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

Akseer, N.; Mehta, S.; Wigle, J.; Chera, R.; Brickman, Z. J.; Al-Gashm, S.; Sorichetti, B.; Vandermorris, A.; Hipgrave, D. B.; Schwalbe, N.; Bhutta, Z. A.

doi:10.1186/s12889-020-09988-5

BMC Public Health

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%

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
^a Level 3 multivariable model includes all statistically significant (p < 0.15) distal variables as listed
^b Level 2 multivariable model includes level 3 model+ all statistically significant (p < 0.15) intermediate I variables as listed
^c Level 1 multivariable model includes level 2 model+ all statistically significant (p < 0.15) intermediate II variables as list

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ISSN: 1471-2458

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