# Decomposing wealth-based inequalities in ideal cardiovascular health in Kenya

## TL;DR

Wealthier Kenyan adults have better heart health than poorer adults, with significant differences in factors like blood pressure and BMI.

## Contribution

This study is the first to decompose wealth-based inequalities in ideal cardiovascular health in Kenya using national survey data.

## Key findings

- Wealthier individuals in Kenya have higher ideal cardiovascular health, especially among women.
- Urban residence, wealth, region, and education explain most of the inequality in heart health.
- Poverty is linked to better nicotine exposure and fruit/vegetable intake but worse overall heart health.

## Abstract

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.

This study examines how wealth affects heart health in Kenya. Using national survey data from 2015, we measure wealth disparities in “ideal cardiovascular health,” a set of seven behaviours and health factors linked to the risk of heart disease. We find that wealthier people are more likely to have ideal heart health, especially among women. People with wealth have healthier body weight, blood pressure, and cholesterol levels, while people living in poverty individuals are less likely to smoke and more likely to eat fruits and vegetables. Factors such as living in urban areas, income, education, and region of residence explain most of the inequality. To reduce these gaps, heart-health programmes should focus on people living in poverty, less-educated groups, particularly women living in urban areas.

Oguta et al. examine wealth-based inequalities for ideal cardiovascular health (iCVH) in Kenya using data from the 2015 WHO STEPs survey. They find a pro-rich inequality with a higher prevalence of iCVH in people with wealth, that is more pronounced in women, underscoring the need for equitable cardiovascular disease prevention policies.