Socioeconomic and gender inequalities in NCD risk factors in Malta: a pre-pandemic baseline

Background

Health equity remains a prominent topic in European public health, yet socioeconomic health inequalities persist, further compounded by the long-term disruptions of the COVID-19 pandemic. Malta, a small, densely populated state with a high non-communicable disease (NCD) burden, offers a valuable opportunity to analyse these disparities. This study thus provides a robust pre-pandemic baseline to assess post-pandemic trends, whilst also serving as a pilot investigation applicable to other comparable states.

Methods

Data from the 2016 National Health Examination Survey were analysed to measure inequalities across education, occupation and employment status. Absolute (Slope Index of Inequality/SII) and relative (Relative Index of Inequality/RII) measures were utilized. Gender-stratified analyses and interaction testing were conducted to identify sex-associated differences in the social patterning of health.

Results

Marked socioeconomic gradients were observed across most outcomes among 1,861 respondents. Lower educational attainment strongly predicted obesity (RII 1.98; SII +24%), smoking (RII 1.95), and physical inactivity (RII 1.54), with occupational class showing comparable associations of smaller magnitude. Gender-stratified analyses revealed more pronounced educational inequalities among women and occupational inequalities among men. Furthermore, adverse health outcomes were significantly more prevalent among unemployed, retired, and especially among women engaged in domestic tasks.

Conclusions

This analysis provides empirical evidence of the socioeconomic health gradients in Malta, highlighting the inequitable conditions on which the pandemic acted. The distinct patterning of these gradients and the associated gender differences pinpoint the urgent need for gender-sensitive, equity-oriented interventions to mitigate the NCD burden and foster a more resilient landscape following the pandemic-related disruptions.

Key messages

• Clear socioeconomic gradients in NCD risks highlight persistent health inequalities in Malta.

• Gender-specific inequalities call for targeted, equity-focused public health interventions.