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Socioeconomic inequality in cardio-metabolic risk factors in a nationally representative sample of Iranian adolescents using an Oaxaca-Blinder decomposition method: the CASPIAN-III study

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Abstract

Objectives

The present research was conducted aiming at assessing the association of socioeconomic inequality in the prevalence of risk factors associated with cardio-metabolic disorders in a sample population of nationally representative Iranian adolescents and to identify its influencing factors.

Methods

This study was conducted as part of a national-based surveillance program performed on 5625 individuals aged 10–18 years in 27 provinces in Iran. To determine the socioeconomic status (SES) of participants, we defined a new variable by applying the principal component analysis. Doing so, the socioeconomic inequality in cardio-metabolic risk factors was examined over the tertiles of SES using concentration index (C). Then, Oaxaca-Blinder decomposition analysis was carried out in order to decide upon the roots of inequality in the health system.

Results

The mean (standard deviation) age of participants was 14.73 (2.41) years. The prevalence of cardio-metabolic parameters had considerable difference across SES tertiles. Elevated fasting blood glucose (FBG), elevated triglycerides (TG), abdominal obesity, elevated total cholesterol (TC), and metabolic syndrome (MetS) increased linearly by increasing SES tertiles. C index for depressed high density lipoprotein- cholesterol (HDL-C) was negative, which was suggestive of inequality in favor of high SES groups and for other cardio-metabolic parameters, it was positive, which indicate inequality was in favor of the lowest SES groups. The highest gap between the first and third tertiles of socioeconomic was for frequency of abdominal obesity; 13.18% of the lowest SES groups and 20.11% of the highest SES groups had abdominal obesity which accounts 6.93% gap in favor of the highest SES groups. The living area could be named as the main variables standing for the inequality of elevated FBS, elevated LDL-c, low HDL-c and abdominal obesity frequency between the first and the last SES group. In addition, BMI could stand as the main independent variable explaining the gap in elevated TG, elevated TC, elevated BP and MetS prevalence across the lowest and the highest SES group.

Conclusions

The study revealed the considerable inequality in the prevalence of cardio-metabolic risk factors between the highest and the lowest SES groups of Iranian adolescents. Living area and BMI are the two main factors which explained inequality in prevalence of cardio metabolic risk factors between SES groups. These estimations could provide health policy markers with practical information for future complementary analyses.

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Funding

Ministry of Health and Education.

Author information

Authors and Affiliations

  1. Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran

    Gita Shafiee & Ramin Heshmat

  2. Non-communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran

    Mostafa Qorbani

  3. Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran

    Mostafa Qorbani, Armita Mahdavi-Gorabi, Gelayol Ardalan & Zeinab Ahadi

  4. Food and Nutrition Policy and Planning Research Department, National Nutrition & Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran

    Fatemeh Mohammadi

  5. Department of Epidemiology and Biostatistics, Shahid Beheshti University of Medical Science, Tehran, Iran

    Ali Sheidaei

  6. Department of Pediatrics, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran

    Mohammad Esmaeil Motlagh

  7. Department of Pediatrics, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non-communicable Disease, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

    Roya Kelishadi

Authors
  1. Gita Shafiee
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Contributions

RK, MEM, RH, GA and MQ: designing the study, GS, FM and MQ Drafting of the manuscript, MQ, AS and RH: Analysis and interpretation of data AMG and ZA: Acquisition of data and RK and MQ: Critical revision of the manuscript for important intellectual content. All authors read and approved the final manuscript.

Corresponding authors

Correspondence to Mostafa Qorbani or Roya Kelishadi.

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The authors also have no conflicts of interest and have no involvement that might raise the question of bias in the results reported here.

Ethical approval

The present study was approved by ethical committee of Tehran University of Medical Sciences and Isfahan University of Medical Sciences.

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The authors declare that they have no competing interests.

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Shafiee, G., Qorbani, M., Heshmat, R. et al. Socioeconomic inequality in cardio-metabolic risk factors in a nationally representative sample of Iranian adolescents using an Oaxaca-Blinder decomposition method: the CASPIAN-III study. J Diabetes Metab Disord 18, 145–153 (2019). https://doi.org/10.1007/s40200-019-00401-6

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