ARC Centre of Excellence for Children and Families over the Life Course

A large number of genetic loci are associated with adult body mass index. However, the genetics of childhood body mass index are largely unknown. We performed a meta-analysis of genome-wide association studies of childhood body mass index, using sex- and age-adjusted standard deviation scores. We included 35 668 children from 20 studies in the discovery phase and 11 873 children from 13 studies in the replication phase. In total, 15 loci reached genome-wide significance (P-value < 5 × 10(-8)) in the joint discovery and replication analysis, of which 12 are previously identified loci in or close to ADCY3, GNPDA2, TMEM18, SEC16B, FAIM2, FTO, TFAP2B, TNNI3K, MC4R, GPR61, LMX1B and OLFM4 associated with adult body mass index or childhood obesity. We identified three novel loci: rs13253111 near ELP3, rs8092503 near RAB27B and rs13387838 near ADAM23. Per additional risk allele, body mass index increased 0.04 Standard Deviation Score (SDS) [Standard Error (SE) 0.007], 0.05 SDS (SE 0.008) and 0.14 SDS (SE 0.025), for rs13253111, rs8092503 and rs13387838, respectively. A genetic risk score combining all 15 SNPs showed that each additional average risk allele was associated with a 0.073 SDS (SE 0.011, P-value = 3.12 × 10(-10)) increase in childhood body mass index in a population of 1955 children. This risk score explained 2% of the variance in childhood body mass index. This study highlights the shared genetic background between childhood and adult body mass index and adds three novel loci. These loci likely represent age-related differences in strength of the associations with body mass index.

BACKGROUND: Bullying victimisation is a global public health problem that has been predominantly studied in high income countries. This study aimed to estimate the population level prevalence of bullying victimisation and its association with peer and parental supports amongst adolescents across low and middle income to high income countries (LMIC-HICs). METHODS: Data were drawn from the Global School-based Student Health Survey of school children aged 12-17 years, between 2003 and 2015, in 83 LMIC-HICs in the six World Health Organization (WHO) regions. We estimated the weighted prevalence of bullying victimisation at country, region and global level. We used multiple binary logistic regression models to estimate the adjusted association of age, gender, socioeconomic status, and parental support and peer support, and country level variables (GDP and government expenditure on education) with adolescent bullying victimisation. FINDINGS: Of the 317,869 adolescents studied, 151,036 (48%) were males, and 166,833 (52%) females. The pooled prevalence of bullying victimisation on one or more days in the past 30 days amongst adolescents aged 12-17 years was 30·5% (95% CI: 30·2-31·0%). The highest prevalence was observed in the Eastern Mediterranean Region (45·1%, 44·3-46·0%) and African region (43·5%, 43·0-44·3%), and the lowest in Europe (8·4%, 8·0-9·0%). Bullying victimisation was associated with male gender (OR: 1·21; 1·11-1·32), below average socio-economic status (OR: 1·47, 1·35-1·61), and younger age (OR: 1·11, 1·0-1·24). Higher levels of peer support (0·51, 0·46-0·57), higher levels of parental support (e.g., understanding children's problems (OR: 0·85, 0·77-0·95), and knowing the importance of free time spent with children (OR: 0·77, 0·70-0·85)), were significantly associated with a reduced risk of bullying victimisation. INTERPRETATIONS: Bullying victimisation is prevalent amongst adolescents globally, particularly in the Eastern Mediterranean and African regions. Parental and peer supports are protective factors against bullying victimisation. A reduction in bullying victimisation may be facilitated by family and peer based interventions aimed at increasing social connectedness of adolescents.

BackgroundSuicidal ideation and anxiety are common among adolescents although their prevalence has predominantly been studied in high income countries. This study estimated the population prevalence of suicidal ideation and anxiety and their correlates with peer support, parent-adolescent relationship, peer victimization, conflict, isolation and loneliness across a range of low-income, lower-middle-income, upper-middle-income countries and high-income countries (LMIC HICs).MethodsData were drawn from the Global School-based Student Health Survey (GSHS) of adolescents aged 12–17 years between 2003 and 2015 in 82 LM-HICs from the six World Health Organization (WHO) regions. For those countries with repeated time point data in this study, we used data from the most recent survey. We estimated weighted prevalence of suicidal ideation and anxiety by country, region and at a global level with the following questions:-“Did you ever seriously consider attempting suicide during the past 12 months?” and “During the past 12 months, how often have you been so worried about something that you could not sleep at night?”. We used multiple binary logistic regression to estimate the adjusted association between adolescent age, sex, socioeconomic status, peer support, parent-adolescent relationship, peer victimization, conflict, isolation and loneliness with suicidal ideation and anxiety.FindingsThe sample comprised of 275,057 adolescents aged 12–17 years (mean age was 14.6 (SD 1.18) years of whom 51.8% were females). The overall 12 months pooled prevalence of suicidal ideation and anxiety were 14.0% (95% CI 10.0–17.0%) and 9.0% (7.0–12.0%) respectively. The highest pooled prevalence of suicidal ideation was observed in the Africa Region (21.0%; 20.0–21.0%) and the lowest was in the Asia region (8.0%, 8.0–9.0%). For anxiety, the highest pooled prevalence was observed in Eastern Mediterranean Region (17.0%, 16.0–17.0%) the lowest was in the European Region (4.0%, 4.0–5.0%). Being female, older age, having a lower socioeconomic status and having no close friends were associated with a greater risk of suicidal ideation and anxiety. A higher levels of parental control was positively associated with a greater likelihood of experiencing suicidal ideation (OR: 1.65, 1.45–1.87) and anxiety (1.53, 1.30–1.80). Parental understanding and monitoring were negatively associated with mental health problems. Similarly, the odds of experiencing suicidal ideation and anxiety were higher among adolescents who had been experiencing peer conflict (1.36, 1.24–1.50; 1.54, 1.40–1.70), peer victimization (1.26, 1.15–1.38; 1.13, 1.02–1.26), peer isolation (1.69, 1.53–1.86; 1.76, 1.61–1.92) and reported loneliness (2.56, 2.33–2.82; 5.63, 5.21–6.08).InterpretationsSuicidal ideation and anxiety are prevalent among adolescents although there is significant global variation. Parental and peer supports are protective factors against suicidal ideation and anxiety. Peer based interventions to enhance social connectedness and parent skills training to improve parent-child relationships may reduce suicidal ideation and anxiety. Research to inform the factors that influence country and regional level differences in adolescent mental health problems may inform preventative strategies.FundingNone

In recent years policy makers and social scientists have devoted considerable attention to wellbeing, a concept that refers to people's capacity to live healthy, creative and fulfilling lives. Two conceptual approaches dominate wellbeing research. The objective approach examines the objective components of a good life. The subjective approach examines people's subjective evaluations of their lives. In the objective approach how subjective wellbeing relates to objective wellbeing is not a relevant research question. The subjective approach does investigate how objective wellbeing relates to subjective wellbeing, but has focused primarily on one objective wellbeing indicator, income, rather than the comprehensive indicator set implied by the objective approach. This paper attempts to contribute by examining relationships between a comprehensive set of objective wellbeing measures and subjective wellbeing, and by linking wellbeing research to inequality research by also investigating how subjective and objective wellbeing relate to class, gender, age and ethnicity. We use three waves of a representative state-level household panel study from Queensland, Australia, undertaken from 2008 to 2010, to investigate how objective measures of wellbeing are socially distributed by gender, class, age, and ethnicity. We also examine relationships between objective wellbeing and overall life satisfaction, providing one of the first longitudinal analyses linking objective wellbeing with subjective evaluations. Objective aspects of wellbeing are unequally distributed by gender, age, class and ethnicity and are strongly associated with life satisfaction. Moreover, associations between gender, ethnicity, class and life satisfaction persist after controlling for objective wellbeing, suggesting that mechanisms in addition to objective wellbeing link structural dimensions of inequality to life satisfaction.

In recent years the recreational use of inhaled nitrous oxide gas (N2O) is becoming increasingly popular, yet little is known about the characteristics of its users or the effects they experience. This paper presents original research from the 2014 Global Drug Survey (GDS) (n=74,864). GDS runs the largest survey of recreational drug use in the world. The findings confirm N2O as a very common drug of use, in particular in the UK and US (38.6% and 29.4% lifetime prevalence). In the UK N2O was reported to be the eighth most commonly used substance. N2O was generally consumed via gas-filled balloons, at festivals and clubs where use of other substances was common. The vast majority of users use infrequently, and their use is not associated with significant harm. However, there appears to be a subpopulation of heavy users who may be using in a dependent pattern. Analysis of last year N2O users (n=4883), confirms that N2O is associated with hallucinations and confusion (which may be the desired effects) and persistent numbness and accidental injury (27.8%, 23.9%, 4.3% and 1.2% of last year users, respectively). Accidental injury is associated with the highest number of 'hits' per session, suggesting a dose-response relationship. The presence of significant harm is discussed in the light of public education on the risks of N2O use and harm-reduction strategies appropriate to N2O use. Further work needs to be completed to confirm the presence of persistent neurological symptoms in recreational users.

The expanding domain of digital mental health is transitioning beyond traditional telehealth to incorporate smartphone apps, virtual reality, and generative artificial intelligence, including large language models. While industry setbacks and methodological critiques have highlighted gaps in evidence and challenges in scaling these technologies, emerging solutions rooted in co-design, rigorous evaluation, and implementation science offer promising pathways forward. This paper underscores the dual necessity of advancing the scientific foundations of digital mental health and increasing its real-world applicability through five themes. First, we discuss recent technological advances in digital phenotyping, virtual reality, and generative artificial intelligence. Progress in this latter area, specifically designed to create new outputs such as conversations and images, holds unique potential for the mental health field. Given the spread of smartphone apps, we then evaluate the evidence supporting their utility across various mental health contexts, including well-being, depression, anxiety, schizophrenia, eating disorders, and substance use disorders. This broad view of the field highlights the need for a new generation of more rigorous, placebo-controlled, and real-world studies. We subsequently explore engagement challenges that hamper all digital mental health tools, and propose solutions, including human support, digital navigators, just-in-time adaptive interventions, and personalized approaches. We then analyze implementation issues, emphasizing clinician engagement, service integration, and scalable delivery models. We finally consider the need to ensure that innovations work for all people and thus can bridge digital health disparities, reviewing the evidence on tailoring digital tools for historically marginalized populations and low- and middle-income countries. Regarding digital mental health innovations as tools to augment and extend care, we conclude that smartphone apps, virtual reality, and large language models can positively impact mental health care if deployed correctly.

Abstract The safe, highly effective measles vaccine has been recommended globally since 1974, yet in 2017 there were more than 17 million cases of measles and 83,400 deaths in children under 5 years old, and more than 99% of both occurred in low- and middle-income countries (LMICs) 1–4 . Globally comparable, annual, local estimates of routine first-dose measles-containing vaccine (MCV1) coverage are critical for understanding geographically precise immunity patterns, progress towards the targets of the Global Vaccine Action Plan (GVAP), and high-risk areas amid disruptions to vaccination programmes caused by coronavirus disease 2019 (COVID-19) 5–8 . Here we generated annual estimates of routine childhood MCV1 coverage at 5 × 5-km 2 pixel and second administrative levels from 2000 to 2019 in 101 LMICs, quantified geographical inequality and assessed vaccination status by geographical remoteness. After widespread MCV1 gains from 2000 to 2010, coverage regressed in more than half of the districts between 2010 and 2019, leaving many LMICs far from the GVAP goal of 80% coverage in all districts by 2019. MCV1 coverage was lower in rural than in urban locations, although a larger proportion of unvaccinated children overall lived in urban locations; strategies to provide essential vaccination services should address both geographical contexts. These results provide a tool for decision-makers to strengthen routine MCV1 immunization programmes and provide equitable disease protection for all children.

Abstract This paper reviews the role of locus of control in the labor market. I begin with a discussion of the conceptual origins of locus of control, including its relationship to related concepts such as self-efficacy, motivation, and self-control. The relationship between locus of control and labor market success is then summarized. In doing so, I pay careful attention to what we know about three potential mechanisms – human capital investments, hiring decisions, and optimal incentive contracts – through which locus of control might operate. Finally, the broader implications of these relationships for public policy and future research are discussed.

While survey data supports a strong relationship between personality and labour market outcomes, the exact mechanisms behind this association remain unexplored. We take advantage of a controlled laboratory set‐up to explore whether this relationship operates through productivity. Using a real‐effort task, we analyse the impact of the Big Five personality traits on performance. We find that more neurotic subjects perform worse, and that more conscientious individuals perform better. These findings suggest that at least part of the effect of personality on labour market outcomes operates through productivity. In addition, we find evidence that gender and university major affect this relationship.

Major life events affect our wellbeing. However the comparative impact of different events, which often co-occur, has not been systematically evaluated, or studies assumed that the impacts are equivalent in both amplitude and duration, that different wellbeing domains are equally affected, and that individuals exhibit hedonic adaptation. We evaluated the individual and conditional impact of eighteen major life-events, and compared their effects on affective and cognitive wellbeing in a large population-based cohort using fixed-effect regression models assessing within person change. Several commonly cited events had little, if any, independent effect on wellbeing (promotion, being fired, friends passing), whilst others had profound impacts regardless of co-occurring events (e.g., financial loss, death of partner, childbirth). No life events had overall positive effects on both types of wellbeing, but separation, injury/illnesses and monetary losses caused negative impacts on both, which did not display hedonic adaptation. Affective hedonic adaptation to all positive events occurred by two years but monetary gains and retirement had ongoing benefits on cognitive wellbeing. Marriage, retirement and childbirth had positive effects on cognitive wellbeing but no overall effect on affective wellbeing, whilst moving home was associated with a negative effect on cognitive wellbeing but no affective wellbeing response. Describing the independent impact of different life events, and, for some, the differential affective and life satisfaction responses, and lack of hedonic adaptation people display, may help clinicians, economists and policy-makers, but individual's hopes for happiness from positive events appears misplaced.

Considerable work-family research has investigated the gendered division of work and care. Gender differences in leisure time have received much less attention from work-family scholars, despite the potential importance of such inequalities for women’s quality of life. Combining key insights from the substantial gendered leisure studies literature with work-family scholarship, the current study examines cross-national variation in gender differences in leisure quality. Using data on 23 countries from the 2007 International Social Survey Program, we expected that women’s leisure quality would be lower than men’s, but the gender gap would be smaller in countries with more gender egalitarian attitudes and divisions of care (via de-familialisation and paternity leave) and where women have more bargaining power. Our results show that these country characteristics moderate the association between gender and the extent to which free time is used to relax and recover. In countries with conservative gender norms, low levels of childcare coverage, limited paternity leave and lower political power for women, women’s leisure quality is lower than men’s. In more egalitarian countries, the gender gap in leisure quality is lower and in some cases, reversed. These results are in line with findings from cross-national research on the gendered division of labor and offer an important contribution to understanding gender differences in leisure quality across countries.

Background: Modifiable non-communicable disease (NCD) risk factors are becoming increasingly common among adolescents, with clustering of these risk factors in individuals of particular concern. The aim of this study was to assess global status of clustering of common modifiable NCD risk factors among adolescents. Methods: We used latest available data from nationally representative survey for 140 countries, namely the Global School-based Student Health Survey, the Health Behaviour in School-Aged Children and the longitudinal study of Australian Children. Weighted mean estimates of prevalence with corresponding 95% confidence intervals of nine NCD risk factors - physical inactivity, sedentary behaviour, insufficient fruits and vegetable consumption, carbonated soft drink consumption, fast food consumption, tobacco use, alcohol consumption and overweight/obesity - were calculated by country, region and sex. Findings: Over 487,565 adolescents, aged 11-17 years, were included in this study. According to trend analysis, prevalence of four or more NCD risk factors increased gradually over time. Prevalence of four or more NCD risk factors was 14.8% in 2003-2007 and increased to 44% in 2013-2017, an approximately three-fold increase (44.0%). Similar trends were also observed for three and two risk factors. Large variation between countries in the prevalence of adolescents with four or more risk factors was found in all regions. The country level range was higher in the South-East Asia Region (minimum Sri Lanka = 8%, maximum Myanmar = 84%) than Western Pacific Region (minimum China = 3%, maximum Niue = 72%), European Region (minimum Sweden = 13.9%, maximum Ireland = 66.0%), African Region (minimum Senegal = 0.8%, maximum Uganda = 82.1%) and Eastern Mediterranean Region (minimum Libya = 0.2%, maximum Lebanon = 80.2%). Insufficient vegetable consumption, insufficient fruit consumption and physically inactivity were three of the four most prevalent risk factors in all regions. Interpretation: Our results suggest a high prevalence of four or more NCD risk factors in adolescents globally, although variation was found between countries. Results from our study indicate that efforts to reduce adolescent NCD risk factors and the associated health burden need to be improved. These findings can assist policy makers to target the rollout of country- specific interventions. Funding: None.

Background: This study examines substance use disparities among homosexual, bisexual and heterosexual adolescents and young adults from nine countries. Methods: Data from 58 963 respondents (aged 16 and 35 years) to the 2015 'Global Drug Survey' were utilized. Rates of lifetime, last-year, last-month use and age of onset of 13 different substances were compared across sexual identity subgroups. Results: Adolescents and young adults with a sexual minority identity generally reported higher rates of substance use and an earlier age of onset compared to their heterosexual counterparts. Differences in substance use were larger among female groups than male groups, and rates of substance use were generally higher among bisexuals than homosexuals of both genders. Conclusion: Higher rates of substance use in bisexuals compared with homosexuals among both genders and larger differences between female groups highlight the importance of differentiating between sexual minority identities in substance use research, and in designing substance misuse interventions for people with a sexual minority identity.

BACKGROUND: Understanding the early roots of physical activity and sedentary behaviors is critical to developing intervention programs that promote healthy lifestyle habits in infants and children. There is, however, no evidence on how these behaviors cluster and develop together during early childhood. The aim of this study was to identify single and joint longitudinal trajectories in physical activity and screen time amongst children aged 0 to 9 years, their social-demographic predictors and their prospective health-related quality-of-life and socio-emotional outcomes. METHODS: Three waves of data from The Longitudinal Study of Australian Children, a national study tracking two cohorts every 2 years (B-cohort, 0-5 years, n = 4,164; K-cohort, 4-9 years, n = 3,974) were analysed. Growth mixture modelling was applied to longitudinal time-use diary data to identify joint trajectories in children's physical activity and screen time over Waves 1-3. Key socio-demographic variables measured at Wave 1 were used to predict membership in different trajectories. The prospective consequences (at Wave 3) of time-use trajectories on health-related quality-of-life and socio-emotional outcomes were assessed. RESULTS: Three physical-activity/screen-time trajectories were identified for both cohorts: Cluster-A-children who maintained low levels of physical activity and screen time (∽50% of the sample), Cluster-B-children who progressively increased physical activity and maintained low screen-time levels (∽25%), and Cluster-C-children who maintained low physical-activity levels and increased screen time (∽25%). Children in Cluster-B experienced the best health-related quality-of-life and socio-emotional outcomes, while those in Cluster-C experienced the worst. Children who were female, Indigenous, from non-English-speaking backgrounds, not living with two biological parents, in more affluent households and neighbourhoods, without siblings and with parents with poor mental health were at greater risk of falling into Cluster-A or Cluster-C. CONCLUSION: Our findings identified which children are most at-risk of falling into time-use trajectories that lead to poor health-related quality-of-life and socio-emotional outcomes later in life, increasing our ability to monitor, detect and prevent these suboptimal behaviours prior to their onset.

BACKGROUND AND PURPOSE: Depression is known to increase stroke risk. Although limited, there is some evidence for age differences, with a suggestion for a stronger association in younger groups. We investigated the effect of depression on stroke incidence in a large cohort of midaged women. METHODS: We included 10 547 women without a history of stroke aged 47 to 52 years from the Australian Longitudinal Study on Women's Health, surveyed every 3 years from 1998 to 2010. Depression was defined at each survey using the Center for Epidemiological Studies Depression Scale (shortened version) and antidepressant use in the past month. Stroke was ascertained through self-report and mortality data. We determined the association between depression and stroke at the subsequent survey, using generalized estimating equation analysis, adjusting for time-varying covariates. RESULTS: At each survey, ≈24% were defined as having depression. During follow-up, 177 strokes occurred. Depression was associated with a >2-fold increased odds of stroke (odds ratio, 2.41; 95% confidence interval, 1.78-3.27), which attenuated after adjusting for age, socioeconomic status, lifestyle, and physiological factors (odds ratio, 1.94; 95% confidence interval, 1.37-2.74). Findings were robust to sensitivity analyses addressing methodological issues, including definition of depression, antidepressant use, and missing covariate data. CONCLUSIONS: Depression is a strong risk factor for stroke in midaged women, with the association partially explained by lifestyle and physiological factors. Further studies of midaged and older women from the same population are needed to confirm whether depression is particularly important in younger women and to inform targeted intervention approaches.

BACKGROUND: Caesarean delivery on maternal request (CDMR) is considered a significant contributor to the unprecedented increase in caesarean deliveries (CDs) for nonclinical reasons. Current literature lacks a reliable assessment of the rate of CDMR, which hinders the planning and delivery of appropriate interventions for reducing CDMR rates. OBJECTIVES: To conduct a systematic review of the literature and meta-regression to explore the global incidence of CDMR. SEARCH STRATEGY: PubMed, Embase, CINAHL, Medline, Google scholar and grey literature were searched from January 1985 to May 2019. SELECTION CRITERIA: Observational studies that report CDMR data were included. We excluded non-English articles, case notes, editorial reviews and articles reporting elective CDs from pregnancy risk factors. DATA COLLECTION AND ANALYSIS: Two reviewers independently conducted the screening and quality appraisal using a validated tool. The weighted average of CDMR over total deliveries (absolute proportion) and by total CDs (relative proportion) were generated. Quality-effects meta-regression was used to explain the variability of the CDMR estimates by moderators, including study methodology and demography of study participants. MAIN RESULTS: We identified 31 articles from 14 countries that include 5 million total births. The absolute proportion of CDMR varies between 0.2 and 42.0%, with significant variations across studies and subgroups. The economic status of the country and study year together explained 84% of the absolute and 76% of the relative proportion of CDMR variation. CONCLUSIONS: An appropriate reporting of CDMR should be a key priority in maternal health policies and practices. TWEETABLE ABSTRACT: Globally, the proportion of maternal requested caesarean delivery has mostly been influenced by the economic status of the country.

Abstract Panel data from the Household, Income and Labour Dynamics in Australia Survey are used to examine the impact of involuntary job loss on the mental health of spouses and adolescent children. Estimates from fixed effects models show that the mental health of women (but not men) declines following a spouse’s job loss, but only if that job loss results in a sustained period of non-employment or if the couple experienced prior financial hardship or relationship strain. A negative effect of parental job loss on the mental health of adolescent children is also found but is restricted to girls. JEL Classification : I31, J10, J65

The discrimination literature treats outcomes as relative. But does a differential arise because agents discriminate against others – exophobia – or because they favour their own kind – endophilia? Using a field experiment that assigned graders randomly to students’ examinations that did/did not contain names, we find favouritism but no discrimination by nationality nor by gender. We are able to identify these preferences under a wide range of behavioural scenarios regarding the graders. That endophilia dominates exophobia alters how we should measure discriminatory wage differentials and should inform the formulation of anti‐discrimination policy.

This study explores whether gender patterns in personality traits contribute to the gender gap in hourly wage rates, focusing on traits that reflect an individual's confidence to take on a challenge. To capture confidence, we use a psychological measurement known as Achievement Motivation, which is dually comprised of 'hope for success' and 'fear of failure'. This personality dimension is examined in addition to the Big Five personality traits and Locus of Control (LOC). Using 2013 wage data from the Household, Income and Labour Dynamics in Australia (HILDA) Survey, our Oaxaca-Blinder decomposition model reveals that men's stronger hope for success, lower fear of failure and lower agreeableness contribute to the gender wage gap, while women's higher level of conscientiousness is the only trait that serves to narrow it.

OBJECTIVES: This study aimed to examine the prevalence and distribution in the comorbidity of non-communicable diseases (NCDs) among the adult population in Bangladesh by measures of socioeconomic status (SES). DESIGN: This was a cross-sectional study. SETTING: This study used Bangladesh Demographic and Health Survey 2011 data. PARTICIPANTS: Total 8763 individuals aged ≥35 years were included. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome measures were diabetes mellitus (DM), hypertension (HTN) and overweight/obesity. The study further assesses factors (in particular SES) associated with these comorbidities (DM, HTN and overweight/obesity). RESULTS: ). Just over 1% of the sample had all three conditions, 3% had both DM and HTN, 3% DM and overweight/obesity and 7% HTN and overweight/obesity. DM, HTN and overweight/obesity were more prevalent those who had higher education, were non-manual workers, were in the richer to richest SES and lived in urban settings. Individuals in higher SES groups were also more likely to suffer from comorbidities. In the multivariable analysis, it was found that individual belonging to the richest wealth quintile had the highest odds of having HTN (adjusted OR (AOR) 1.49, 95% CI 1.29 to 1.72), DM (AOR 1.63, 95% CI 1.25 to 2.14) and overweight/obesity (AOR 4.3, 95% CI 3.32 to 5.57). CONCLUSIONS: In contrast to more affluent countries, individuals with NCDs risk factors and comorbidities are more common in higher SES individuals. Public health approaches must consider this social patterning in tackling NCDs in the country.