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Chung W, Kim R. A Reversal of the Association between Education Level and Obesity Risk during Ageing: A Gender-Specific Longitudinal Study in South Korea. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17186755. [PMID: 32948024 PMCID: PMC7559988 DOI: 10.3390/ijerph17186755] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 09/12/2020] [Accepted: 09/14/2020] [Indexed: 12/16/2022]
Abstract
This study aimed to examine and quantify obesity risk across different education levels during ageing using the dataset of a nationally representative longitudinal survey. A total of 45,391 observations of 9991 individuals aged ≥45 years were included in this study. Obesity was defined as a body mass index of ≥25, according to a guideline for Asians by the World Health Organization, and education level was grouped into three categories. Socio-demographics, lifestyles, and health conditions were used as covariates. Adjusted odds ratios and predicted probabilities of obesity were computed and adjusted for a complex survey design. With respect to gender, education level and age were significantly associated with obesity risk, and the association was stronger in women than in men. Furthermore, education level was negatively associated with obesity risk in the middle age in each gender. However, the association became positive in the old age, specifically among highly educated women. Therefore, policy efforts to reduce obesity risk and the resulting education gradients should be established based on studies considering their old age. Further longitudinal studies are required to examine whether these findings are valid in other socio-cultural or economic settings.
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Affiliation(s)
- Woojin Chung
- Department of Health Policy and Management, Graduate School of Public Health, Yonsei University, Seoul 03722, Korea;
- Institute of Health Services Research, Yonsei University, Seoul 03722, Korea
| | - Roeul Kim
- Labor Welfare Research Institute, Korea Workers’ Compensation and Welfare Service, Seoul 07254, Korea
- Correspondence: ; Tel.: +82-2-2670-0448
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Chung W, Lim SJ, Lee S, Kim R, Kim J. Gender-specific interactions between education and income in relation to obesity: a cross-sectional analysis of the Fifth Korea National Health and Nutrition Examination Survey (KNHANES V). BMJ Open 2017; 7:e014276. [PMID: 29288171 PMCID: PMC5770831 DOI: 10.1136/bmjopen-2016-014276] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES To identify gender-specific associations between education and income in relation to obesity in developed countries by considering both the interaction-effect terms of the independent variables and their main-effect terms. DESIGN A cross-sectional study. Education and income levels were chosen as socioeconomic status indicators. Sociodemographics, lifestyles and medical conditions were used as covariates in multivariable logistic regression models. Adjusted ORs and predicted probabilities of being obese were computed and adjusted for a complex survey design. SETTING Data were obtained from the Fifth Korea National Health and Nutrition Examination Survey (2010-2012). PARTICIPANTS The sample included 7337 male and 9908 female participants aged ≥19 years. OUTCOME MEASURE Obesity was defined as body mass index of ≥25, according to a guideline for Asians. RESULTS In models with no interaction-effect terms of independent variables, education was significantly associated with obesity in both men and women, but income was significant only in women. However, in models with the interaction-effect terms, education was significant only in women, but income was significant only in men. The interaction effect between income and education was significant in men but not in women. Participants having the highest predicted probability of being obese over educational and income levels differed between the two types of models, and between men and women. A prediction using the models with the interaction-effect terms demonstrated that for all men, the highest level of formal education was associated with an increase in their probability of being obese by as much as 26%. CONCLUSIONS The well-known, negative association between socioeconomic status and obesity in developed countries may not be valid when interaction effects are included. Ignoring these effects and their gender differences may result in the targeting of wrong populations for reducing obesity prevalence and its resultant socioeconomic gradients.
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Affiliation(s)
- Woojin Chung
- Department of Health Policy, Graduate School of Public Health, Yonsei University, Seoul, Republic of Korea
- Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea
| | - Seung-Ji Lim
- Health Insurance Policy Research Institute, National Health Insurance Service, Wonju, Republic of Korea
| | - Sunmi Lee
- Health Insurance Policy Research Institute, National Health Insurance Service, Wonju, Republic of Korea
| | - Roeul Kim
- Labor Welfare Research Institute, Korea Worker's Compensation and Welfare Service, Seoul, Republic of Korea
| | - Jaeyeun Kim
- Health Insurance Policy Research Institute, National Health Insurance Service, Wonju, Republic of Korea
- Department of Public Health, Graduate School, Yonsei University, Seoul, Republic of Korea
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Pickering K, Monahan M, Guariglia A, Roberts TE. Time to tighten the belts? Exploring the relationship between savings and obesity. PLoS One 2017; 12:e0179921. [PMID: 28662132 PMCID: PMC5491068 DOI: 10.1371/journal.pone.0179921] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Accepted: 06/06/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Literature suggests that the higher the rate of time preference people have, the less likely they are to save for the future. Likewise, it has been hypothesised that rising rates of being overweight/obesity are associated with an increase in peoples' marginal rate of time preference. AIM To investigate the relationship between being overweight/ obese and the rate of time preference in an older English population, using savings as a proxy for time preference. METHODS Three different econometric methods-Random-effects Probit Estimation, Fixed-effects Estimation, and Generalised Method of Moments Estimation-were used to explore the link between being overweight/ obese and rate of time preference in the English Longitudinal Study of Ageing dataset. Six waves of panel data spanning eleven years provided the data to test whether savings variables are related to being overweight/ obese. RESULTS The decision to save was shown to hold a statistically significant negative relationship with body mass index but only in the Generalised Method of Moments model. Placing savings in safe, low risk investments was significantly related to a lower probability of being obese but only in the random-effects Probit model. The proportion that people saved relative to their income was not found to be significantly associated with the probability of being overweight/ obese in any of the models. CONCLUSION There is an unclear relationship between saving behaviour and being overweight/ obese in an older English population. A financial variable such as savings is a potentially appropriate but imperfect proxy for the rate of time preference of the population. Further research is required to clarify the relationship in order to help develop strategies for obesity prevention. The inconsistency in the results between methods highlights the importance of using a wide range of alternative techniques before implementing important policy decisions.
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Affiliation(s)
- Karen Pickering
- Health Economics Unit, University of Birmingham, Birmingham, United Kingdom
| | - Mark Monahan
- Health Economics Unit, University of Birmingham, Birmingham, United Kingdom
| | | | - Tracy E. Roberts
- Health Economics Unit, University of Birmingham, Birmingham, United Kingdom
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Pérez-Hernández B, García-Esquinas E, Graciani A, Guallar-Castillón P, López-García E, León-Muñoz LM, Banegas JR, Rodríguez-Artalejo F. Desigualdades sociales en los factores de riesgo cardiovascular de los adultos mayores de España: estudio ENRICA-Seniors. Rev Esp Cardiol 2017. [DOI: 10.1016/j.recesp.2016.05.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Prevalence of Metabolic Syndrome and Related Factors in Korean Career Firefighters in Comparisons With Other Occupational Groups. J Occup Environ Med 2017; 59:384-388. [PMID: 28157765 DOI: 10.1097/jom.0000000000000956] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE The aim of this study was to investigate the prevalence of metabolic syndrome (MS) and its relationships with socio-demographic and lifestyle-related factors in firefighters comparing it to general workers. METHODS Data from 257 Korean men career firefighters and 1064 Korean men workers were analyzed. RESULTS There was no significant difference in the prevalence of MS between firefighters (21.4%) and general workers (25.6%). We found that age and obesity were independent risk factors for MS in both firefighters and general workers. After adjusting for age and obesity, the risk for MS in firefighters was not significantly different from that in the most of occupational groups except sales workers. CONCLUSIONS About one-fifth of firefighters had MS showing a similar prevalence compared with general workers. Therefore continuous monitoring and preventive programs for MS are needed in firefighters.
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Gender-Specific Associations between Socioeconomic Status and Psychological Factors and Metabolic Syndrome in the Korean Population: Findings from the 2013 Korean National Health and Nutrition Examination Survey. BIOMED RESEARCH INTERNATIONAL 2016; 2016:3973197. [PMID: 28050556 PMCID: PMC5165127 DOI: 10.1155/2016/3973197] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 10/27/2016] [Indexed: 11/17/2022]
Abstract
We aimed to assess the gender-specific associations between psychological factors and socioeconomic status (SES) and metabolic syndrome (MetS) in Korean adults. We examined 4,689 Korean adults aged 20-79 years who participated in the 2013 Korean National Health Examination and Nutrition Survey. With regard to SES, occupation status (none, manual, and nonmanual), marital status (single, married, divorced, and widowed), and psychological factors (detection of stress, depressive symptoms, and suicidal thoughts) were determined via questionnaires. Compared with married men, single and divorced men exhibited ORs (95% confidence interval [CIs]) for MetS of 0.45 (0.31-0.65) and 1.61 (1.02-2.55), respectively, after adjusting for covariates. However, this association was not significant in women. Compared with those in the lowest household income group and least educated group in women, the ORs for MetS in the highest income group and the most educated group were 0.63 (CI 0.46-0.86) and 0.46 (CI 0.32-0.67), respectively. Suicidal thoughts in men (OR 1.64, CI 1.03-2.61) and perceived stress in women (OR 1.26, CI 1.01-1.59) were associated with MetS. In this study, MetS has gender-specific associations with lower SES and psychological factors. Thus, gender-specific public health interventions based on SES and psychological factors are needed to prevent and treat MetS and reduce additional cardiovascular disease risk.
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Rodriguez-Caro A, Vallejo-Torres L, Lopez-Valcarcel B. Unconditional quantile regressions to determine the social gradient of obesity in Spain 1993-2014. Int J Equity Health 2016; 15:175. [PMID: 27756299 PMCID: PMC5070139 DOI: 10.1186/s12939-016-0454-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Accepted: 09/26/2016] [Indexed: 11/22/2022] Open
Abstract
Background There is a well-documented social gradient in obesity in most developed countries. Many previous studies have conventionally categorised individuals according to their body mass index (BMI), focusing on those above a certain threshold and thus ignoring a large amount of the BMI distribution. Others have used linear BMI models, relying on mean effects that may mask substantial heterogeneity in the effects of socioeconomic variables across the population. Method In this study, we measure the social gradient of the BMI distribution of the adult population in Spain over the past two decades (1993–2014), using unconditional quantile regressions. We use three socioeconomic variables (education, income and social class) and evaluate differences in the corresponding effects on different percentiles of the log-transformed BMI distribution. Quantile regression methods have the advantage of estimating the socioeconomic effect across the whole BMI distribution allowing for this potential heterogeneity. Results The results showed a large and increasing social gradient in obesity in Spain, especially among females. There is, however, a large degree of heterogeneity in the socioeconomic effect across the BMI distribution, with patterns that vary according to the socioeconomic indicator under study. While the income and educational gradient is greater at the end of the BMI distribution, the main impact of social class is around the median BMI values. A steeper social gradient is observed with respect to educational level rather than household income or social class. Conclusion The findings of this study emphasise the heterogeneous nature of the relationship between social factors and obesity across the BMI distribution as a whole. Quantile regression methods might provide a more suitable framework for exploring the complex socioeconomic gradient of obesity. Electronic supplementary material The online version of this article (doi:10.1186/s12939-016-0454-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Alejandro Rodriguez-Caro
- Department of Quantitative Methods, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain.
| | - Laura Vallejo-Torres
- UCL Department of Applied Health Research, UCL, University College London, Gower Street, London, WC1E 6BT, UK
| | - Beatriz Lopez-Valcarcel
- Department of Quantitative Methods, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
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Pérez-Hernández B, García-Esquinas E, Graciani A, Guallar-Castillón P, López-García E, León-Muñoz LM, Banegas JR, Rodríguez-Artalejo F. Social Inequalities in Cardiovascular Risk Factors Among Older Adults in Spain: The Seniors-ENRICA Study. ACTA ACUST UNITED AC 2016; 70:145-154. [PMID: 27519455 DOI: 10.1016/j.rec.2016.05.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Accepted: 05/27/2016] [Indexed: 11/18/2022]
Abstract
INTRODUCTION AND OBJECTIVES To examine the distribution of the main cardiovascular risk factors (CVRF) according to socioeconomic level (SEL) among older adults in Spain. METHODS A cross-sectional study conducted in 2008-2010 with 2699 individuals representative of the noninstitutionalized Spanish population aged ≥ 60 years. Socioeconomic level was assessed using educational level, occupation, and father's occupation. The CVRF included behavioral and biological factors and were measured under standardized conditions. RESULTS In age- and sex-adjusted analyses, higher educational level was associated with a higher frequency of moderate alcohol consumption and leisure time physical activity, and less time spent watching television. An inverse educational gradient was observed for frequency of obesity (odds ratio [OR] in university vs primary level or below education, 0.44; 95% confidence interval [95%CI], 0.33-0.57; P-trend < .01), metabolic syndrome (OR = 0.56; 95%CI, 0.43-0.71; P-trend < .01), diabetes (OR = 0.68; 95%CI, 0.49-0.95; P-trend < .05), and cardiovascular disease (OR = 0.52; 95%CI, 0.29-0.91; P-trend < .05). Compared with a nonmanual occupation, having a manual occupation was associated with a higher frequency of several CVRF; this association was stronger than that observed for father's occupation. Differences in CVRF across SELs were generally greater in women than in men. CONCLUSIONS There are significant social inequalities in CVRF among older adults in Spain. Reducing these inequalities, bringing the levels of CVRF in those from lower SEL in line with the levels seen in higher SEL, could substantially reduce the prevalence of CVRF in the older adult population.
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Affiliation(s)
- Bibiana Pérez-Hernández
- Departamento de Medicina Preventiva y Salud Pública, Facultad de Medicina, Universidad Autónoma de Madrid/IdiPaz, CIBER de Epidemiología y Salud Pública, CIBERESP, Madrid, Spain
| | - Esther García-Esquinas
- Departamento de Medicina Preventiva y Salud Pública, Facultad de Medicina, Universidad Autónoma de Madrid/IdiPaz, CIBER de Epidemiología y Salud Pública, CIBERESP, Madrid, Spain.
| | - Auxiliadora Graciani
- Departamento de Medicina Preventiva y Salud Pública, Facultad de Medicina, Universidad Autónoma de Madrid/IdiPaz, CIBER de Epidemiología y Salud Pública, CIBERESP, Madrid, Spain
| | - Pilar Guallar-Castillón
- Departamento de Medicina Preventiva y Salud Pública, Facultad de Medicina, Universidad Autónoma de Madrid/IdiPaz, CIBER de Epidemiología y Salud Pública, CIBERESP, Madrid, Spain
| | - Esther López-García
- Departamento de Medicina Preventiva y Salud Pública, Facultad de Medicina, Universidad Autónoma de Madrid/IdiPaz, CIBER de Epidemiología y Salud Pública, CIBERESP, Madrid, Spain
| | - Luz M León-Muñoz
- Departamento de Medicina Preventiva y Salud Pública, Facultad de Medicina, Universidad Autónoma de Madrid/IdiPaz, CIBER de Epidemiología y Salud Pública, CIBERESP, Madrid, Spain
| | - José R Banegas
- Departamento de Medicina Preventiva y Salud Pública, Facultad de Medicina, Universidad Autónoma de Madrid/IdiPaz, CIBER de Epidemiología y Salud Pública, CIBERESP, Madrid, Spain
| | - Fernando Rodríguez-Artalejo
- Departamento de Medicina Preventiva y Salud Pública, Facultad de Medicina, Universidad Autónoma de Madrid/IdiPaz, CIBER de Epidemiología y Salud Pública, CIBERESP, Madrid, Spain
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Hui LL, Leung GM, Schooling CM. Social Patterning in Adiposity in Adolescence: Prospective Observations from the Chinese Birth Cohort ''Children of 1997''. PLoS One 2016; 11:e0146198. [PMID: 26735134 PMCID: PMC4703380 DOI: 10.1371/journal.pone.0146198] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Accepted: 12/13/2015] [Indexed: 10/27/2022] Open
Abstract
INTRODUCTION Low early life socio-economic position is more strongly associated with adiposity among women than men. We examined whether the sex difference of social patterning in general and central adiposity exists before adulthood. METHODS In Hong Kong's "Children of 1997" birth cohort, we used multivariable regression to examine the association of parental education, a marker of early life socio-economic position, with body mass index (BMI) (n = 7252, 88% follow-up) and waist-height ratio (n = 5636, 68% follow-up), at 14 years. RESULTS Parental education of Grade 9 or below, compared to Grade 12 or above, was associated with higher waist-height ratio z-score particularly in girls (0.30, 95% confidence interval (CI) 0.19, 0.41) compared to boys (0.12, 95% CI 0.02, 0.22) (p for sex interaction = 0.02). Lower parental education was associated with greater BMI z-score in adolescents of locally born mothers, but not adolescents of migrant mothers, with no difference by sex. CONCLUSIONS Different social patterning in different markers of adiposity may imply different sociological and biological mediating pathways. A stronger association between low early life socio-economic position and waist-height ratio in adolescent girls may indicate sex-specific influences of SEP related early life exposures on central adiposity.
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Affiliation(s)
- L. L. Hui
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Gabriel M. Leung
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - C. Mary Schooling
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
- CUNY School of Public Health and Hunter College, New York City, New York, United States of America
- * E-mail:
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Johari SM, Shahar S. Metabolic syndrome: The association of obesity and unhealthy lifestyle among Malaysian elderly people. Arch Gerontol Geriatr 2014; 59:360-6. [PMID: 24882592 DOI: 10.1016/j.archger.2014.04.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2011] [Revised: 04/08/2014] [Accepted: 04/24/2014] [Indexed: 11/30/2022]
Abstract
The aim of this study is to investigate the prevalence of metabolic syndrome (MetS) and its predictors among Malaysian elderly. A total of 343 elderly aged ≥ 60 years residing low cost flats in an urban area in the central of Malaysia were invited to participate in health screening in community centers. Subjects were interviewed to obtain socio demography, health status and behavior data. Anthropometric measurements were also measured. A total of 30 ml fasting blood was taken to determine fasting serum lipid, glucose level and oxidative stress. MetS was classified according to The International Diabetes Federation (IDF) criteria. The prevalence of MetS was 43.4%. More women (48.1%) were affected than men (36.3%) (p<0.05). Being obese or overweight was the strongest predictor for MetS in men and women (p<0.05, both gender). High carbohydrate intake increased risk of MetS in men by 2.8 folds. In women, higher fat free mass index, physical inactivity and good appetite increased risk of MetS by 3.9, 2.1 and 2.3 folds respectively. MetS affected almost half of Malaysian elderly being investigated, especially women, and is associated with obesity and unhealthy lifestyle. It is essential to develop preventive and intervention strategies to curb undesirable consequences associated with MetS.
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Affiliation(s)
- Sa'ida Munira Johari
- Dietetic Program, School of Healthcare Sciences, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Suzana Shahar
- Dietetic Program, School of Healthcare Sciences, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia.
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Kim J, Sharma SV, Park SK. Association between socioeconomic status and obesity in adults: evidence from the 2001 to 2009 Korea national health and nutrition examination survey. J Prev Med Public Health 2014; 47:94-103. [PMID: 24744826 PMCID: PMC3988287 DOI: 10.3961/jpmph.2014.47.2.94] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2013] [Accepted: 01/16/2014] [Indexed: 01/03/2023] Open
Abstract
Objectives The present study examined relationships between socioeconomic status (SES) and obesity and body mass index (BMI) as well as the effects of health-related behavioral and psychological factors on the relationships. Methods A cross-sectional population-based study was conducted on Korean adults aged 20 to 79 years using data from the 2001, 2005, and 2007 to 2009 Korea National Health and Nutrition Examination Survey. Multivariate logistic and linear regression models were used to estimate odds ratios of obesity and mean differences in BMI, respectively, across SES levels after controlling for health-related behavioral and psychological factors. Results We observed significant gender-specific relationships of SES with obesity and BMI after adjusting for all covariates. In men, income, but not education, showed a slightly positive association with BMI (p<0.05 in 2001 and 2005). In women, education, but not income, was inversely associated with both obesity and BMI (p<0.0001 in all datasets). These relationships were attenuated with adjusting for health-related behavioral factors, not for psychological factors. Conclusions Results confirmed gender-specific disparities in the associations of SES with obesity and BMI among adult Korean population. Focusing on intervention for health-related behaviors may be effective to reduce social inequalities in obesity.
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Affiliation(s)
- Jihye Kim
- Department of Epidemiology, University of Texas School of Public Health, Houston, TX, USA
| | - Shreela V Sharma
- Department of Epidemiology, Michael and Susan Dell Center for Healthy Living, University of Texas School of Public Health, Houston, TX, USA
| | - Sung Kyun Park
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, USA
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Malhotra R, Malhotra C, Chan A, Østbye T. Life-course socioeconomic status and obesity among older Singaporean Chinese men and women. J Gerontol B Psychol Sci Soc Sci 2012; 68:117-27. [PMID: 23161348 DOI: 10.1093/geronb/gbs102] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES To elucidate the association between life-course socioeconomic status (SES) and obesity among older (aged 60 and older) Singaporean Chinese men and women. METHODS Data from the Social Isolation, Health and Lifestyles Survey (single-stage stratified random sampling design) was utilized. Obesity (body mass index >27.4 kg/m(2)) was assessed for 1,530 men and 2,036 women. Childhood (family financial status while growing up), adult (education), and older adult (housing type) SES indicators were used to define the accumulation of risk (cumulative socioeconomic disadvantage), social mobility (8 trajectories using the 3 SES indicators), and sensitive period (independent effect of each SES indicator) conceptual models. Association between the 3 life-course SES conceptual models and obesity was assessed using logistic regression analysis. RESULTS Among women and men, low childhood SES lowered the odds of obesity. Low adult SES increased the odds of obesity only among women. There was no association between cumulative socioeconomic disadvantage and obesity. Women experiencing upward social mobility had lower odds of obesity relative to both those experiencing low SES and high SES through the life-course. DISCUSSION Association of the life-course SES conceptual models with obesity among older Singaporeans is different from that reported among younger Western populations, suggesting the association to be context specific. The different conceptual models complement each other.
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Affiliation(s)
- Rahul Malhotra
- Health Services and Systems Research, Duke-NUS Graduate Medical School, 8 College Road, Singapore 169857.
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Li X, Sundquist K, Sundquist J. Parental Occupation and Risk of Hospitalization for Asthma in Children and Adolescents. J Asthma 2009. [DOI: 10.1080/02770900903141260] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Senese LC, Almeida ND, Fath AK, Smith BT, Loucks EB. Associations between childhood socioeconomic position and adulthood obesity. Epidemiol Rev 2009; 31:21-51. [PMID: 19648176 PMCID: PMC2873329 DOI: 10.1093/epirev/mxp006] [Citation(s) in RCA: 118] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Childhood socioeconomic position (SEP) is inversely associated with cardiovascular disease and all-cause mortality. Obesity in adulthood may be a biologic mechanism. Objectives were to systematically review literature published between 1998 and 2008 that examined associations of childhood SEP with adulthood obesity. Five databases (Cochrane Library, MEDLINE, EMBASE, PsycINFO, Web of Science) were searched for studies from any country, in any language. Forty-eight publications based on 30 studies were identified. In age-adjusted analyses, inverse associations were found between childhood SEP and adulthood obesity in 70% (14 of 20) of studies in females and 27% (4 of 15) in males. In studies of females showing inverse associations between childhood SEP and adulthood obesity, typical effect sizes in age-adjusted analyses for the difference in body mass index between the highest and lowest SEP were 1.0-2.0 kg/m(2); for males, effect sizes were typically 0.2-0.5 kg/m(2). Analyses adjusted for age and adult SEP showed inverse associations in 47% (8 of 17) of studies in females and 14% (2 of 14) of studies in males. When other covariates were additionally adjusted for, inverse associations were found in 4 of 12 studies in females and 2 of 8 studies in males; effect sizes were typically reduced compared with analyses adjusted for age only. In summary, the findings suggest that childhood SEP is inversely related to adulthood obesity in females and not associated in males after adjustment for age. Adulthood SEP and other obesity risk factors may be the mechanisms responsible for the observed associations between childhood SEP and adulthood obesity.
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Affiliation(s)
- Laura C Senese
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montréal, Québéc, Canada
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Chapman BP, Fiscella K, Duberstein P, Kawachi I, Coletta M. Can the influence of childhood socioeconomic status on men's and women's adult body mass be explained by adult socioeconomic status or personality? Findings from a national sample. Health Psychol 2009; 28:419-27. [PMID: 19594266 PMCID: PMC2732202 DOI: 10.1037/a0015212] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVES On the basis of a life-course risk-chain framework, the authors examined whether (a) residual associations between childhood socioeconomic status (SES) and adult obesity and body mass index (BMI) would be observed in women but not men after adjusting for adult SES, (b) adult Big Five personality traits would be associated with adult body mass in both genders, and (c) personality would explain unique variation in outcomes beyond child and adult SES. DESIGN National survey (Midlife Development in the United States study; N = 2,922). MAIN OUTCOME MEASURES BMI and obesity. RESULTS (a) In both genders, association between childhood SES and adult obesity were accounted for entirely by adult SES, but its effect on adult BMI was observed only in women; (b) higher conscientiousness was associated with lower obesity prevalence and BMI in both genders, although more strongly in women, and in men, greater obesity prevalence was associated with higher agreeableness and neuroticism; and (c) personality explained unique outcome variation in both genders. CONCLUSIONS Early social disadvantage may affect adult weight status more strongly in women owing to gender differences in the timing and nature of weight-management socialization. Personality may enhance or detract from risks incurred by childhood or adulthood SES in either gender, necessitating the consideration of dispositional differences in prevention and intervention programs.
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Affiliation(s)
- Benjamin P Chapman
- Department of Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, NY 14642, USA.
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González D, Nazmi A, Victora CG. Childhood poverty and abdominal obesity in adulthood: a systematic review. CAD SAUDE PUBLICA 2009; 25 Suppl 3:S427-40. [DOI: 10.1590/s0102-311x2009001500008] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2009] [Accepted: 09/23/2009] [Indexed: 11/21/2022] Open
Abstract
Adverse socioeconomic conditions in childhood can have lasting effects on health, but evidence is lacking from prospective studies concerning the effects of early poverty on abdominal obesity in adulthood. Cross-sectional studies in adults from middle and high-income countries show that current socioeconomic status is inversely related to obesity in women, but the pattern in men is not consistent. A systematic review was undertaken to assess the influence of early socioeconomic status on waist circumference, hip circumference, and waist-hip ratio in adulthood. Thirteen relevant articles were located (five cross-sectional and eight cohort), including only one from a middle-income country and the remainder from high-income settings. In all the studies, childhood poverty was associated with higher levels of abdominal obesity in women. In men, the associations were weaker, and no clear pattern emerged.
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Affiliation(s)
| | - Aydin Nazmi
- California Polytechnic State University, U.S.A
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Martín AR, Nieto JMM, Ruiz JPN, Jiménez LE. Overweight and obesity: The role of education, employment and income in Spanish adults. Appetite 2008; 51:266-72. [DOI: 10.1016/j.appet.2008.02.021] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2007] [Revised: 02/21/2008] [Accepted: 02/22/2008] [Indexed: 12/22/2022]
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Sánchez-Chaparro MA, Calvo-Bonacho E, González-Quintela A, Fernández-Labandera C, Cabrera M, Sáinz JC, Fernández-Meseguer A, Banegas JR, Ruilope LM, Valdivielso P, Román-García J. Occupation-related differences in the prevalence of metabolic syndrome. Diabetes Care 2008; 31:1884-5. [PMID: 18753667 PMCID: PMC2518364 DOI: 10.2337/dc08-0431] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To investigate the prevalence of metabolic syndrome in the Spanish working population and determine how the prevalence varies according to occupation and sex. RESEARCH DESIGN AND METHODS This was a cross-sectional study of 259,014 workers (mean age 36.4 years, range [16-74]; 72.9% male) who underwent a routine medical checkup. The Adult Treatment Panel III (2001) definition for metabolic syndrome was used. RESULTS The prevalence of metabolic syndrome was 11.6% (95% CI 11.5-11.7) in male subjects and 4.1% (4.0-4.2) in female subjects and increased with age. The prevalence of metabolic syndrome varied in the different categories of occupational activity depending on the sex considered. Among female subjects, the age-adjusted prevalence of metabolic syndrome was higher in blue-collar than in white-collar workers, but this difference was not evident among male workers. CONCLUSIONS The prevalence of metabolic syndrome varies in the different categories of occupational activity in the Spanish working population. This variation also depends on sex.
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Affiliation(s)
- Miguel-Angel Sánchez-Chaparro
- Ibermutuamur (Mutua de Accidentes de Trabajo y Enfermedades Profesionales de la Seguridad Social 274), Madrid, Spain.
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Santos AC, Ebrahim S, Barros H. Gender, socio-economic status and metabolic syndrome in middle-aged and old adults. BMC Public Health 2008; 8:62. [PMID: 18282285 PMCID: PMC2270270 DOI: 10.1186/1471-2458-8-62] [Citation(s) in RCA: 98] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2007] [Accepted: 02/18/2008] [Indexed: 12/03/2022] Open
Abstract
Background Studies that addressed social and economic determinants of cardiovascular diseases, consistently showed an increase prevalence of the individual features of metabolic syndrome in the lower socio-economic strata. Thus, this study aimed to evaluate the association between social class and metabolic syndrome in a sample of urban middle-aged and old Portuguese adults. Methods We evaluated 1962 subjects (1207 women and 755 men) aged 40 or more years. Marital status, education, occupation, menarche age and height distribution were used as socioeconomic indicators. Metabolic syndrome was defined according to the ATP III, by the presence of at least three of the following characteristics: waist circumference >102 cm in men and >88 cm in women; triglycerides ≥ 150 mg/dl; HDL cholesterol <40 mg/dl in men and <50 mg/dl in women; blood pressure ≥ 130/85 mm Hg; and fasting glucose ≥ 110 mg/dl. Proportions were compared using the chi square test or Fisher's exact test. Odds ratios (OR) and 95% confidence intervals (95% CI) were computed using unconditional logistic regression to estimate the magnitude of the associations. Results Metabolic syndrome was significantly more frequent in females (24.9 vs. 17.4, p < 0.001). In females, the odds favoring metabolic syndrome significantly increased with age and in unfavorable social class as described by occupation, and decreased with education level. In males, metabolic syndrome was significantly more frequent in the 60–69 years age class (OR = 1.82; 95%CI: 1.02–3.26) when compared to those in the 40–49 years age class. Concerning other socioeconomic indicators no significant associations were found. Conclusion This study showed that gender influenced the association of socio-economic status indicators with metabolic syndrome. Females in lower social classes, as defined by education and occupational classification, more frequently presented metabolic syndrome, no such association was found in males.
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Affiliation(s)
- Ana C Santos
- Department of Hygiene and Epidemiology, University of Porto Medical School, Porto, Portugal.
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Adipositas ist mehr als eine Essstörung - die multidimensionale Betrachtung einer Pandemie. ZEITSCHRIFT FUR PSYCHOSOMATISCHE MEDIZIN UND PSYCHOTHERAPIE 2008; 54:4-31. [DOI: 10.13109/zptm.2008.54.1.4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Salsberry PJ, Corwin E, Reagan PB. A complex web of risks for metabolic syndrome: race/ethnicity, economics, and gender. Am J Prev Med 2007; 33:114-20. [PMID: 17673098 DOI: 10.1016/j.amepre.2007.03.017] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2006] [Revised: 02/20/2007] [Accepted: 03/29/2007] [Indexed: 11/24/2022]
Abstract
BACKGROUND Metabolic syndrome is a recognizable clinical cluster of risks known to be associated in combination and independently with an increased risk for cardiovascular disease (CVD). Identifying and treating metabolic syndrome is one promising strategy to reduce CVD. The intersection of race/ethnicity, gender, and economic status complicates our understanding of who is at risk for metabolic syndrome, but understanding this social patterning is important for the development of targeted interventions. This study examines the relationship between metabolic syndrome (and the underlying contributing risk factors) and race/ethnicity, economic status, and gender. METHODS National Health and Nutrition Examination Survey data collected from 1999 through 2002 were used; analysis was completed in 2006-2007. Metabolic syndrome was defined using the Adult Treatment Panel III definition. Economic status was measured using income as a percentage of the poverty level. Prevalence of metabolic syndrome and each of its contributing risk factors were determined by race/ethnicity and economic group. Logistic regressions were estimated. All analyses were stratified by gender. RESULTS Economic effects were seen for women, but not men. Women in the lowest economic group were more likely to be at risk in four of the five risk categories when compared with women in the highest economic group. Differences in the contributing risk profiles for metabolic syndrome were seen by race/ethnicity. CONCLUSIONS Strategies to reduce CVD must be built on a clear understanding of the differences in contributing risk factors for metabolic syndrome across subgroups. The findings from this study provide further information to guide the targeting of these strategies.
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Affiliation(s)
- Pamela J Salsberry
- College of Nursing, The Ohio State University, Columbus, Ohio 43210, USA.
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Abstract
The present paper reviews the development of life course epidemiology since its origins during the 1990s from biological programming, birth cohort research and the study of health inequalities. Methods of studying the life course are examined, including birth cohort studies, linked register datasets and epidemiological archaeology. Three models of life course epidemiology are described: critical periods, accumulation, and pathways. Their conceptual and empirical differentiation can be difficult, but it is argued that accumulation is the underlying social process driving life course trajectories, while the critical period and pathway models are distinguished by their concern with specific types of aetiological process. Among the advantages of the accumulation model are predictive power, aetiological insights, contributions to health inequality debates and social policy implications. It is emphasised that the life course approach is not opposed to, or an alternative to, a concern with cross-sectional and current effects; major social disruption can have a large and immediate impact on health. Other limitations of the life course approach include a spectrum of impact (life course effects can be strong in relation to physiology, but often are weaker in relation to behaviour and psychological reactions to everyday life) and, more speculatively, the possibility that life course effects are diluted in the older age groups where morbidity and mortality are highest. Three issues for the future of life course epidemiology are identified. Many life course data are collected retrospectively. We need to know which items of information are recalled with what degree of accuracy over how many decades; and what methods of collecting these retrospective data maximise accuracy and duration. Second, the two partners in life course research need to take more seriously each other's disciplines. Social scientists need to be more critical of such measures as self-assessed health, which lacks an aetiology and hence biological plausibility. Natural scientists need to be more critical of such concepts as socio-economic status, which lacks social plausibility because it fails to distinguish between social location and social prestige. Finally, European comparative studies can play an important part in the future development of life course epidemiology if they build on the emerging infrastructure of European comparative research.
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Affiliation(s)
- D Blane
- Department of Primary Care and Social Medicine, Imperial College, London W6 8RP, UK.
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Abstract
Little prior research has investigated whether the correlates of obesity differ between men and women. The objective of this study was to examine gender-specific disparities in obesity by rurality of residence, race/ethnicity, and socioeconomic status. Particular emphasis was devoted to examining potential differences between residents of urban, suburban, and rural areas. Data from the adult version of the 2003 Behavioral Risk Factor Surveillance System (BRFSS) for the state of Texas were used to model the crude and adjusted odds of being obese as compared to normal weight. The findings showed that males of other race/ethnicity had lower adjusted odds of obesity than non-Hispanic whites, but other race/ethnicity was insignificant for females. Females who were Hispanic or black/African American had higher adjusted odds of obesity than non-Hispanic whites, but Hispanic ethnicity and black/African American race were insignificant for males. Men and women residing in non-metropolitan areas had higher adjusted odds of obesity than their counterparts in metropolitan areas. No economic disparities were revealed among men, but females with high household income had lower odds of obesity than those with low income. Educational status was insignificant for men and women. The findings suggest that programs and policies aimed at curbing obesity should target males and females residing in non-metropolitan localities. Other initiatives should focus on particular groups of women, including those who are Hispanic or black/African American and have low household income.
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Affiliation(s)
- Tyrone F Borders
- Department of Health Policy and Management, Fay W. Boozman College of Public Health, Little Rock, Arkansas 72205-7199, USA.
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Regidor E, Banegas JR, Gutiérrez-Fisac JL, Domínguez V, Rodríguez-Artalejo F. Influence of childhood socioeconomic circumstances, height, and obesity on pulse pressure and systolic and diastolic blood pressure in older people. J Hum Hypertens 2005; 20:73-82. [PMID: 16121198 DOI: 10.1038/sj.jhh.1001925] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
This study assesses the association of childhood socioeconomic circumstances, height, and obesity with components of blood pressure. We selected 4009 people representative of the Spanish population aged 60 years and older, and estimated systolic blood pressure (SBP), diastolic blood pressure (DBP), and pulse pressure (PP) according to childhood social class, height, and obesity. No association was found between childhood social class and blood pressure. SBP showed an inverse gradient and DBP a direct gradient with height, although an independent association between height and DBP was found only in women. Stature was independently associated with increased DBP in women with central obesity, but there was no association between height and DBP in women without central obesity. Short stature was independently associated with increased PP. Body mass index and waist-to-hip ratio were independently associated with increased DBP in women, and waist-to-hip ratio was independently associated with increased PP in men, while waist circumference was independently associated with increased DBP and increased PP in women. These results do not support the assumed effect of socioeconomic circumstances in early life on blood pressure, which may depend on the context and/or study population. The relations observed between height and blood pressure support the hypothesis that PP could be a mediator of the association between short stature and increased cardiovascular risk. The relationship between obesity measures and components of blood pressure reinforces the recommendation to reduce body weight in order to reduce blood pressure.
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Affiliation(s)
- E Regidor
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain.
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