE = 0.004, p < 0.001), healthy weight (HII = 0.03, SE = 0.006, p < 0.001), and fruits and vegetables consumption (HII = 0.04, SE = 0.004, p < 0.001). These findings indicate the need to address and mitigate income-based inequalities in diet-related risk factors of NCDs and underscore the need of policies directed at mitigating NCDs risk exposure and achieving improved and equitable access to healthcare.

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UN Sustainable Development Goals (SDGs)

This output has contributed to the advancement of the following goals:

#3 Good Health and Well-Being
#10 Reduced Inequalities

Source: SDGs in the Output

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