Socioeconomic Determinants of Noncommunicable Disease Risk Factors in Rapidly Changing Societies: Multi-country analysis of six countries of the former Soviet Union

Abstract

Ei-tarttuvien tautien riskitekijöiden yhteys sosioekonomisiin muuttujiin nopeasti muuttuvissa yhteiskunnissa; kuuden entisen Neuvostoliiton maan analyysi

Tausta: Sosioekonomisilla muuttujilla on merkittävä rooli ei-tarttuvien tautien riskitekijöiden jakautumisessa väestössä, ja tämä rooli voi olla erityisen kriittinen entisen Neuvostoliiton maissa johtuen niiden nopeista yhteiskunnallisista muutoksista. Tämän väitöskirjan tavoitteena oli tutkia ei-tarttuvien tautien riskitekijöiden esiintymisen yhteyttä sosioekonomiseen asemaan nopeasti muuttuvissa yhteiskunnissa, sekä niiden merkitystä ei-tarttuvien tautien ehkäisy- ja kontrolliohjelmille.

Menetelmät: Aineistona oli 15 501 aikuista kuudesta entisen Neuvostoliiton maasta (Georgia, Latvia, Kazakstan, Ukraina, Venäjä ja Viro), jotka olivat mukana World Health Survey - tutkimuksessa 2002-2004. Tutkimuksen kohteena olevat ei-tarttuvien tautien riskitekijät olivat tupakointi, runsas alkoholin käyttö, ylipaino ja lihavuus, vähäinen vihannesten ja hedelmien kulutus sekä liian vähäinen liikunta. Koulutusta, nykyistä työtä ja varallisuutta käytettiin kuvaamaan sosioekonomista asemaa.

Tulokset: Vähäinen vihannesten ja hedelmien kulutus, ylipaino ja lihavuus sekä miesten tupakointi olivat yleisiä riskitekijöitä tutkimuksen kohteena olevassa väestössä, sen sijaan runsas alkoholin käyttö ja liian vähäinen liikunta olivat odotettua vähäisempiä riskitekijöitä. Sosioekonomista asemaa kuvaavista indikaattoreista varallisuus ja nykyinen työ liittyivät vahvemmin riskitekijöiden esiintymiseen kuin koulutustaso.

Johtopäätökset: Sosioekonomisilla tekijöillä on tutkimuksen kohteena olevissa maissa suuri merkitys ei-tarttuvien tautien riskitekijöiden yleisyyteen. Ei-tarttuvien tautien riskitekijöiden yleisyyttä pitäisi pyrkiä alentamaan sekä väestö- että yksilötasoisilla terveyden edistämiseen ja tautien ehkäisyyn pyrkivillä terveysohjelmilla, joiden tulisi erityisesti kohdistua korkeimman riskin omaaviin ja köyhimpiin väestöryhmiin.

Socioeconomic determinants play a substantial role in the distribution of noncommunicable disease (NCD) risk factors, and this can be specifically critical in countries of the former Soviet Union (FSU) due to the rapid changes in society. The collapse of the Soviet Union in 1991 has brought immense social, political and economic changes with damaging consequences on the population health and health sector, and a rapid rise in social inequalities in health in this particular part of the world. The transition process of the region and its consequences on health have given important insights into health determinants such as smoking, alcohol, diet and others. Although general picture of these nations is similar, some countries are doing better than the rest while some are still struggling much.

The aim of this dissertation was to examine the socioeconomic determinants of noncommunicable disease risk factors in rapidly changing societies and their implications for noncommunicable disease prevention and control programmes. To achieve this aim, the data from the World Health Survey (2002-2004) was used which covered 15 501 adults from six countries of the FSU, namely: Estonia, Georgia, Kazakhstan, Latvia, Russia and Ukraine. The NCD risk factors were smoking, heavy alcohol use, overweight and obesity, low fruit and vegetable intake, and physical inactivity. Additionally, co-occurrence of these five risk factors were studied by creating a new variable ‘multiple risk factors’ for people with none to all risk factors. Socioeconomic status was measured by education, current job and wealth quintile. All analyses were stratified by sex as the prevalence and patterns of NCD risk factors varied by sex. Multivariable logistic regression analyses were performed, employing a general modelling approach in favour of the study results to be comparable.

The prevalence of low fruit and vegetable intake, male smoking, and overweight and obesity was high in this population, while that of heavy alcohol use and physical inactivity was lower than expected. Moreover, the level of multiple risk factors was very high in both sexes, but men had a higher number of co-occurring risk factors. The most common co-occurring combinations were low fruit and vegetable intake, overweight and obesity, and also smoking for men.

From studied SES indicators, wealth quintile and current job were the most significant predictors of NCD risk factors rather than education. Educational level was not related to all NCD risk factors and multiple risk factors for females; whereas for males, it was associated with only smoking and multiple risk factors. Better educated men had lower likelihoods of smoking and three or more risk factors. On the contrary, wealth was associated with the majority of risk factors for both sexes. Wealthier males were less likely to be smokers, had higher intake of fruit and vegetables, and yet were more overweight and obese. Those from poor and the richest quintiles had lower likelihoods of multiple risk factors. Similarly to men, wealthier women were more likely to have adequate amount of fruits and vegetables. Rural women from the richest quintile had sedentary lifestyle, while wealth quintile was not significant for urban women. Likewise in men, wealthier women had more excess weight but it was only relevant for those women aged 45 and above. Wealth had some protective effect for heavy alcohol use among females, but not among males. Females working for pay, except those working for government, smoked more than those not working. Employers from both sexes had higher consumption of fruit and vegetables, in addition to government employees and self-employed men. All government employees and as well those males who are non-government employees or self-employed were at higher level of physical activity. Self-employed men from urban areas were more likely to have excess weight.

Based on the study results, following conclusions can be drawn: 1) To tackle effectively certain public health problems, it is important to consider and understand the history and background of the society in regards to their social, economic and political context. 2) It is crucial to use all three dimensions of socioeconomic status (education, occupation, and wealth or income) in health inequality studies to detect the true picture for any particular population. Thus, it is advisable to gather all essential demographic and socioeconomic indicators in any data for health. 3) Finally, this thesis highlights the importance of socioeconomic determinants of NCD risk factors in these transition or rapidly changing countries with inadequate health systems. Health policies should address high levels of NCD risk factors by providing population-wide and individual-based preventive measures and policies, explicitly targeting those who are most vulnerable and poor, in addition to the implementation of multiple-intervention strategies that will achieve greater health gains targeting the most common co-occurring combinations of NCD risk factors.