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Table 1 Summary of results for incidence or prevalence of NCDs

From: Socioeconomic inequalities in non-communicable diseases and their risk factors: an overview of systematic reviews

Author, Year

Population

Outcome

Results

Risk of Bias

Cardiovascular diseases

   

Age-adjusted mean stroke incidence rates:

Feigin et al., 2009 [24]

General population in HIC and LMIC

Incidence of stroke

HIC: 42 % reduction from 1970–79 to 2000–08 (p < 0.004); LMIC: >50 % increase from 1970–79 to 2000–08 (p < 0.0001)

Unclear

Stroke mean incidence rates over time by age groups (1970–79 vs 2000–8):

HIC: 44 % (<75 y) and 41 % (> 75 y) reduction (both p < 0.0001); LMIC: 2-fold (< 75 y) and almost 4-fold (≥ 75 years) increase (p = 0.001 and p < 0.0001)

Fowkes et al. 2013 [16]

General population in HIC and LMIC

Prevalence of PAD

Prevalence of PAD was higher in women from LMIC than HIC at all ages up to 60–64 years, above which the prevalence was higher in HIC. Prevalence of PAD was higher in men from HIC than LMIC at all ages.

High

Rate of change from 2000 to 2010 was 28.7 % in LMIC and 13.1 % in HIC.

Galobardes et al., 2006 [15]

General population mostly in HIC

Incidence or prevalence of overall CVD, CHD, stroke, other CVD subtypes

9 out of 9 prospective studies found a higher incident risk of CVD among those with low childhood SES.

High

7 of 11 case-control studies showed an association of low childhood SES and risk for MI, angina, or stroke.

5 cross-sectional studies found a higher prevalence of CHD among those with low childhood SES.

   

HR for stroke incidence:

Kerr et al., 2011 [23]

General population mostly in HIC (all but 1 study)

Incidence of stroke

Unadjusted Meta-analysis (low vs high) Education, occupation or income: 1.67, 95 % CI: 1.46–1.91

Unclear

Meta-analysis adjusted for grouped vascular risk factors (low vs high) Education, occupation or income: 1.31, 95 % CI: 1.16–1.48

   

RR for acute MI:

Manrique-Garcia et al., 2011 [22]

General population in HIC and LMIC

Incidence of acute MI

Meta-analysis across countries (low vs high) Education: 1.34, 95 % CI: 1.22–1.47; Occupation: 1.35. 95 % CI: 1.19–1.53; Income: 1.71, 95 % CI: 1.43—2.05

Unclear

HIC (low vs high) Education: 1.39, 95 % CI: 1.25–1.55; Occupation: 1.41, 95 % CI: 1.25–1.59; Income: 1.76, 95 % CI: 1.46–2.12

LMIC (low vs high) Education: 1.16, 95 % CI: 0.97–1.39; Occupation: 0.51, 95 % CI: 0.27–0.99; Income:1.46, 95 % CI: 0.60–3.54

Pollitt et al., 2005 [17]

General population from HIC

Incidence of CVD (MI, IHD, carotid IMT; CHD, AP), stroke

8 out of 9 studies found a higher incident risk of CVD among those with low childhood SES, but only few studies reported inverse adjusted (CVD risk factors and/or adult SES) associations. 2 out of 2 studies showed no significant associations between stroke risk and childhood SES. 1 study found an association between cumulative life course exposure to low SES conditions and increased CVD outcome.

High

Sposato et al., 2012 [21]

General population in HIC, MIC, and LIC

First-ever incidence of stroke

Lower PPP-aGDP correlated with higher incident risk of stroke (ρ = -0.661, p = 0.027).

Unclear

Lower PPP-aTHE correlated with higher incident risk of stroke (ρ = -0.623, p = 0.040).

There were no correlations between unemployment rate and risk of stroke incidence (ρ = -0.492, p = 0.12).

Cancers

Adam et al., 2008 [11]

Children in HIC

Incidence of childhood leukaemia

Two studies showed an increased risk of leukaemia in children from deprived areas, 4 studies showed a decreased risk of leukaemia in children from deprived areas or lower SES, 1 study found SES not to be a determinant of leukaemia in children.

High

   

RR for lung cancer incidence:

Sidorchuk et al., 2009 [26]

General population in HIC and MIC

Incidence of lung cancer

Meta-analysis, adjusted for smoking, RR (low vs high) Education: 1.61, 95 % CI: 1.40–1.85; Occupation: 1.48, 95 % CI: 1.34–1.65; Income: 1.37, 95 % CI: 1.06–1.77

Unclear

HIC (low vs high) Education: 1.66, 95 % CI: 1.10–2.51; Occupation: 1.42, 95 % CI: 1.26–1.62; Income: 1.39. 95 % CI: 1.13–1.69

MIC (low vs high) Education: 1.66, 95 % CI: 1.28–2.16; Occupation: 0.90, 95 % CI: 0.66–1.23; Income: 1.30, 95 % CI: 0.23–7.31

Slatore et al., 2010 [25]

General population in the US

Incidence of lung cancer

1 study found higher incidence rates of lung cancer for women and men from all age groups with Medicaid insurance compared to non-Medicaid. 1 study found higher incidence rates of lung cancer for Medicare patients alone compared to Medicaid/Medicare patients, but the effect was removed when the comparison group was restricted to patients covered by Medicaid >12 months before diagnosis.

Unclear

   

RR for lung cancer incidence:

Uthman et al., 2013 [27]

General population in HIC, MIC, and LIC

Incidence of gastric cancer

Overall (low vs high) Education: 2.97, 95 % CI: 1.92–4.58; Occupation: 4.33, 95 % CI: 2.57–7.29; Income: 1.25, 95 % : 0.93–1.68; Combined SEP: 2.64, 95 % CI:1.05–6.63

Unclear

HIC (low vs high) Education: 2.65, 95 % CI 1.64–4.30; Occupation: 6.79, 95 % CI 3.42–13.50; Income: 1.09, 95 % CI: 0.76–1.56; Combined SEP: 4.50, 95 % CI: 0.84–24.16

 

MIC (low vs high) Education: 5.11, 95 % CI 2.71–9.65; Occupation: 3.06, 95 % CI 2.10–4.8; Income: 1.48, 95 % CI: 0.61–3.58; Combined SEP: 1.36, 95 % CI: 0.52–3.60

 

Type 2 diabetes

   

RR for type 2 diabetes incidence:

Agardh et al., 2011 [28]

General population in HIC, MIC, and LIC

Incidence of type 2 diabetes

Overall (low vs high) Education: 1.41, 95 % CI: 1.28–1.51; Occupation: 1.31, 95 % CI: 1.09–1.57; Income: 1.40, 95 % CI: 1.04–1.88

Unclear

HIC (low vs high) Education: 1.45, 95 % CI: 1.28–1.63; Occupation: 1.31, 95 % CI: 1.05–1.63; Income: 1.40, 95 % CI: 0.81–2.42

MIC (low vs high) Education: 1.59, 95 % CI: 1.28–1.97; Occupation: 1.27, 95 % CI: 0.96–1.68; Income: 1.39, 95 % CI: 1.06–1.82

LIC (low vs high; n = 1); Education: –; Occupation: –; Income: RR 1.27, 95 % CI: 0.99–1.62

Tamayo et al., 2010 [18]

General population in HIC and MIC

Incidence of type 2 diabetes in later life

4 out of 6 studies showed an increased risk of type 2 diabetes in either girls or boys from low parental occupational status, 2 studies showed no association. For education, 2 out of 3 studies showed an increased risk of type 2 diabetes in children from low SES. 1 study showed no statistically significant association between type 2 diabetes incidence and childhood adversity.

High

Chronic respiratory diseases

Gershon et al., 2012 [29]

General population in HIC

Prevalence and incidence of COPD

6 out of 8 studies found individuals of the lowest SES strata more likely to have or develop.

Low

COPD than those of the highest (point estimates of OR ranging from 0.8–3.7, RII ranging from 2.2 to 3.2).

  1. RR Relative risk, CI Confidence interval, SES Socioeconomic status, COPD Chronic obstructive pulmonary disease, OR Odds ratio, RII Relative index of inequality, na not available, SEP Socioeconomic position, y years, vs versus, p p-value, LMIC Low and middle income countries, LIC Low income countries, MIC Middle income countries, HIC High income countries, PAD Peripheral artery disease, MI Myocardial infarction, CVD Cardiovascular diseases, CHD Coronary heart disease, IHD Ischaemic heart disease, IMT Intima-media thickness, AP Angina pectoris, PPP-aGDP Per capita GDP adjusted for purchasing power parity, PPP-aTHE total health expenditures per capita at purchasing power parity, ρ Spearman rank correlation coefficient, n number of studies, NCDs Non-communicable diseases, HR Hazard ratio
  2. aRelative Index of Inequality is an indicator of the degree of inequality across socioeconomic categories