Equitable utilization of non-communicable disease services in low- and middle-income countries; associated factors and intervention effects: a systematic review and meta-analysis

With aging populations, a double burden of disease, and post-COVID-19 economic strain, managing non-communicable diseases (NCDs) has become a major challenge in low- and middle-income countries (LMICs). While most studies examine inequities in general healthcare utilization, few focus specifically on NCDs services. This review addresses that gap by synthesizing evidence on associated factors of equitable NCDs service utilization and assessing interventions to improve utilization. A systematic review and meta-analysis were conducted following PRISMA-Equity guidelines, including studies published between 2014 and 2024. Eligible studies examined socioeconomic and demographic associated factors of NCDs service utilization or evaluated interventions to reduce inequities. In the meta-analysis, pooled estimates for NCDs service utilization were performed using a random effects model. Heterogeneity among studies was assessed using I² statistics. Twenty-three studies were included. Overall, NCDs service utilization showed a clear pro-rich pattern, with wealthier groups consistently utilizing more services. The pooled outpatient NCD service utilization was 52.84% (95% CI: 41.04–64.64). Compared with the poorest wealth quintile, higher wealth status was significantly associated with greater NCDs service utilization (AOR = 1.44; 95% CI: 1.18–1.74). Socioeconomic status was the strongest associated factor, while gender, rural residence, and insurance status showed no consistent effects. Interventions such as patient-centered care, provider training, system-level reforms, and digital health integration showed promising outcomes. This review highlights that inequities in NCDs service utilization are driven primarily by poverty and structural barriers, not demographic factors alone. By focusing specifically on NCDs, it adds new evidence to equity literature that has previously concentrated on general healthcare use. Targeted pro-poor strategies and innovative interventions are essential to reduce disparities and improve NCD outcomes in LMICs.