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    Non-communicable diseases mortality rate and prevalence of high BMI by income and income inequality across countries: Associations and methodological considerations, an ecological analysis
    (European Publishing, 2024-03) Thomas-Lange, Jeffrey; Urra-Miguieles, Diego
    Introduction: Today, non-communicable diseases (NCDs) represent the highest morbidity and mortality burden worldwide, with high body mass index (BMI) as one of the main risk factors. NCDs mortality rate and prevalence of high BMI have a clear relationship with wealth but not with other economic indicators such as income inequality. There are well-known theories in dispute – social integration and neomaterial – trying to reveal this relationship. Methods: In this ecological study, utilizing open datasets from World Bank (WB) and Global Health Observatory, we explore the associations between countries’ economic indicators (income and income inequality) and relevant health outcomes (NCDs mortality rate and prevalence of high BMI) using bivariate correlations. To investigate the impact of inequality on health among similar-wealth nations, countries were grouped by the WB’s income classification method. Results: Multiple correlation analyses were conducted, revealing significant associations between the health variables and economic indicators, but more robust with income than inequality. Specifically, high BMI was positively correlated with income (r=0.46, p<0.05) and negatively correlated with inequality (r= -0.17, p<0.05). NCDs mortality rate showed a negative correlation with income (r= -0.54, p<0.05) and a positive correlation with inequality (r=0.20, p<0.05). At the income level groups, most associations were no longer observable, remaining a few in the higher income groups without a clear pattern. Conclusions: Globally, while income inequality may be related to worse health outcomes, this association is significant only once poverty has been largely overcome, compatible with both theories in dispute. Whether these associations observed at a general level are maintained at the grouped level will depend on the health outcomes studied, the construction of the wealth indicator, and the methodological limitations of country-income grouped analysis. These characteristics, typical of ecological studies on health inequity, could explain the literature’s mixed results in this regard.