Key messages
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Our study explains the income-related inequalities in cardiovascular risk factors among Tunisian adults during the last decade.
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It compares two methods (sensitivity analysis of logistic regression model and Wagstaff decomposition analysis).
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Both methods pointed tofound similar factors explaineding inequalities (income, educational level and regional conditions (area and region)) but with different rankings of importance.
Introduction
Methods
Study population
Measurements
Socio-economic and demographic variables
Cardiovascular risk factors
Statistical analysis
Sensitivity analysis to select the most influencing risk factors
GSA in a logistic regression model
Wagstaff-type decomposition analysis
Results
Socioeconomic and demographic characteristics of the study populations
Study | TAHINA-2005 N = 7553 | THES-2016 N = 5449 | ||
---|---|---|---|---|
N | Weighted % | N | Weighted % | |
Characteristics | ||||
Gender | ||||
Male | 3233 | 49.6 | 2610 | 49.8 |
Female | 4320 | 50.4 | 2839 | 50.2 |
Age-Groups (years) | ||||
35–44 | 2992 | 43.2 | 1803 | 37.5 |
45–54 | 2469 | 31.0 | 1708 | 31.5 |
55–64 | 1319 | 17.2 | 1443 | 23.4 |
65–70 | 773 | 8.5 | 495 | 7.6 |
Mean age | 49.0 ± 9.5 | 49.2 ± 9.7 | ||
Area | ||||
Urban | 4372 | 67.7 | 3606 | 67.6 |
Rural | 3181 | 32.3 | 1843 | 32.4 |
Region | ||||
District of Tunis | 925 | 24.4 | 685 | 23.2 |
North East | 1024 | 14.0 | 799 | 15.0 |
North West | 1124 | 13.0 | 886 | 11.8 |
Centre East | 1099 | 22.4 | 836 | 24.6 |
Centre West | 1176 | 12.3 | 763 | 11.9 |
South East | 1070 | 8.4 | 708 | 8.0 |
South West | 1135 | 5.5 | 772 | 5.5 |
Level of education | ||||
Illiterate | 3258 | 34.9 | 1240 | 19.3 |
Primary | 2588 | 35.1 | 2117 | 39.2 |
Secondary | 1233 | 20.1 | 1472 | 28.9 |
University | 474 | 9.8 | 620 | 12.6 |
Occupation | ||||
Upper | 980 | 15.8 | 484 | 10 |
Intermediate | 359 | 6.0 | 317 | 6.8 |
Employee/worker | 2370 | 35.0 | 2187 | 43.4 |
Unemployed/retired | 3844 | 43.2 | 2461 | 39.9 |
Household income | ||||
1st quintile | 1510 | 15.7 | 1089 | 18.1 |
2nd quintile | 1510 | 17.3 | 1090 | 19.0 |
3rd quintile | 1511 | 20.6 | 1090 | 20.9 |
4th quintile | 1511 | 21.0 | 1090 | 21.5 |
5th quintile | 1511 | 25.4 | 1090 | 20.5 |
High cardiovascular risk in the last decade by social determinants
Evolution of high cardiovascular risk prevalence in the last decade by social determinants
Study | TAHINA-2005 | THES-2016 | ||
---|---|---|---|---|
N | High cardiovascular risk prevalence %[CI 95] | N | High cardiovascular risk prevalence %[CI 95] | |
Characteristics | ||||
Gender | P = 0.110 | P = 0.269 | ||
Male | 3233 | 13.6 [12.0–15.0] | 2610 | 21.1 [19.2–22.9] |
Female | 4320 | 11.2 [10.1–12.4] | 2839 | 19.6 [17.9–21.3] |
Age-Groups (years) | p < 10−3 | P < 10−3 | ||
35–44 | 2992 | 7.4 [6.2–8.7] | 1803 | 11.2 [9.4–13.0] |
45–54 | 2469 | 14.1 [12.3–15.9] | 1708 | 22.9 [20.6–25.3] |
55–64 | 1319 | 19.1 [16.5–21.7] | 1443 | 27.7 [25.0–30.3] |
65–70 | 773 | 17.7 [14.5–21.0] | 495 | 31.9 [27.3–36.4] |
Area | P < 10−3 | P < 10−3 | ||
Urban | 4372 | 14.8 [13.5–16.1] | 3606 | 22.8 [21.2–24.4] |
Rural | 3181 | 7.3 [6.3–8.3] | 1843 | 15.1 [13.3–17.0] |
Region | P < 10−3 | p = 0.003 | ||
District of Tunis | 925 | 19.2 [16.3–22.0] | 685 | 22.4 [19.1–25.7] |
North East | 1024 | 9.5 [7.6–11.4] | 799 | 20.2 [17.3–23.0] |
North West | 1124 | 6.6 [5.2–8.1] | 886 | 19.0 [16.3–21.7] |
Centre East | 1099 | 15.1 [12.9–17.2] | 836 | 22.1 [19.6–25.3] |
Centre West | 1176 | 7.9 [6.3–9.4] | 763 | 16.2 [13.5–18.8] |
South East | 1070 | 8.8 [6.9–10.6] | 708 | 16.2 [13.4–19.0] |
South West | 1135 | 8.0 [6.4–9.6] | 772 | 20.3 [17.4–23.3] |
Level of education | P = 0.057 | P = 0.003 | ||
Illiterate | 3258 | 10.7 [9.4–11.9] | 1240 | 22.9 [20.2–25.6] |
Primary | 2588 | 12.3 [10.7–13.9] | 2117 | 21.1 [19.1–23.1] |
Secondary | 1233 | 15.9 [13.3–18.4] | 1472 | 19.6 [17.3–22.0] |
University | 474 | 11.7 [8.3–15.1] | 620 | 15.6 [12.1–19.0] |
Occupation | P = 0.021 | P = 0.038 | ||
Unemployed/retired | 3844 | 11.5 [10.2–12.8] | 2461 | 22.6 [20.7–24.5] |
Employee/worker | 2370 | 12.2 [10.6–13.9] | 2187 | 18.9 [17.0–20.8] |
Intermediate | 359 | 14.9 [10.4–19.4] | 317 | 18.9 [13.7–24.1] |
Upper | 980 | 14.2 [11.5–16.9] | 484 | 18.6 [14.4–22.8] |
Quintile income | P < 10−3 | P = 0.017 | ||
1st quintile | 1510 | 6.9 [5.4–8.3] | 1089 | 18.2 [15.6–20.8] |
2nd quintile | 1510 | 9.0 [7.2–10.7] | 1090 | 18.7 [16.0–21.4] |
3rd quintile | 1511 | 12.2 [10.2–14.3] | 1090 | 21.9 [19.1–24.7] |
4th quintile | 1511 | 14.9 [12.6–17.1] | 1090 | 22.5 [19.6–25.4] |
5th quintile | 1511 | 16.2 [13.9–18.5] | 1090 | 19.8 [17.0–22.6] |
Total | 7553 | 12.4 [11.4–13.3] | 5449 | 20.3 [19.1–21.6] |
Global sensitivity analysis in a logistic regression model method of high cardiovascular risk
Social determinants | 2005 | 2016 | ||||
---|---|---|---|---|---|---|
SI | Si (%) | Rank | SI | Si (%) | Rank | |
Gender | 0.009 | 0.9 | 7 | 0.006 | 0.4 | 7 |
Age | 0.117 | 11.1 | 5 | 0.031 | 2.3 | 6 |
Area | 0.323 | 30.7 | 1 | 0.35 | 26.2 | 2 |
Region | 0.225 | 21.4 | 2 | 0.109 | 8.1 | 5 |
Education level | 0.045 | 4.3 | 6 | 0.483 | 36.1 | 1 |
Occupation | 0.122 | 11.6 | 4 | 0.157 | 11.7 | 4 |
Household income | 0.212 | 20.1 | 3 | 0.202 | 15.1 | 3 |
Total | 1.053 | 100.0 | 1.338 | 100.0 |
Wagstaff-type decomposition analysis of high cardiovascular risk prevalence
2005 | 2016 | |||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
Coef | Elast | CI | Cont to C | % cont | % Adj | Coef | Elast | CI | Cont to C | % cont | % Adj | |
Gender | 1.0 | 2.1 | ||||||||||
Female (Ref) | ||||||||||||
Male | 0.004 | 0.015 | 0.129 | 0.002 | 1.7 | 1.0 | 0.021 | 0.048 | 0.070 | 0.003 | 3.9 | 2.1 |
Age | 4.8 | 6.3 | ||||||||||
35–44 years (Ref) | 0.0 | 0.0 | ||||||||||
45–54 years | 0.071 | 0.221 | 0.043 | 0.010 | 8.2 | 4.8 | 0.133 | 0.203 | 0.050 | 0.010 | 12.0 | 6.3 |
55–64 years | 0.150 | 0.249 | − 0.032 | − 0.008 | −6.9 | 0.0 | 0.184 | 0.238 | −0.081 | − 0.019 | − 22.7 | 0.0 |
65–70 years | 0.162 | 0.158 | − 0.157 | − 0.025 | − 21.3 | 0.0 | 0.238 | 0.106 | − 0.179 | − 0.019 | − 22.2 | 0.0 |
Area | 34.6 | 40.3 | ||||||||||
Rural (ref) | 0.0 | 0.0 | ||||||||||
Urbain | 0.032 | 0.174 | 0.398 | 0.069 | 59.5 | 34.6 | −0.079 | −0.131 | − 0.497 | 0.065 | 76.4 | 40.3 |
Region | 21.8 | 4.6 | ||||||||||
District of Tunis (Ref) | 0.0 | 0.0 | ||||||||||
North_east | −0.049 | −0.063 | 0.014 | −0.001 | − 0.7 | 0.0 | 0.006 | 0.004 | 0.043 | 0.000 | 0.2 | 0.1 |
North_west | −0.060 | − 0.085 | −0.232 | 0.020 | 17.0 | 9.9 | 0.003 | 0.002 | −0.275 | −0.001 | − 0.7 | 0.0 |
Central_east | −0.016 | −0.022 | 0.244 | −0.005 | −4.6 | 0.0 | 0.022 | 0.016 | 0.252 | 0.004 | 4.8 | 2.5 |
Central_west | −0.046 | −0.068 | − 0.262 | 0.018 | 15.2 | 8.9 | −0.013 | −0.009 | − 0.265 | 0.002 | 2.7 | 1.4 |
South_east | −0.052 | −0.071 | 0.035 | −0.002 | −2.1 | 0.0 | −0.053 | − 0.034 | −0.024 | 0.001 | 0.9 | 0.5 |
South_west | −0.054 | −0.078 | − 0.078 | 0.006 | 5.2 | 3.0 | −0.001 | −0.001 | 0.060 | 0.000 | 0.0 | 0.0 |
Education Level | 13.8 | 14.0 | ||||||||||
Illiterate | 0.015 | 0.060 | −0.412 | −0.025 | −21.3 | 0.0 | 0.082 | 0.091 | −0.509 | −0.047 | −54.6 | 0.0 |
Primary | 0.038 | 0.125 | −0.008 | −0.001 | − 0.9 | 0.0 | 0.071 | 0.134 | −0.220 | −0.029 | −34.4 | 0.0 |
Secondary | 0.042 | 0.066 | 0.421 | 0.028 | 23.7 | 13.8 | 0.052 | 0.068 | 0.334 | 0.023 | 26.6 | 14.0 |
University (ref) | 0.0 | 0.0 | ||||||||||
Occupation | 13.2 | 13.6 | ||||||||||
Unemployed | −0.022 | −0.106 | −0.216 | 0.023 | 19.7 | 11.5 | −0.021 | −0.045 | − 0.202 | 0.009 | 10.7 | 5.7 |
Workers | −0.028 | −0.084 | − 0.041 | 0.003 | 3.0 | 1.7 | −0.039 | −0.077 | − 0.167 | 0.013 | 15.0 | 7.9 |
Medium | −0.014 | −0.006 | 0.683 | −0.004 | −3.7 | 0.0 | −0.016 | − 0.005 | 0.506 | − 0.002 | −2.7 | 0.0 |
High (Ref) | 0.0 | 0.0 | ||||||||||
Household income | 10.8 | 19.2 | ||||||||||
Lowest quintile | −0.035 | −0.068 | −0.993 | −0.067 | −57.7 | 0.0 | −0.022 | −0.022 | − 0.999 | 0.022 | 25.4 | 13.4 |
2 | −0.021 | −0.041 | − 0.507 | 0.021 | 17.8 | 10.3 | 0.004 | 0.004 | −0.498 | −0.002 | −2.1 | 0.0 |
3 | −0.006 | −0.011 | 0.001 | 0.000 | 0.0 | 0.0 | 0.024 | 0.023 | 0.005 | 0.000 | 0.1 | 0.1 |
4 | 0.001 | 0.002 | 0.498 | 0.001 | 0.7 | 0.4 | 0.019 | 0.019 | 0.498 | 0.009 | 10.9 | 5.7 |
Highest quintile (ref) | 0.000 | 0.0 | 0.0 | |||||||||
C (conindu) | 0.116 | 0.085 | ||||||||||
Residual | 0.055 | 0.042 |