Socio-economic status and chronic disease in the West Bank and the Gaza Strip - among Palestinians living in and outside refugee camps

Marie Jonassen, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.

E-mail: [email protected]

Amira Shaheen, Public Health Division, An Najah National University, Palestine

Mohammed Duraidi, Palestinian Central Bureau of Statistics, Ramallah, Palestine

KhaledQalalwa, Palestinian Central Bureau of Statistics, Ramallah, Palestine

Bernard Jeune, Institute of Public Health, University of Southern Denmark, Odense, Denmark

Henrik Brønnum-Hansen, Department of Public Health, University of Copenhagen, Copenhagen, Denmark

Abstract

Background: In the Occupied PalestinianTerritory (OPT) a larger part of the population is exposed to poverty, unemployment and low educational attainment.The purpose of the study was to investigatethe association between socio-economic status (SES) and self-reported chronic disease among the Palestinian population in the West bank and the Gaza Strip, and whether this association differed among Palestinians living in refugee camps.

Methods: The study wasbased on data from two representative samples of the Palestinian population in OPT collected by the Palestinian Central Bureau of Statisticsin 2006 and 2010. Completed level of education, wealth, and employment status among Palestinians aged 25 and olderwere used as SES measurements. The participants were categorized as having a chronic disease if they reported to have been diagnosed with at least one chronic diseaseby a medical physician and received treatment for the disease.The association between SES and chronic disease wasestimated by logistic regression models adjusting for age, gender, marital status, region (The West bank or the Gaza Strip), type of area (urban, rural or refugee camp) and smoking.Themodels were further stratified on participants living in or outside the refugee camps in order to estimate the association for the two subpopulations. Finally, the prevalence of chronic disease between Palestinians living in or outside the refugee campswas compared and further adjustedby SES.

Findings:Overall, increasing prevalence of self-reported chronic disease among men and a decreasing prevalence among women from 2006 to 2010 in all categories of the three SES measurements was observed. Highly significant associations between all SES measurements and self-reported chronic disease were found. In 2010 OR of reported chronic disease among illiterate men was 1.37 (95% CI: 1.21-1.56) compared to men with anelementary or preparatory level of education. Among women OR was 1.45 (CI:1.29-1.63).Compared with men in the richest quintile, OR among men in the poorest quintilewas1.70 (CI: 1.47-1.96). Among women OR was 1.80 (CI: 1.56-2.07).Compared with employed,OR among unemployed was1.50 (CI:1.31-1.71) for men and 1.12 (CI: 0.76-1.65) for women.Similar results were found for 2006. The associations between the three SES measurements and chronic disease did not differbetween participants living in or outside refugee camps. However, the prevalence of self-reported chronic disease was significantly higher among Palestinians living in refugee camps compared to those living outside refugee camps, except for women in 2006, and this higher prevalence of self-reported chronic disease did not change significantly when adjusted for SES.

Interpretation: We found highly significant associations between SES and self-reported chronic disease in the Palestinian population in the West Bank and the Gaza Strip with the strongest association for the part of the population with the lowest level of SES.Although the prevalence of chronic disease was significantly higher among Palestinians living in refugee camps than among those living outside the refugee camps, the pattern of association between SES and self-reported chronic disease did not differ between the two subpopulations.

Conference Title

7th LPHA Conference

Conference Country

Jordan

Conference Date

March 7, 2016 - March 8, 2016

Conference Sponsor

LPHA