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

Abstract

Objectives

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

Methods

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).

Results

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.

Conclusions

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.

This is a preview of subscription content, log in to check access.

Fig. 1
Fig. 2

References

  1. Akinyemiju T, Ogunsina K, Okwali M, Sakhuja S, Braithwaite D (2017) Lifecourse socioeconomic status and cancer-related risk factors: analysis of the WHO study on global ageing and adult health (SAGE). Int J Cancer 140:777–787

    Article  CAS  PubMed  Google Scholar 

  2. Allen L, Williams J, Townsend N, Mikkelsen B, Roberts N, Foster C, Wickramasinghe K (2017) Socioeconomic status and non-communicable disease behavioural risk factors in low-income and lower-middle-income countries: a systematic review. Lancet Glob Health 5:e277–e289. https://doi.org/10.1016/S2214-109X(17)30058-X

    Article  PubMed  PubMed Central  Google Scholar 

  3. American Cancer Society (2017) Alcohol use and cancer. https://www.cancer.org/cancer/cancer-causes/diet-physical-activity/alcohol-use-and-cancer.html. Accessed 24 Mar 2018

  4. Arokiasamy P, Bloom D, Lee J, Feeney K, Ozolins M (2012) Longitudinal aging study in india: vision, design, implementation, and preliminary findings. In: Smith JP, Majmundar M (eds) Aging in Asia: findings from new and emerging data initiatives. National Academies Press, Washington, pp 36–76

    Google Scholar 

  5. Bull FC, Maslin TS, Armstrong T (2009) Global physical activity questionnaire (GPAQ): nine country reliability and validity study. J Phys Act Health 6:790–804

    Article  PubMed  Google Scholar 

  6. Caldwell TM, Rodgers B, Clark C, Jefferis BJ, Stansfeld SA, Power C (2008) Lifecourse socioeconomic predictors of midlife drinking patterns, problems and abstention: findings from the 1958 British Birth Cohort Study. Drug Alcohol Depend 95:269–278

    Article  CAS  PubMed  Google Scholar 

  7. Christie P, Collins C (1982) Bantu education: apartheid ideology or labour reproduction? Comp Educ 18:59–75

    Article  Google Scholar 

  8. Deaton A, Grosh M (2000) Consumption. In: Grosh M, Glewwe P (eds) Designing household survey questionnaires for developing countries: lessons from 15 years of the living standards measurement study. The World Bank, Washington, pp 91–134

    Google Scholar 

  9. Ford ES, Zhao G, Tsai J, Li C (2011) Low-risk lifestyle behaviors and all-cause mortality: findings from the National Health and Nutrition Examination Survey III Mortality Study. Am J Public Health 101:1922–1929

    Article  PubMed  PubMed Central  Google Scholar 

  10. Gómez-Olivé FX, Montana L, Wagner RG, Kabdula CW, Rohr JK, Kahn K, Barnighausen T, Canning D, Gaziano T, Salomon JA, Payne CF, Wade A, Tollman SM, Berkman L (2018) Cohort profile: health and ageing in africa: a longitudinal study of an INDEPTH community in South Africa (HAALSI). Int J Epidemiol. https://doi.org/10.1093/ije/dyx247

    Article  PubMed  PubMed Central  Google Scholar 

  11. Grundy E, Holt G (2011) The socioeconomic status of older adults: how should we measure it in studies of health inequalities? J Epidemiol Community Health 55:895–904. https://doi.org/10.1136/jech.55.12.895

    Article  Google Scholar 

  12. Grundy E, Sloggett A (2003) Health inequalities in the older population: the role of personal capital, social resources and socio-economic circumstances. Soc Sci Med 56:935–937. https://doi.org/10.1016/S0277-9536(02)00093-X

    Article  PubMed  Google Scholar 

  13. Headey B (2008) Poverty is low consumption and low wealth, not just low income. Soc Indic Res 89:23–39. https://doi.org/10.1007/s11205-007-9231-2

    Article  Google Scholar 

  14. Hentschel J, Lanjouw P (1996) Constructing an indicator of consumption for the analysis of poverty: principles and illustrations with reference to Ecuador. World Bank, Washington, LSMS Working Paper Number 124

  15. Howe LD, Galobardes B, Maijasevic A, Gordon D, Johnson D, Onwujekwe O, Patel R, Webb EA, Lawlor DA, Hargreaves JR (2012) Measuring socio-economic position for epidemiological studies in low-and middle-income countries: a methods of measurement in epidemiology paper. Int J Epidemiol 41:871–886. https://doi.org/10.1093/ije/dys037

    Article  PubMed  PubMed Central  Google Scholar 

  16. Jin M, Cai S, Guo J, Zhu Y, Li M, Yu Y, Zhang S, Chen K (2013) Alcohol drinking and all cancer mortality: a meta-analysis. Ann Oncol 24:807–816. https://doi.org/10.1093/annonc/mds508

    Article  CAS  PubMed  Google Scholar 

  17. Kabudula CW, Houle B, Collinson MA, Kahn K, Gómez-Olivé FX, Clark SJ, Tollman S (2017) Progression of the epidemiological transition in a rural South African setting: findings from population surveillance in Agincourt, 1993–2013. BMC Public Health 17:424. https://doi.org/10.1186/s12889-017-4312-x

    Article  PubMed  PubMed Central  Google Scholar 

  18. Katzmarzyk PT, Mason CJ (2009) The physical activity transition. Phys Act Health 6:269–280

    Article  Google Scholar 

  19. Khaw KT, Wareham N, Bingham S, Welch A, Luben R, Day N (2008) Combined impact of health behaviours and mortality in men and women: the EPIC-Norfolk prospective population study. PLOS Med 5:e12. https://doi.org/10.1371/journal.pmed.0050012

    Article  PubMed  PubMed Central  Google Scholar 

  20. Kobayashi LC, Glymour MM, Kahn K, Payne CF, Wagner RG, Montana L, Mateen FJ, Tollman SM, Berkman LF (2017) Childhood deprivation and later-life cognitive function in a population-based study of older, rural South Africans. Soc Sci Med 190:20–28. https://doi.org/10.1016/j.socscimed.2017.08.009

    Article  PubMed  PubMed Central  Google Scholar 

  21. Kvaavik E, Batty D, Ursin G, Huxley R, Gale C (2011) Influence of individual and combined health behaviors on total and cause-specific mortality in men and women: the United Kingdom Health and Lifestyle Survey. Arch Intern Med 170:711–719

    Article  Google Scholar 

  22. McCullough ML, Patel AV, Kushi LH, Patel R, Willett WC, Doyle C, Thun MJ, Gapstur SM (2011) Following cancer prevention guidelines reduces risk of cancer, cardiovascular disease, and all-cause mortality. Cancer Epidemiol Biomark Prev 20:1089–1097

    Article  Google Scholar 

  23. National Department of Health (2017) South African demographic and health survey 2016: key indicators report. https://www.statssa.gov.za/publications/Report%2003-00-09/Report%2003-00-092016.pdf. Accessed 5 May 2018

  24. Pampel F (2008) Tobacco use in sub-Sahara Africa: estimates from the demographic health surveys. Soc Sci Med 66:1772–1783

    Article  PubMed  PubMed Central  Google Scholar 

  25. Popkin BM, Adair LS, Ng SW (2012) NOW AND THEN: the global nutrition transition: the pandemic of obesity in developing countries. Nutr Rev 70:3–21. https://doi.org/10.1111/j.1753-4887.2011.00456.x

    Article  PubMed  PubMed Central  Google Scholar 

  26. Prince M, Wimo A, Guerchet M, Ali G-C, Wu Y-T, Prina M, Alzheimer’s Disease International (2015) World alzheimer report 2015: the global impact of dementia: an analysis of prevalence, incidence, cost, and trends. https://www.alz.co.uk/research/WorldAlzheimerReport2015.pdf. Accessed 5 May 2018

  27. Riumallo-Herl C, Canning D, Wagner R, Kabudula C, Collinson M (2017) Health gradients in South Africa: inequalities in the measure of the beholder. PGDA Working Paper 139. https://cdn1.sph.harvard.edu/wp-content/uploads/sites/1288/2012/11/Health-Gradients-in-South-Africa-Inequalities-in-the-Measure-of-the-Beholder-May_3_2017.pdf. Accessed 5 May 2018

  28. Roerecke M, Rehm J (2010) Irregular heavy drinking occasions and risk of ischemic heart disease: a systematic review and meta-analysis. Am J Epidemiol 171:633–644. https://doi.org/10.1093/aje/kwp4515

    Article  PubMed  Google Scholar 

  29. Rutstein SO, Johnson K (2004) DHS comparative reports no 6: the DHS wealth index. https://dhsprogram.com/pubs/pdf/cr6/cr6.pdf. Accessed 7 May 2018

  30. Sartorius K, Sartorius B, Tollman S, Schatz E, Kirsten J, Collinson M (2013) Rural poverty dynamics and refugee communities in south africa: a spatial-temporal model. Popul Space Place 19:103–123. https://doi.org/10.1002/psp.697

    Article  PubMed  Google Scholar 

  31. Shisana O et al (2013) South African national health and nutrition examination survey (SANHANES-1). HSRC Press, Cape Town. http://www.hsrc.ac.za/uploads/pageNews/72/SANHANES-launch%20edition%20(online%20version).pdf. Accessed 7 May 2018

  32. Statistics South Africa (2014) Census 2011: Profile of older persons in South Africa (Report no. 03-01-60). https://www.statssa.gov.za/publications/Report-03-01-60/Report-03-01-602011.pdf. Accessed 7 May 2018

  33. Tehranifar P, Liao Y, Ferris JS, Terry MB (2009) Life course socioeconomic conditions, passive tobacco exposures and cigarette smoking in a multiethnic birth cohort of U.S. women. Cancer Causes Control 20:867–876

    Article  PubMed  PubMed Central  Google Scholar 

  34. Tucker JS (2002) Health-related social control within older adults’ relationships. J Gerontol B Psychol Sci Soc Sci 57:3873995

    Article  Google Scholar 

  35. United Nations (1963) Apartheid in South Africa: summary of the report of the special committee on the policies of apartheid of the government of South Africa. United Nations, Geneva

    Google Scholar 

  36. Wiseman M (2008) The second World Cancer Research Fund/American Institute for Cancer Research expert report. Food, nutrition, physical activity, and the prevention of cancer: a global perspective. Proc Nutr Soc 67:253–256

    Article  PubMed  Google Scholar 

  37. World Health Organization (2010) Global recommendations on physical activity for health. http://www.who.int/dietphysicalactivity/global-PA-recs-2010.pdf. Accessed 7 May 2018

  38. World Health Organization (2017a) Countries: South Africa. http://www.afro.who.int/countries/south-africa. Accessed 7 May 2018

  39. World Health Organization (2017b) Obesity and Overweight Fact Sheet. http://www.who.int/mediacentre/factsheets/fs311/en/. Accessed 7 May 2018

  40. World Health Organization (2018) Tobacco fact sheet. http://www.who.int/mediacentre/factsheets/fs339/en/. Accessed 7 May 2018

  41. Zou G (2004) A modified poisson regression approach to prospective studies with binary data. Am J Epidemiol 159:702–7066

    Article  PubMed  Google Scholar 

Download references

Funding

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.

Author information

Affiliations

Authors

Corresponding author

Correspondence to Lindsay C. Kobayashi.

Ethics declarations

Conflict of interest

The authors have no conflicts of interest to declare.

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.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOCX 18 kb)

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

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). https://doi.org/10.1007/s00038-018-1173-8

Download citation

Keywords

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