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Table 4 Hierarchical bivariate and multivariable determinants of NCD DALYs among adolescents in 194 countries, 2015

From: Non-communicable diseases among adolescents: current status, determinants, interventions and policies

Domain/Indicator Outcome: DALYs attributed to NCDs among adolescents (rate, 2015)
  Bivariate Multivariable
  R-Square Β estimate (Standard error)
P-value 		StB Β estimate (Standard error)
P-value
Level 3 Model- Distal: Macro Structural Factors a
Conflict Source & Year     
Battle related deaths (total; log) World Bank, 2013 1% −23.5 (16.92)
0.1673 		− 0.10 –
Internally displaced persons (total; log) World Bank, 2013 1% −21.8 (24.92)
0.3838 		− 0.07 –
Refugee populations by country of asylum (total; log) World Bank, 2014 16% −58.3 (10.31)
<.0001 		− 0.39 −19.8 (8.13)
0.0156
Governance
Political stability/absence of terrorism World Bank, 2013 0% −11.3 (60.98)
0.8534 		−0.01 –
Government effectiveness 1 World Bank, 2013 11% −264.4 (56.03)
<.0001 		−0.33 − 442.4 (44.27)
<.0001
Corruption 1 World Bank, 2013 10% −245.9 (56.74)
<.0001 		−0.31 –
Environment
 Frequency of natural disasters (total; log)   0% −72.2 (84.02)
0.3914 		−0.07 –
 Cost damage of natural disasters (USD; log)   2% −11.7 (6.91)
0.0924 		−0.13 –
  Distal Model R2:
38%
Level 2 Model- Intermediate I: National Structural Factors b
 Infrastructure and Urbanization
  Urbanization (% of population; log) UNICEF, 2016 14% − 597.0 (111.74)
<.0001 		−0.37 − 261.0 (120.39)
0.0316
  Access to electricity (% population; cubed) World Bank 9% −0.00057 (0.00014)
<.0001 		−0.30 − 0.0005 (0.00016)
0.0014
 Population Density
  Population density (people per m2 land; log) World Bank 2% −91.2 (43.15)
0.036 		−0.16 −52.8 (33.41)
0.1162
 Telecommunications Access
  Mobile cellular subscriptions (per 100 people; log) World Bank, 2014 3% − 266.1 (114.17)
0.0209 		−0.17 –
  Internet users (per 100 people; log) World Bank, 2014 6% −147.7 (43.14)
0.0008 		−0.25 –
 National Wealth
  GDP per capita, 5 year lag (USD; log) 3 World Bank, 2014 11% −172.9 (37.70)
<.0001 		−0.33 –
 Health Spending
  Government expenditure on health, 2 year lag (% of total health expenditure; log) WHO, 2013 1% −165.0 (151.16)
0.2766 		−0.08 –
  Total health expenditure per capita, 2 year lag (PPP, NCU per USD; log) 3 WHO, 2013 12% − 169.7 (34.83)
<.0001 		−0.34 −111.3 (62.56)
0.0771
  Intermediate I Model R2:
47%
Level 3- Intermediate II: Community, Household & Individual Factors c
 Socioeconomic Status (Education and Employment)
  Adult literacy rate (% of adults ages 15+ years; cubed) World Bank 1% −0.00024 (0.00022)
0.2767 		−0.10  
  Primary school enrolment ratio (gross %; log) World Bank, 2003–2014 1% 719.0 (499.43)
0.1519 		0.11  
  Secondary school enrolment ratio (gross %; log) World Bank, 2013 7% − 496.9 (144.18)
0.0007 		−0.27  
  Employment to population ratio (% of adults 15+ years; log) World Bank 4% 724.5 (282.59)
0.0112 		0.19  
 Youth Empowerment
  Youth literacy rate (% total 15–24 year olds; squared) World Bank, 2014 3% −0.1 (0.03)
0.0718 		−0.16 –
  Female youth literacy rate (% 15–24 year olds; squared) World Bank, 2014 2% −0.04 (0.03)
0.1169 		− 0.14 –
  Youth unemployment rate (% total 15–24 year olds; log) World Bank, 2013 1% −95.3 (76.09)
0.212 		− 0.10 –
  Adolescent fertility rate (births per 1000 females aged 15–19 years; log) World Bank, 2009–2014 12% 256.0 (52.22)
<.0001 		0.34 224.4 (66.17)
0.0009
 Women Empowerment and Gender Equity
  Total fertility rate (births per woman; log) World Bank, 2013 7% 454.5 (122.04)
0.0003 		0.27 –
  Adult female literacy rate (% females 15+ years who can read and write; cubed) World Bank 0.5% −0.016 (0.021)
0.4481 		−0.07 –
  Women in parliament (% of parliamentary seats held by women; log) World Bank, 2014 4% −92.3 (35.97)
0.0111 		−0.19 –
  Secondary school gender parity index (ratio of girls to boys in secondary education; log) World Bank, 2013 3% − 877.5 (416.20)
0.0366 		−0.17 − 700.4 (341.58)
0.0422
  Tertiary school gender parity index (ratio of girls to boys in tertiary education; log) World Bank, 2013 6% − 206.4 (66.82)
0.0024 		− 0.25 –
 Income Equity
  GINI index (log)2 World Bank, 2012 12% 1072.6 (269.17)
0.0001 		0.35 –
 Access to Health Services and Commodities
  Out of pocket expenditure as % of total health expenditure (log) WHO, 2013 0.06% −23.7 (75.81)
0.7544 		−0.02 –
  Physician density per 1000 population (log) WHO, 2003–2013 10% − 177.1 (47.11)
0.0003 		− 0.32 –
  Intermediate II Model R2:
62%
  1. Note: variables significant at p < 0.20 in bivariate analysis were entered into elastic net linear regression models; 1 Government effectiveness and corruption were strongly collinear (> 80%) and thus only the former was entered into multivariable modeling; 2 Due to small sample size (n = 117 countries), GINI index not considered in multivariable analysis; 1 GDP per capita and health expenditure per capita were strongly collinear (> 80%) and thus only the latter was entered into multivariable modeling
  2. a Level 3 multivariable model includes all statistically significant (p < 0.15) distal variables as listed
  3. b Level 2 multivariable model includes level 3 model+ all statistically significant (p < 0.15) intermediate I variables as listed
  4. c Level 1 multivariable model includes level 2 model+ all statistically significant (p < 0.15) intermediate II variables as list
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BMC Public Health

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