Poverty and poor choices: socioeconomic gradients of unhealthy behaviors among adults in a multi-center cross-sectional study in Iran

While the association between socioeconomic status (SES) and mortality/morbidity is well-documented, the specific relationship between SES and unhealthy behaviors in countries like Iran remains understudied. Therefore, this study aims to examine the socioeconomic inequalities in the prevalence of seven unhealthy behaviors among 3,518 adults from nine provinces in Iran. Significant socioeconomic status (SES)-related disparities were observed across multiple health behaviors. The poorest groups exhibited higher rates of physical inactivity (53.4% in the poorest vs. 41.2% in the richest; inequality ratio: 1.3), infrequent dental flossing (63.7% in the poorest vs. 30.1% in the richest; inequality ratio: 2.1), infrequent tooth brushing (27.4% in the poorest vs. 8.5% in the richest; inequality ratio: 3.2), poor sleep quality (27.2% in the poorest vs. 9.7% in the richest; inequality ratio: 2.8), and breakfast skipping (58.2% in the poorest vs. 47.6% in the richest). Conversely, alcohol consumption was more prevalent among the richest group (22.5% in the richest vs. 10.7% in the poorest; inequality ratio: 0.5). Current smoking rates were 26.5% for the poorest and 21.2% for the richest. Concentration index analysis revealed pro-poor gradients for all unhealthy behaviors except alcohol consumption (CI = 0.1041, p < 0.001), with notable pro-poor gradients observed for physical inactivity (CI= -0.0586, p = 0.002), poor sleep quality (CI= -0.1997, p < 0.001) and tooth brushing (CI= -0.2542, p < 0.001). The sex-stratified analysis revealed distinct socioeconomic patterns: physical inactivity exhibited stronger pro-poor gradients in males (CI= -0.0701) compared to females (CI= -0.0483).