Socioeconomic gradients in chronic disease risk behaviors in a population-based study of older adults in rural South Africa



To investigate the associations between household wealth, household consumption, and chronic disease risk behaviors among older adults in rural South Africa.


Data were from baseline assessments of 5059 adults aged ≥ 40 in the population-based “Health and Aging in Africa: A Longitudinal Study of an INDEPTH Community in South Africa” in 2015. Confounder-adjusted prevalence ratios were estimated for the associations between each of household wealth and household consumption quintiles with low moderate-to-vigorous physical activity (MVPA), current smoking, frequent alcohol intake, and overweight/obese body mass index (BMI).


Low MVPA and overweight/obese BMI were common (57% and 58%, respectively), and linearly increased in prevalence across household wealth quintiles. Low MVPA decreased and overweight/obese BMI increased in prevalence across household consumption quintiles. Smoking and frequent alcohol intake were rare (9% and 6%, respectively); they decreased in prevalence across wealth quintiles, but did not vary by consumption quintile.


Chronic disease risk behaviors are socioeconomically graded among older, rural South African adults. The high prevalence of overweight and obesity in rural South Africa is a public health concern requiring urgent attention.

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This work was funded by a Grant from the National Institute on Aging of the National Institutes of Health (P01 AG041710). The funder had no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the article; or in the decision to submit it for publication.

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Correspondence to Lindsay C. Kobayashi.

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Ethical approval

Ethical approval was granted by the University of Witwatersrand Human Research Ethics Committee (M141159), the Harvard T. H. Chan Harvard School of Public Health, Office of Human Research Administration (C13-1608-02), and the Mpumalanga Provincial Research and Ethics Committee. Informed consent was obtained from all individual participants included in the study. All procedures involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors.

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Kobayashi, L.C., Frank, S., Riumallo-Herl, C. et al. Socioeconomic gradients in chronic disease risk behaviors in a population-based study of older adults in rural South Africa. Int J Public Health 64, 135–145 (2019).

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  • South Africa
  • Aging
  • Rural
  • Physical activity
  • Smoking
  • Alcohol
  • Body mass index
  • Socioeconomic inequalities