Socioeconomic Inequalities in Non-Communicable Diseases and Self Assessed Health in Turkey

Background: Inequities in health need to be monitored and necessary actions should be taken to reduce them. This study aimed to determine the socioeconomic distribution of self-reported chronic diseases and self-assessed health (SAH) in Turkey and try to evaluate the determinants of such inequalities in terms of their contributions. Methods: Cross-sectional data from the Turkish Health Survey conducted during year 2008, covering 14,655 adults aged 15 or older were analyzed for the first time to assess socioeconomic inequalities in chronic disease and suboptimal SAH prevalence by calculating concentration index (CI), which ranges from -1 to + 1 (concentration of disease among lower and higher socioeconomic groups) and the relative index of inequality (RII), reflecting the prevalence ratio between the two extremes of wealth. Results: Several diseases and sub-optimal SAH were more concentrated among those with lower incomes. The concentration indices of chronic obstructive pulmonary disease (COPD), arthritis, chronic bronchitis, migraine and poor SAH were-0.180 (95% CI = -0.241,-0.111), -0.126 (95% CI = -0.148,-0.105),-0.118 (95% CI = -0.149,-0.079), 0.248( 95% CI = (-0.278,-0.219) respectively. Of all chronic diseases, COPD demonstrated the highest relative inequality with a RII value of 2.51 (95% CI: 1.57-4.01). Income was the major contributor to inequality in occurrence of COPD (88.2%), migraine (80.4%) and arthritis (77.7%). Conclusion: The findings indicate that majority of chronic diseases were more concentrated among less wealthy individuals in Turkey. Wealth and education had the largest contributions to observed inequalities. These inequalities need to be explicitly addressed and vulnerable subgroups should be targeted to reduce these socioeconomic disparities.