Mind the Gap

Background: In order to face the Double Burden of Disease, Health Policy in LMICs has to adapt. In order to do so a clear insight in the distribution of NCDs throughout the population is required. Knowledge of possible confounders of SES inequality is also necessary for an adequate policy response towards NCDs. Methods: Using WHO SAGE data measures of NCD Prevalence, Diagnosis Gap, and Treatment Gap are created for NCDs separately as well as for any NCD. Subsequently this is related to an asset index – construed using PCA – in order to investigate SES inequality. SES inequality is measured in absolute terms using Erreyger’s corrected Concentration Index and in relative terms using logit models. Results: It turns out that prevalence rates for NCDs in LMICs are overall quite high. Moreover, prevalence is higher for the wealthier. More specific, compared to the lowest wealth tertile, prevalence is relatively highest in the second tertile. Also the Diagnosis Gap is big for all NCDs, although it differs for countries and NCDs. No country or NCD clearly stands out in this respect. The Gap is for all NCDs for almost every country more concentrated among the poor in absolute terms. In relative terms, the wealthier are less likely to go undiagnosed. Again, in terms of magnitude the effect is stronger for the second wealth tertile than for the third tertile. The Treatment Gap for NCDs in LMICs is even bigger than the Diagnosis Gap. Again, for almost all countries, Treatment Gap for all NCDs is more concentrated among the poor. This is also true in relative terms. Conclusion: Apart from SES, age appears to be an important confounder of NCD Prevalence, Diagnosis Gap, and Treatment Gap. The rise of NCDs can thus to a large extent be explained by an increasing life expectancy in LMICs. The NCDs are more prevalent among the rich, while they go undiagnosed and untreated to a lesser extent than the poor. Since the wealthy are more likely to get older, the relation between wealth and the outcome variables could run through age. It is however also possible that the wealthy, although having a higher chance of having an NCD, get diagnosed and treated and therefore live longer.