Sex and age differences in the association between social determinants of health and cardiovascular health according to household income among Mongolian adults: Cross-sectional study (Preprint)

Abstract

Social determinants of health (SDH) are an underlying cause of poor cardiovascular health (CVH), but there is insufficient evidence about this link among Mongolian adults.

To explore whether education, household income, and health insurance were associated with CVH according to sex and age among Mongolian adults.

The final sample included data on 5,691 participants (men: 2,521 and women: 3,170) aged 18–69 from the 2019 WHO STEPwise Approach to Noncommunicable Disease (NCD) Risk Factor Surveillance. CVH was measured using a modified version of Life’s Simple 7 and classified into poor, intermediate, and ideal levels as recommended by American Heart Association. Multinomial logistic regression analyses examined SDH and CVH associations by sex and age.

Those with the lowest household income, having less than 12 years of education and not having health insurance were associated with poor CVH (education level, odds ratio (OR): 2.42, 95% confidence interval (CI): 1.30–4.51; health insurance, OR: 2.17, 95% CI: 1.13–4.18). These associations were more profound among women (education level, OR: 2.99, 95% CI: 1.35–6.63; health insurance, OR: 3.23, 95% CI: 1.55–6.74) and those aged 18–44 years old (education level, OR: 2.54, 95% CI: 1.09–5.90; health insurance, OR: 2.02, 95% CI: 0.98–4.16).

Participants in the lowest household income group with lower educational levels and without health insurance were more likely to have poor CVH. These findings suggest the need to develop strategies for CVH equity in Mongolian women and young adults that consider income levels, education levels, and health insurance.