Socioeconomic Differential of Cardiovascular Diseases Risk Factors in Bangladesh: Findings From a Nationally Representative Survey

Abstract

Diabetes, hypertension, and overweight/obesity are three major risk factors for cardiovascular diseases (CVD). However, their distributions across socioeconomic status (SES) are debated despite its critical importance to design healthcare system. This study aimed to examine the associations between SES and diabetes, hypertension, and overweight/obesity in Bangladesh. Data was extracted from the 2017/18 Bangladesh Demographic and Health Survey. Diabetes, hypertension, and overweight/obesity were outcome of interest. Three variables —wealth quintiles, education, and paid employment— were considered as proxy of respondents’ SES, as such the major explanatory variables of interest. Age-standardised prevalence of diabetes, hypertension, and overweight/obesity by SES were estimated using direct standardisation.  Associations between SES and CVD risk factors were examined using multilevel Poisson regression model with robust variance. The overall age-standardized prevalence of diabetes, hypertension, and overweight/obesity in the sample were 9.82% (95% CI, 9.11-10.58), 27.37% (95% CI, 26.37-28.40) and 40.11% (35% CI, 38.82-41.42), respectively. We found a significant gradient of diabetes, hypertension, and overweight/obesity in Bangladesh with a higher prevalence among the respondents of advantageous wealth quintiles, education, and paid employment. In the fully adjusted models improved wealth quintiles and higher education were found as important predictors of diabetes and overweight/obesity. Prevalence ratio of hypertension and overweight/obesity was found lower among respondents with no education/pre-school or primary education as compared to the respondents with primary education. Diabetes, hypertension, and overweight/obesity are not distributed proportionately by SES in Bangladesh, especially by wealth quintiles and levels of education. Policies and programs to increase awareness on importance of controlling weight and regular screening for diabetes and hypertension are important. Treatment facilities for diabetes and hypertension should also need to be spread up at the community level.