Work

Decomposing wealth-based inequalities in ideal cardiovascular health in Kenya

Year: 2025

Type: article

Abstract: BACKGROUND: This study examined wealth-related inequalities in ideal cardiovascular health (iCVH), as defined by the 2010 American Heart Association guideline, among Kenyan adults. METHODS: The study analysed data from 3816 adults who participated in the 2015 World Health Organization (WHO) STEPwise survey on non-communicable disease risk factors. The concentration index (C) and concentration curves were used to quantify inequalities in overall iCVH and its seven-component metrics, and a Wagstaff-type decomposition analysis was performed to identify the main factors contributing to the observed inequalities. RESULTS: A pro-rich inequality (higher prevalence in individuals with wealth) is observed in overall iCVH (C = 0.08; p = 0.006), which is more pronounced among women. Pro-rich inequalities are also evident for ideal body mass index (C = 0.31; p < 0.001), ideal blood pressure (C = 0.16; p < 0.001), and ideal total cholesterol (C = 0.15; p = 0.005). Conversely, pro-poor inequalities (higher prevalence in individuals living in poverty) are observed in ideal nicotine exposure (C = -0.10; p = 0.012) and fruit and vegetable intake (C = -0.09; p = 0.048). No significant inequalities are detected for ideal fasting blood glucose (C = -0.03; p = 0.534) or physical activity (C = 0.05; p = 0.291). Decomposition analysis shows that urban residence (31.4%), wealth (30.7%), region (16.5%), and education (8.5%) contribute most to the observed pro-rich inequality in iCVH. CONCLUSIONS: Socioeconomic inequalities for iCVH in Kenya are more prevalent in people with wealth, particularly among women. Addressing these disparities requires equity-oriented, gender-sensitive prevention policies targeting people living in poverty and less-educated populations, especially in urban settings.

Source: Communications Medicine

DOI: 10.1038/s43856-025-01286-8