Who bears the burden of NCD’s?

As non-communicable diseases (NCDs) continue to grow as a major global health burden, where you live influences who is bearing that burden.

The link between socioeconomic status and the development of NCDs has been long established. In low-income countries, there are higher rates of NCDs in the high-income populations while in high-income countries, it is low-income communities bearing the burden of NCDs. This reversal of the relationship between socioeconomic status and health outcomes in different stages of economic development has been labelled the "reversal hypothesis". This view suggests the burden of NCDs shifts from the rich to the poor as a country's economic and social development progresses.

Crowd of people wearing surgical face mask on a pedestrian road in Wuhan Hubei China

Understanding the distribution of NCDs and risk factors in the population helps target prevention strategies to reduce the burden of NCDs in the whole country. As China's economic & social development progresses is there evidence that the reversal hypothesis is occurring?

Using data from the China Health and Retirement Longitudinal Study in 2015, we examined the reversal hypothesis in the Chinese setting and at the subnational level. Five risk factors (smoking, heavy drinking, physical inactivity, overweight, and obesity) and three NCDs (diabetes, hypertension, dyslipidemia) were examined in our study. We compared the outcomes for people across different socioeconomic statuses in provincial, and urban and rural areas. We also looked at the outcomes across generations.

We found NCDs and risk factors continue to be concentrated in richer population groups in China. Some evidence of early stages of reversal may be detectable, to the extent that richer provinces have lower concentrations of NCDs and risk factors in richer population groups and that this phenomenon appears more marked with respect to risk factors than established diseases as might be expected.

If these patterns persist over time, the trend will likely feed through to metabolic disorders which will increasingly become diseases of the poor. To improve equity in healthcare, targeted policy response is required to ensure the burden of NCDs in the world’s largest economy in transition is not borne by the most disadvantaged populations.

Read the paper on the study Re-examining the reversal hypothesis: A nationwide population-based study of the association between socioeconomic status, and NCDs and risk factors in China

Xuemei Zhang is a PhD Candidate at the Nossal  Institute for Global Health. Xuemei 's PHD study will further develop an understanding of the health and economic burden of multimorbidity in LMICs, provide policy considerations

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Xuemei Zhang

  • non-communicable diseases
  • reversal hypothesis
  • NCD
  • Xuemei Zhang
  • Tianxin Pan
  • Barbara McPake