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Table 5 Hierarchical bivariate and multivariable determinants of NCD DALYs among adults in 194 countries, 2015

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

Domain/Indicator Outcome: DALYs attributed to NCDs among adults (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 9% 492.95 (242.94)
0.0487
0.17
Internally displaced persons (total; log) World Bank, 2013 0% 31.75 (218.61)
0.8847
0.01
Refugee populations by country of asylum (total; log) World Bank, 2014 3% −262.897 (127.60)
0.0410
- 0.13  
Governance
Political stability/ absence of terrorism World Bank, 2013 2% − 960.160 (512.51)
0.0673
−0.13
Government effectiveness 1 World Bank, 2013 7% − 1831.88 (498.67)
0.0003
−0.26
Corruption 1 World Bank, 2013 4% − 1288.79 (507.14)
0.0119
−0.18 −1288.79 (507.14)
0.0119
Environment
 Frequency of natural disasters (total; log)   0.3% −487.76 (751.42)
0.5172
−0.05
 Cost damage of natural disasters (USD; log)   0.8% − 257.35 (403.53)
0.5266
−0.09
  Distal Model R2:
4%
Level 2 Model- Intermediate I: National Structural Factors b
Infrastructure and Urbanization
  Urbanization (% of population; log) UNICEF, 2016 6% − 3405.14 (1004.45)
.0009
−0.24 − 2668.44 (1064.88)
0.0131
  Access to electricity (% population; cubed) World Bank 5% −0.0037 (0.0012)
<.0001
−0.22 0.0025 (0.0015)
0.1040
Population Density
  Population density (people per m2 land; log) World Bank 0.8% − 445.2 (378.10)
0.2406
−0.09
Telecommunications Access
  Mobile cellular subscriptions (per 100 people; log) World Bank, 2014 15% − 5158.49 (919.96)
<.0001
−0.38
  Internet users (per 100 people; log) World Bank, 2014 5% − 1098.425 (376.30)
0.0040
−0.17
National Wealth
  GDP per capita, 5 year lag (USD; log) 2 World Bank, 2014 9% − 1168.48 (271.40)
<.0001
−0.25 − 1515.97 (586.38)
0.0105
Health Spending
  Government expenditure on health, 2 year lag (% of total health expenditure; log) WHO, 2013 4% − 2627.68 (1032.80)
0.0118
−0.15
  Total health expenditure per capita, 2 year lag (PPP, NCU per USD; log)2 WHO, 2013 8% −999.81 (250.55)
<.0001
−0.23
  Intermediate I Model R2:
14%
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 0.7% −0.0015 (0.0016)
0.3635
−0.07
  Primary school enrolment ratio (gross %; log) World Bank, 2003–2014 0.1% 1311.79 (3489.26)
0.7074
0.02
  Secondary school enrolment ratio (gross %; log) UNICEF, 2013 1% − 1465.82 (990.54)
0.1410
−0.09 4166.21 (2642.13)
0.1182
  Employment to population ratio (% of adults 15+ years; log) World Bank 0.2% 1325.91 (2539.92)
0.6023
0.04  
Youth Empowerment
  Youth literacy rate (% total 15–24 year olds; squared)4 World Bank, 2014 2% −0.3266 (0.2154)
0.1320
−0.11
  Female youth literacy rate (% 15–24 year olds; squared)4 World Bank, 2014 1% −0.2504 (0.1997)
0.2125
− 0.09
  Youth unemployment rate (% total 15–24 year olds; log) World Bank, 2013 0% 1.5364 (672.15)
0.9982
0.0002
  Adolescent fertility rate (births per 1000 females aged 15–19 years; log) World Bank, 2009–2014 0% −81.08 (485.13)
0.8675
−0.012
Women Empowerment and Gender Equity
  Total fertility rate (births per woman; log) World Bank, 2013 0.7% 1223.67 (1106.03)
0.2700
0.08
  Adult female literacy rate (% females 15+ years who can read and write; cubed) World Bank 0.3% −0.0010 (0.0015)
0.5232
−0.05
  Women in parliament (% of parliamentary seats held by women; log) World Bank, 2014 2% − 1270.29 (714.36)
0.0771
−0.13
  Secondary school gender parity index (ratio of girls to boys in secondary education; log) World Bank, 2013 2% − 5512.67 (2829.38)
0.0532
−0.12 −18,846.97 (5432.46)
0.0008
  Tertiary school gender parity index (ratio of girls to boys in tertiary education; log) World Bank, 2013 2% − 1268.27 (834.61)
0.1308
−0.09 3176.62 (1776.29)
0.0770
Income Equity
  GINI index (log) World Bank, 2012 0% 312.54 (2260.12)
0.8903
0.01
Access to Health Services and Commodities
  Out of pocket expenditure as % of total health expenditure (log) WHO, 2013 0.5% − 513.4 (524.81)
0.3292
−0.07
  Physician density per 1000 population (log) WHO, 2003–2013 3% − 715.62 (366.23)
0.0529
− 0.15 1786.88 (844.88)
0.0371
  Intermediate II Model R2:
31%
  1. Note: variables significant at p < 0.20 in bivariate analysis were entered into elastic net linear regression models; 1 Political stability and Corruption were strongly collinear (> 80%) and thus only the later was entered into multivariable modeling; 2 Health expenditure per capita and GDP per capita were strongly collinear (> 80%) and thus only the latter was entered into multivariable modeling; 3 Due to small sample size (n = 117 countries), GINI index not considered in multivariable analysis; 4 Female Youth Literacy Rate and Youth Literacy Rate Both 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