Decomposing wealth-based inequalities in ideal cardiovascular health in Kenya

This study examined wealth-related inequalities in ideal cardiovascular health (iCVH), as defined by the 2010 American Heart Association guideline, among Kenyan adults.

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.

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.

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.