Assessment and decomposition of excessive red meat consumption among hypertensive adults: A Wagstaff decomposition analysis

Introduction Red meat consumption is an important dietary factor in hypertension management, yet its distribution may vary across socioeconomic groups. This study examines wealth-related inequality in red meat consumption among hypertensive adults in Iran. Objective To quantify wealth-related inequality in red meat consumption among hypertensive adults in Iran and explore factors associated with this inequality. Methods Utilizing data from the 2021 Iranian STEPS survey, a nationally representative sample of 9,024 hypertensive adults was analyzed. Excessive consumption was defined as consuming red meat four or more times per week. Wealth-related inequality in consumption was then assessed using a wealth index derived from principal component analysis (PCA) of household assets and living conditions. Wagstaff decomposition analysis was employed to disaggregate the concentration index (CI) and explore the contribution of each factor to the observed inequality. Results The hypertensive adults included in the study had a mean age (95% CI) of 56.1 years (55.8, 56.5). The proportion of excessive red meat consumption was 16.5%. A significant wealth-related inequality was observed in excessive red meat consumption (CI = 0.179, p < 0.001), indicating that excessive consumption was concentrated among wealthier individuals. Wagstaff decomposition analysis showed that higher educational attainment (≥12 years) was the largest contributor to the observed inequality (20.6%), followed by unpaid work (6.8%), unemployment (4.4%), and age 40–59 years (4.2%). Overall, the included determinants explained 29.4% of the observed inequality. Conclusion This study identified significant wealth-related inequality in excessive red meat consumption among hypertensive adults in Iran, with higher consumption concentrated among wealthier groups. Educational attainment was the largest contributor to the observed inequality. Policies should consider socioeconomic differences in dietary behaviors and promote targeted nutrition interventions to reduce cardiovascular risk and improve dietary equity.