1
|
Fayosse A, Dumurgier J, Dugravot A, Landré B, Singh-Manoux A, Sabia S. Cross-sectional and longitudinal associations of obesity with disability between age 50 and 90 in the SHARE study. Arch Gerontol Geriatr 2024; 119:105320. [PMID: 38171031 DOI: 10.1016/j.archger.2023.105320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 12/12/2023] [Accepted: 12/17/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND Obesity is associated with disability but whether age and ageing modify this association remains unclear. We examined whether this association changes between 50 and 90 years, and whether change in disability rates over 14 years differs by body mass index (BMI) categories. METHODS BMI and ADL-disability data on 28,453 individuals from 6 waves (2004-2018, SHARE study) were used to examine the cross-sectional absolute and relative associations, extracted at age 50, 60, 70, 80, and 90 years using logistic mixed models. Then baseline BMI and change in disability rates over 14-years were examined using logistic-mixed models. RESULTS At age 50, the probabilities of ADL disability in individuals with BMI 30-34.9 and ≥35 kg/m² were 0.07 (0.06, 0.09) and 0.11 (0.09, 0.12), increasing to 0.47 (0.44, 0.50) and 0.55 (0.50, 0.60) at age 90; the increase in both these groups was greater than that in the normal-weight group (p for increase with age<0.001). On the relative scale the OR at age 50 in these obesity groups was 2.37 (1.79, 3.13) and 5.03 (3.38, 7.48), decreasing to 1.51 (1.20, 1.89) and 2.19 (1.50, 3.21) at age 90; p for decrease with age=0.05 and 0.02 respectively. The 14-year increase in probability of disability was greatest in those with BMI≥35 kg/m² at age 50, 60, and 70 at baseline: differences in increase compared to normal weight were 0.08 (0.02, 0.14), 0.11 (0.07, 0.15), and 0.09 (0.02, 0.16) respectively. CONCLUSIONS ADL disability is increasingly prevalent with age in individuals with obesity. Relative measures of change obscure the association between obesity and disability due to age-related increase in disability rates in all groups.
Collapse
Affiliation(s)
- Aurore Fayosse
- Université Paris Cité, Inserm U1153, Epidemiology of Ageing and Neurodegenerative Diseases, Paris 75010, France
| | - Julien Dumurgier
- Université Paris Cité, Inserm U1153, Epidemiology of Ageing and Neurodegenerative Diseases, Paris 75010, France; Cognitive Neurology Center, Saint Louis, Lariboisiere - Fernand Widal Hospital, AP-HP; Université Paris Diderot, France
| | - Aline Dugravot
- Université Paris Cité, Inserm U1153, Epidemiology of Ageing and Neurodegenerative Diseases, Paris 75010, France
| | - Benjamin Landré
- Université Paris Cité, Inserm U1153, Epidemiology of Ageing and Neurodegenerative Diseases, Paris 75010, France
| | - Archana Singh-Manoux
- Université Paris Cité, Inserm U1153, Epidemiology of Ageing and Neurodegenerative Diseases, Paris 75010, France; Faculty of Brain Sciences, Division of Psychiatry, University College London, United Kingdom.
| | - Séverine Sabia
- Université Paris Cité, Inserm U1153, Epidemiology of Ageing and Neurodegenerative Diseases, Paris 75010, France; Faculty of Brain Sciences, Division of Psychiatry, University College London, United Kingdom
| |
Collapse
|
2
|
Colombet Z, Simioni M, Drogue S, Lamani V, Perignon M, Martin-Prevel Y, Merle S, Amiot MJ, Darmon N, Soler LG, Méjean C. Demographic and socio-economic shifts partly explain the Martinican nutrition transition: an analysis of 10-year health and dietary changes (2003-2013) using decomposition models. Public Health Nutr 2021; 24:1-12. [PMID: 34551851 DOI: 10.1017/s136898002100327x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE The Caribbean has seen a dramatic shift in the obesity and chronic disease prevalence over the past decades, suggesting a nutrition transition. Simultaneously, Martinique has faced a demographic transition marked by significant population ageing. We aimed to differentiate the contribution of changes in health status and dietary intakes due to shifts in demographic and socio-economic characteristics (DSEC) from that due to unobserved factors. DESIGN Two cross-sectional surveys conducted in 2003 (n 743) and 2013 (n 573) on representative samples were used. Dietary intakes were estimated by 24-h recalls. The contribution of changes in health status and dietary intakes due to shifts in observed DSEC was differentiated from that due to unobserved factors over a 10-year interval, using Oaxaca-Blinder decomposition models. SETTING Martinique, French region in the Caribbean. PARTICIPANTS Martinican adults (≥16 years). RESULTS Over the study period, health status deteriorated, partly owing to shifts in DSEC, explaining 62 % of the change in the prevalence of hypertension (+13 percentage points (pp)) and 48 % of waist circumference change (+3 cm). Diet quality decreased (mean adequacy ratio -2pp and mean excess ratio + 2 pp) and energy supplied by ultra-processed food increased (+4 pp). Shifts in DSEC marginally explained some changes in dietary intakes (e.g. increased diet quality), while the changes that remained unexplained were of opposite sign, with decreased diet quality, lower fruits, tubers and fish intakes and higher energy provided by ultra-processed foods. CONCLUSION Explained dietary changes were of opposite sign to nutrition transition conceptual framework, probably because unobserved drivers are in play, such as food price trends or supermarkets spread.
Collapse
Affiliation(s)
- Zoé Colombet
- MOISA, Université de Montpellier, CIRAD, CIHEAM-IAMM, INRAE, Montpellier SupAgro, UMR 1110 MOISA, 2 Place Pierre-Viala, Montpellier34000, France
| | - Michel Simioni
- MOISA, Université de Montpellier, CIRAD, CIHEAM-IAMM, INRAE, Montpellier SupAgro, UMR 1110 MOISA, 2 Place Pierre-Viala, Montpellier34000, France
| | - Sophie Drogue
- MOISA, Université de Montpellier, CIRAD, CIHEAM-IAMM, INRAE, Montpellier SupAgro, UMR 1110 MOISA, 2 Place Pierre-Viala, Montpellier34000, France
| | - Viola Lamani
- MOISA, Université de Montpellier, CIRAD, CIHEAM-IAMM, INRAE, Montpellier SupAgro, UMR 1110 MOISA, 2 Place Pierre-Viala, Montpellier34000, France
| | - Marlène Perignon
- MOISA, Université de Montpellier, CIRAD, CIHEAM-IAMM, INRAE, Montpellier SupAgro, UMR 1110 MOISA, 2 Place Pierre-Viala, Montpellier34000, France
| | - Yves Martin-Prevel
- Nutripass, Université de Montpellier, IRD, Montpellier SupAgro, Montpellier, France
| | - Sylvie Merle
- Regional Observatory on Health, Schoelcher, Martinique, France
- Department of Clinical Research and Innovation, University Hospital of Martinique, Fort-de-France, Martinique, France
| | - Marie-Josèphe Amiot
- MOISA, Université de Montpellier, CIRAD, CIHEAM-IAMM, INRAE, Montpellier SupAgro, UMR 1110 MOISA, 2 Place Pierre-Viala, Montpellier34000, France
| | - Nicole Darmon
- MOISA, Université de Montpellier, CIRAD, CIHEAM-IAMM, INRAE, Montpellier SupAgro, UMR 1110 MOISA, 2 Place Pierre-Viala, Montpellier34000, France
| | | | - Caroline Méjean
- MOISA, Université de Montpellier, CIRAD, CIHEAM-IAMM, INRAE, Montpellier SupAgro, UMR 1110 MOISA, 2 Place Pierre-Viala, Montpellier34000, France
| |
Collapse
|
3
|
Witkam R, Gwinnutt JM, Humphreys J, Gandrup J, Cooper R, Verstappen SM. Do associations between education and obesity vary depending on the measure of obesity used? A systematic literature review and meta-analysis. SSM Popul Health 2021; 15:100884. [PMID: 34401462 PMCID: PMC8350379 DOI: 10.1016/j.ssmph.2021.100884] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 07/26/2021] [Accepted: 07/26/2021] [Indexed: 01/22/2023] Open
Abstract
Background Consistent evidence suggests a relationship between lower educational attainment and total obesity defined using body mass index (BMI); however, a comparison of the relationships between educational attainment and total obesity (BMI ≥30 kg/m2) and central obesity (waist circumference (WC) > 102 cm for men and WC > 88 cm for women) has yet to be carried out. This systematic literature review (SLR) and meta-analyses aimed to understand whether i) the associations between education and obesity are different depending on the measures of obesity used (BMI and WC), and ii) to explore whether these relationships differ by gender and region. Methods Medline, Embase and Web of Science were searched to identify studies investigating the associations between education and total and central obesity among adults in the general population of countries in the Organisation for Economic Co-operation and Development (OECD). Meta-analyses and meta-regression were performed in a subset of comparable studies (n=36 studies; 724,992 participants). Results 86 eligible studies (78 cross-sectional and eight longitudinal) were identified. Among women, most studies reported an association between a lower education and total and central obesity. Among men, there was a weaker association between lower education and central than total obesity (OR central vs total obesity in men 0.79 (95% CI 0.60, 1.03)). The association between lower education and obesity was stronger in women compared with men (OR women vs men 1.66 (95% CI 1.32, 2.08)). The relationship between lower education and obesity was less strong in women from Northern than Southern Europe (OR Northern vs Southern Europe in women 0.37 (95% CI 0.27, 0.51)), but not among men. Conclusions Associations between education and obesity differ depending on whether total or central obesity is used among men, but not in women. These associations are stronger among women than men, particularly in Southern European countries.
Collapse
Affiliation(s)
- Rozemarijn Witkam
- Centre for Epidemiology Versus Arthritis, Division of Musculoskeletal and Dermatological Sciences, The University of Manchester, UK
| | - James M. Gwinnutt
- Centre for Epidemiology Versus Arthritis, Division of Musculoskeletal and Dermatological Sciences, The University of Manchester, UK
| | - Jennifer Humphreys
- Centre for Epidemiology Versus Arthritis, Division of Musculoskeletal and Dermatological Sciences, The University of Manchester, UK
- NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, UK
| | - Julie Gandrup
- Centre for Epidemiology Versus Arthritis, Division of Musculoskeletal and Dermatological Sciences, The University of Manchester, UK
| | - Rachel Cooper
- Department of Sport and Exercise Sciences, Musculoskeletal Science and Sports Medicine Research Centre, Manchester Metropolitan University, UK
| | - Suzanne M.M. Verstappen
- Centre for Epidemiology Versus Arthritis, Division of Musculoskeletal and Dermatological Sciences, The University of Manchester, UK
- NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, UK
- Corresponding author. Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK.
| |
Collapse
|
4
|
Großschädl F, Stronegger WJ. Long-term trends (1973-14) for obesity and educational inequalities among Austrian adults: men in the fast lane. Eur J Public Health 2019; 29:790-796. [PMID: 30649259 DOI: 10.1093/eurpub/cky280] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The examination of obesity trends is important to plan public health interventions specific to target-groups. We investigated long-term trends of obesity for the Austrian adult population between 1973 and 2014 according to their sex, age and education and the magnitude of educational-inequalities. METHODS Data were derived from six national, representative, cross-sectional interview surveys (N = 194 030). Data correction factors for self-reported body mass index (BMI) were applied. Obesity was defined as BMI ≥ 30 kg/m2. Absolute changes (ACs) and aetiologic fractions (AFs) were calculated to identify trends in the obesity prevalence. To measure the extent of social inequality, the relative index of inequality was computed based on educational levels. RESULTS In 2014, the age-adjusted prevalence of obesity was 14.6% (95%CI: 14.0-15.3) for women and 16.8% (95%CI: 16.1-17.9) for men. Obesity was most prevalent among subjects aged 55-74 years and those with low educational status. The AC in the obesity prevalence during the study period was highest for men aged 75 years and older with high/middle educational levels (16.2%) and also high for subjects aged 55 years and older with low educational levels. The greatest dynamics for obesity were observed among the oldest men with high/middle educational levels. Educational inequalities for obesity were higher among women, but only increased among men. CONCLUSIONS Since 1973, the prevalence for obesity was observed to be higher for men than women in Austria for the first time. Men showed the greatest increase in prevalence and risk for obesity during the study period. Further studies are needed to determine the drivers behind these trends.
Collapse
Affiliation(s)
| | - Willibald J Stronegger
- Institute of Social Medicine and Epidemiology, Medical University of Graz, Graz, Austria
| |
Collapse
|
5
|
Choi E, Cho HN, Seo DH, Park B, Park S, Cho J, Kim S, Park YR, Choi KS, Rhee Y. Socioeconomic inequalities in obesity among Korean women aged 19-79 years: the 2016 Korean Study of Women's Health-Related Issues. Epidemiol Health 2019; 41:e2019005. [PMID: 30917463 PMCID: PMC6446067 DOI: 10.4178/epih.e2019005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Accepted: 02/13/2019] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVES While the prevalence of obesity in Asian women has remained stagnant, studies of socioeconomic inequalities in obesity among Asian women are scarce. This study aimed to examine the recent prevalence of obesity in Korean women aged between 19 years and 79 years and to analyze socioeconomic inequalities in obesity. METHODS Data were derived from the 2016 Korean Study of Women’s Health-Related Issues. The chi-square test and logistic regression analysis were used to analyze the associations between socioeconomic factors and obesity using Asian standard body mass index (BMI) categories: low (<18.5 kg/m2 ), normal (18.5-22.9 kg/m2 ), overweight (23.0-24.9 kg/m2 ), and obese (≥25.0 kg/ m2 ). As inequality-specific indicators, the slope index of inequality (SII) and relative index of inequality (RII) were calculated, with adjustment for age and self-reported health status. RESULTS Korean women were classified into the following BMI categories: underweight (5.3%), normal weight (59.1%), overweight (21.2%), and obese (14.4%). The SII and RII revealed substantial inequalities in obesity in favor of more urbanized women (SII, 4.5; RII, 1.4) and against of women who were highly educated (SII, -16.7; RII, 0.3). Subgroup analysis revealed inequalities in obesity according to household income among younger women and according to urbanization among women aged 65-79 years. CONCLUSIONS Clear educational inequalities in obesity existed in Korean women. Reverse inequalities in urbanization were also apparent in older women. Developing strategies to address the multiple observed inequalities in obesity among Korean women may prove essential for effectively reducing the burden of this disease.
Collapse
Affiliation(s)
- Eunji Choi
- Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea
| | - Ha Na Cho
- Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea
| | - Da Hea Seo
- Department of Endocrinology and Metabolism, Inha University School of Medicine, Incheon, Korea
| | - Boyoung Park
- Department of Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Sohee Park
- Graduate School of Public Health, Yonsei University, Seoul, Korea
| | - Juhee Cho
- Department of Clinical Research and Evaluation, Sungkyunkwan University, Seoul, Korea
| | - Sue Kim
- College of Nursing, Yonsei University, Seoul, Korea
| | - Yeong-Ran Park
- Division of Silver Industry, Kangnam University, Yongin, Korea
| | - Kui Son Choi
- Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea
| | - Yumie Rhee
- Department of Internal Medicine, Endocrine Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| |
Collapse
|
6
|
Hoebel J, Kuntz B, Kroll LE, Schienkiewitz A, Finger JD, Lange C, Lampert T. Socioeconomic Inequalities in the Rise of Adult Obesity: A Time-Trend Analysis of National Examination Data from Germany, 1990-2011. Obes Facts 2019; 12:344-356. [PMID: 31167203 PMCID: PMC6696774 DOI: 10.1159/000499718] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 03/16/2019] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE Despite extensive study of the obesity epidemic, research on whether obesity has risen faster in lower or in higher socioeconomic groups is inconsistent. This study examined secular trends in obesity prevalence by socioeconomic position and the resulting obesity inequalities in the German adult population. METHODS Data were drawn from three national examination surveys conducted in 1990-1992, 1997-1999 and 2008-2011 (n = 18,541; age range: 25-69 years). Obesity was defined by a body mass index ≥30 kg/m2 using standardised measurements of body height and weight. Education and equivalised household disposable income were used as indicators of socioeconomic position. Time trends in socioeconomic inequalities in obesity were examined using linear probability and log-binomial regression models. RESULTS In each survey period, the highest socioeconomic groups had the lowest prevalence of obesity. The low and medium socioeconomic groups showed increases in obesity prevalence, whereas no such trend was observed in the high socioeconomic groups. Absolute inequalities in obesity by income increased by an average of 0.53 percentage points per year (95% confidence interval [CI] 0.01-1.05, p = 0.047) among men and 0.47 percentage points per year (95% CI 0.05-0.90, p = 0.029) among women. Absolute inequalities in obesity by education increased on average by 0.64 percentage points per year (95% CI 0.19-1.08, p = 0.005) among women but not among men (0.33 percentage points, 95% CI -0.27 to 0.92, p = 0.283). CONCLUSIONS These findings suggest a widening obesity gap between the top and the bottom of the socioeconomic spectrum. This has the potential to have adverse consequences for population health and health inequalities in coming decades. Interventions that are effective in preventing and reducing obesity in socially disadvantaged groups are needed.
Collapse
Affiliation(s)
- Jens Hoebel
- Division of Social Determinants of Health, Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany,
| | - Benjamin Kuntz
- Division of Social Determinants of Health, Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Lars E Kroll
- Division of Social Determinants of Health, Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Anja Schienkiewitz
- Division of Health Behaviour, Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Jonas D Finger
- Division of Health Behaviour, Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Cornelia Lange
- Division of Health Behaviour, Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Thomas Lampert
- Division of Social Determinants of Health, Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| |
Collapse
|
7
|
Alves L, Stringhini S, Barros H, Azevedo A, Marques-Vidal P. Inequalities in obesity in Portugal: regional and gender differences. Eur J Public Health 2018; 27:775-780. [PMID: 28407055 DOI: 10.1093/eurpub/ckx041] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background Obesity levels vary considerably according to geographical region and socio-economic status. We evaluated the prevalence of obesity by education and occupational position across seven Portuguese regions. Relative and absolute inequalities in obesity were also assessed. Methods Data was drawn from the Portuguese Health Survey 2005/6 (26 674 adults, 46.6% women). Education was categorized as ≤4, 5-11 and ≥12 complete years of education. Occupational position was grouped as upper white collar, lower white collar and blue collar. The Relative Index of Inequality (RII) and the Slope Index of Inequality (SII) were used to quantify relative and absolute inequalities in obesity, respectively. Results In women, prevalence of obesity ranged between 10.0% (Algarve) and 20.3% (Azores); in men, it ranged between 13.3% (Algarve) and 16.4% (Lisbon). In women, the educational RII (95% confidence interval) ranged between 2.4 (1.1 to 5.1) in the Centre and 6.6 (3.0 to 14.2) in Alentejo, and the SII (95% CI) between 9.7 (-1.3 to 20.7) and 33.0 (26.0 to 40.0), respectively. In men, the RII ranged between 0.8 (0.4 to 1.5) in Madeira and 1.9 (1.0 to 4.5) in the Centre, and the SII between -8.3 (-19.0 to 2.5) and 9.5 (-0.1 to 19.1), respectively. Occupational RIIs were similar to those for education, although somewhat lower. Conclusion In Portugal, large educational and occupational inequalities in obesity are observed, but they vary considerably by region and are larger among women than men.
Collapse
Affiliation(s)
- Luís Alves
- EPIUnit - Institute of Public Health of the University of Porto (ISPUP), Porto, Portugal.,Department of Clinical Epidemiology, Predictive Medicine and Public Health, University of Porto Medical School, Porto, Portugal.,ICVS/3B's - PT Government Associate Laboratory, Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
| | - Silvia Stringhini
- Institute of Social and Preventive Medicine (IUMSP), University Hospital Centre, Biopole 2, Lausanne, Switzerland
| | - Henrique Barros
- EPIUnit - Institute of Public Health of the University of Porto (ISPUP), Porto, Portugal.,Department of Clinical Epidemiology, Predictive Medicine and Public Health, University of Porto Medical School, Porto, Portugal
| | - Ana Azevedo
- EPIUnit - Institute of Public Health of the University of Porto (ISPUP), Porto, Portugal.,Department of Clinical Epidemiology, Predictive Medicine and Public Health, University of Porto Medical School, Porto, Portugal
| | - Pedro Marques-Vidal
- Department of Medicine, Internal Medicine, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| |
Collapse
|
8
|
Lampert T, Kroll LE, Kuntz B, Hoebel J. Health inequalities in Germany and in international comparison: trends and developments over time. JOURNAL OF HEALTH MONITORING 2018; 3:1-24. [PMID: 35586261 PMCID: PMC8864567 DOI: 10.17886/rki-gbe-2018-036] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Social epidemiological research has consistently demonstrated that people with a low socioeconomic status are particularly at risk of diseases, health complaints and functional limitations, and die at younger ages than those with a higher socioeconomic status. Greater stresses and strains in the workplace, family and living environment are under discussion as possible explanations. Health-related behaviours, psycho-social factors and personal resources, which are important in coping with everyday demands, certainly also play a role. From a public health and health policy perspective, reducing these health inequalities is an important goal. Insights into developments and trends in health inequalities over time can contribute towards highlighting new and emerging problems, and can thus help identify possible target groups and settings for relevant interventions. At the same time, these insights provide a basis upon which the success of policies and programmes that have already been implemented can be analysed and measured. Against this background, this review examines how health inequalities in Germany have developed over the last 20 to 30 years and places its findings within the context of the latest international research in this field.
Collapse
Affiliation(s)
- Thomas Lampert
- Robert Koch Institute, Berlin, Department of Epidemiology and Health Monitoring
| | | | | | | |
Collapse
|
9
|
Emamian MH, Fateh M, Hosseinpoor AR, Alami A, Fotouhi A. Obesity and its socioeconomic determinants in Iran. ECONOMICS AND HUMAN BIOLOGY 2017; 26:144-150. [PMID: 28395273 DOI: 10.1016/j.ehb.2017.03.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Revised: 03/15/2017] [Accepted: 03/30/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To investigate the socioeconomic inequality of obesity and its determinants in Iran. METHODS Data was from Iran's surveillance system for risk factors of non-communicable diseases which was conducted on 89,400 individuals aged 15-64 years in 2005. Principal component analysis was used to create a new variable for defining socioeconomic status of participants. We assessed inequality by calculating a slop index of inequality and concentration index for obesity. Oaxaca-Blinder decomposition analysis was used to determine the determinants of inequality. RESULTS The slop index of inequality and concentration index for obesity was -13.1 (95% Confidence Intervals [CI]: -16.3 to -9.8) percentage points and -0.123, respectively. The level of inequality varied widely between different provinces in Iran and was more severe in women and urban population. Obesity persisted in 20.2% (95% CI: 19.4-20.9) of the low-socioeconomic group and 11.0% (95% CI: 10.5-11.6) of the high-socioeconomic group. More than 90% of this gap was due to differences of independent variables (mainly age, gender and marital status) in two socioeconomic status groups. CONCLUSIONS A pro-rich inequality existed in the obesity in Iran. Older age, female gender and rural residency contributed most to the economic inequality of obesity.
Collapse
Affiliation(s)
- Mohammad Hassan Emamian
- Social Determinants of Health Research Center, Shahroud University of Medical Sciences, Shahroud, Iran.
| | - Mansooreh Fateh
- Center for Health Related Social and Behavioral Sciences Research, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Ahmad Reza Hosseinpoor
- Department of Informatics, Evidence and Research, World Health Organization, CH-1211 Geneva, Switzerland
| | - Ali Alami
- Social Determinants of Health Research Center; Department of Social Medicine, School of Medicine, Gonabad University of Medical Sciences, Gonabad, Iran
| | - Akbar Fotouhi
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
10
|
Hoffmann K, De Gelder R, Hu Y, Bopp M, Vitrai J, Lahelma E, Menvielle G, Santana P, Regidor E, Ekholm O, Mackenbach JP, van Lenthe FJ. Trends in educational inequalities in obesity in 15 European countries between 1990 and 2010. Int J Behav Nutr Phys Act 2017; 14:63. [PMID: 28482914 PMCID: PMC5421333 DOI: 10.1186/s12966-017-0517-8] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2016] [Accepted: 04/22/2017] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The prevalence of obesity increased dramatically in many European countries in the past decades. Whether the increase occurred to the same extent in all socioeconomic groups is less known. We systematically assessed and compared the trends in educational inequalities in obesity in 15 different European countries between 1990 and 2010. METHODS Nationally representative survey data from 15 European countries were harmonized and used in a meta-regression of trends in prevalence and educational inequalities in obesity between 1990 and 2010. Educational inequalities were estimated by means of absolute rate differences and relative rate ratios in men and women aged 30-64 years. RESULTS A statistically significant increase in the prevalence of obesity was found for all countries, except for Ireland (among men) and for France, Hungary, Italy and Poland (among women). Meta-regressions showed a statistically significant overall increase in absolute inequalities of 0.11% points [95% CI 0.03, 0.20] per year among men and 0.12% points [95% CI 0.04, 0.20] per year among women. Relative inequalities did not significantly change over time in most countries. A significant reduction of relative inequalities was found among Austrian and Italian women. CONCLUSION The increase in the overall prevalence aligned with a widening of absolute but not of relative inequalities in obesity in many European countries over the past two decades. Our findings urge for a further understanding of the drivers of the increase in obesity in lower education groups particularly, and an equity perspective in population-based obesity prevention strategies.
Collapse
Affiliation(s)
- Kristina Hoffmann
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, Netherlands
- Mannheim Institute of Public Health, Social and Preventive Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Rianne De Gelder
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, Netherlands
| | - Yannan Hu
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, Netherlands
| | - Matthias Bopp
- Epidemiology, Biostatistics and Prevention Institute, University of Zürich, Zürich, Switzerland
| | - Jozsef Vitrai
- National Institute for Health Development, Budapest, Hungary
| | - Eero Lahelma
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Gwenn Menvielle
- Sorbonne Universités, INSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique (IPLESP UMRS 1136), Paris, France
| | - Paula Santana
- Departamento de Geografia, Centro de Estudos de Geografia e de Ordenamento do Territorio (CEGOT), Colégio de S. Jerónimo, Universidade de Coimbra, Coimbra, Portugal
| | - Enrique Regidor
- Department of Preventive Medicine and Public Health, Universidad Complutense de Madrid, Madrid, Spain
| | - Ola Ekholm
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Johan P. Mackenbach
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, Netherlands
| | - Frank J. van Lenthe
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, Netherlands
| |
Collapse
|
11
|
Kiadaliri AA, Asadi-Lari M, Kalantari N, Jafari M, Vaez Mahdavi MR, Faghihzadeh S. Absolute and relative educational inequalities in obesity among adults in Tehran: Findings from the Urban HEART study-2. Obes Res Clin Pract 2016; 10 Suppl 1:S57-S63. [DOI: 10.1016/j.orcp.2015.05.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Revised: 04/09/2015] [Accepted: 05/01/2015] [Indexed: 10/23/2022]
|
12
|
An obesogenic island in the Mediterranean: mapping potential drivers of obesity in Malta. Public Health Nutr 2015; 18:3211-23. [PMID: 25753315 DOI: 10.1017/s1368980015000476] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE The prevalence of childhood and adult obesity in Malta is among the highest in the world. Although increasingly recognised as a public health problem with substantial future economic implications for the national health and social care systems, understanding the context underlying the burden of obesity is necessary for the development of appropriate counter-strategies. DESIGN We conducted a contextual analysis to explore factors that may have potentially contributed to the establishment of an obesogenic environment in Malta. A search of the literature published between 1990 and 2013 was conducted in MEDLINE and EMBASE. Twenty-two full-text articles were retrieved. Additional publications were identified following recommendations by Maltese public health experts; a review of relevant websites; and thorough hand searching of back issues of the Malta Medical Journal since 1990. SETTING Malta. SUBJECTS Whole population, with a focus on children. RESULTS Results are organised and presented using the ANalysis Grid for Elements Linked to Obesity (ANGELO) framework. Physical, economic, policy and socio-cultural dimensions of the Maltese obesogenic environment are explored. CONCLUSIONS Malta's obesity rates may be the result of an obesogenic environment characterised by limited infrastructure for active living combined with an energy-dense food supply. Further research is required to identify and quantify the strength of interactions between these potential environmental drivers of obesity in order to enable appropriate countermeasures to be developed.
Collapse
|
13
|
Is the different time trend (1997-2008) of the obesity prevalence among adults in the three Belgian regions associated with lifestyle changes? ACTA ACUST UNITED AC 2014; 72:18. [PMID: 24949198 PMCID: PMC4063436 DOI: 10.1186/2049-3258-72-18] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2013] [Accepted: 03/12/2014] [Indexed: 01/22/2023]
Abstract
Background Obesity is a major public health issue with increasing prevalence among adults. However, in Belgium the regional time trends (1997–2008) differed: the prevalence of obesity increased in the Flemish and Brussels Regions, but remained stable in the Walloon Region, the latter still showing the highest prevalence. The purpose of the present study is to explore if the different time trends of obesity prevalence in the three Belgian regions is associated with lifestyle changes. Methods We used data from four successive cross-sectional waves (1997, 2001, 2004 and 2008) of the Belgian Health Interview Survey. The study was restricted to the adult population, resulting in samples of respectively 8,071, 9,391, 10,319 and 8,831 individuals. In line with the WHO definition, obesity was defined as having a BMI ≥ 30. Differences in regional trends of obesity were investigated through stratified analyses. The association between obesity and survey year, adjusted for lifestyle factors (alcohol consumption, smoking, fruit and vegetables consumption and leisure time physical activity), was assessed via logistic regression models. Interactions were added to the models to explore if the association between lifestyle factors and obesity varied over time. Results Obesity was associated with daily alcohol use in the Brussels (OR 0.66, 95% CI 0.50-0.88) and Walloon Regions (OR 0.8, 95% CI 0.6-0.9), with lower tendencies of being obese for daily drinkers. The probability of being obese was lower among smokers in the Flemish (OR 0.7, 95% CI 0.6-0.8) and Walloon Regions (OR 0.7, 95% CI 0.6-0.9) than among non-smokers. A lack of leisure time physical activity was associated with the probability of being obese in all regions (Brussels Region: OR 1.6, 95% CI 1.3-1.8; Flemish Region: OR 1.6, 95% CI 1.4-1.9; Walloon Region: OR 1.8, 95% CT 1.6-2.1). This association decreased significantly between 1997 and 2008 only in the Walloon Region. Conclusion The decreasing association between obesity and a lack of leisure time physical activity in the Walloon Region between 1997 and 2008 could indicate that there is an increasing awareness of risk factors for obesity in the Walloon population, which may have resulted in a more favourable evolution of the obesity epidemic.
Collapse
|
14
|
Nimmt die gesundheitliche Ungleichheit zu? Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2014; 57:431-44. [DOI: 10.1007/s00103-013-1931-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
|
15
|
Etile F. Education policies and health inequalities: evidence from changes in the distribution of Body Mass Index in France, 1981-2003. ECONOMICS AND HUMAN BIOLOGY 2014; 13:46-65. [PMID: 23433879 DOI: 10.1016/j.ehb.2013.01.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2011] [Revised: 01/23/2013] [Accepted: 01/25/2013] [Indexed: 06/01/2023]
Abstract
This paper contributes to the debate over the effectiveness of education policies in reducing overall health inequalities as compared to public health actions directed at the less-educated. Recentered Influence Function (RIF) regressions are used to decompose the contribution of education to the changing distribution of Body Mass Index (BMI) in France, between 1981 and 2003, into a composition effect (the shift in population education due to a massive educational expansion), and a structure effect (a changing educational gradient in BMI). Educational expansion has reduced overall BMI inequality by 3.4% for women and 2.3% for men. However, the structure effect on its own has produced a 10.9% increase in overall inequality for women, due to a steeper education gradient starting from the second quartile of the distribution. This structure effect on overall inequality is also large (7.6%) for men, albeit insignificant as it remains concentrated in the last decile. Educational expansion policies can thus reduce overall BMI inequalities; but attention must still be paid to the BMI gradient in education even for policies addressing overall rather than socioeconomic health inequalities.
Collapse
Affiliation(s)
- Fabrice Etile
- INRA, UR1303 ALISS, 65 Boulevard de Brandebourg, 94205 Ivry-sur-Seine, France; Paris School of Economics, 48 Boulevard Jourdan, 75014 Paris, France.
| |
Collapse
|
16
|
Cohen AK, Rai M, Rehkopf DH, Abrams B. Educational attainment and obesity: a systematic review. Obes Rev 2013; 14:989-1005. [PMID: 23889851 PMCID: PMC3902051 DOI: 10.1111/obr.12062] [Citation(s) in RCA: 243] [Impact Index Per Article: 22.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2013] [Revised: 05/14/2013] [Accepted: 05/28/2013] [Indexed: 01/17/2023]
Abstract
Although previous systematic reviews considered the relationship between socioeconomic status and obesity, almost 200 peer-reviewed articles have been published since the last review on that topic, and this paper focuses specifically on education, which has different implications. The authors systematically review the peer-reviewed literature from around the world considering the association between educational attainment and obesity. Databases from public health and medicine, education, psychology, economics, and other social sciences were searched, and articles published in English, French, Portuguese and Spanish were included. This paper includes 289 articles that report on 410 populations in 91 countries. The relationship between educational attainment and obesity was modified by both gender and the country's economic development level: an inverse association was more common in studies of higher-income countries and a positive association was more common in lower-income countries, with stronger social patterning among women. Relatively few studies reported on lower-income countries, controlled for a comprehensive set of potential confounding variables and/or attempted to assess causality through the use of quasi-experimental designs. Future research should address these gaps to understand if the relationship between educational attainment and obesity may be causal, thus supporting education policy as a tool for obesity prevention.
Collapse
Affiliation(s)
- A K Cohen
- Division of Epidemiology, University of California Berkeley School of Public Health, Berkeley, California, USA
| | | | | | | |
Collapse
|
17
|
Howel D, Stamp E, Chadwick TJ, Adamson AJ, White M. Are social inequalities widening in generalised and abdominal obesity and overweight among English adults? PLoS One 2013; 8:e79027. [PMID: 24250823 PMCID: PMC3826717 DOI: 10.1371/journal.pone.0079027] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2013] [Accepted: 09/18/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Obesity is now more common in lower socioeconomic groups in developed nations, but the socio-economic patterning of obesity has changed over time. This study examines the time trends in the socioeconomic patterning of generalised and abdominal obesity and overweight in English adults. METHODS Data were from core annual samples of the Health Survey for England 1993-2008, including 155 661 participants aged 18-75 years. The prevalence of generalised and abdominal obesity and overweight was reported as crude and age-adjusted estimates. Binomial regression was used to model measures of obesity and overweight with age, sex, survey years, and two indicators of socioeconomic position: Registrar General's Social Class (manual and non-manual occupational groups) and relative length of full time education. Trends in socioeconomic patterning were assessed by formal tests for interactions between socioeconomic position measures and survey periods in these models. RESULTS The prevalence of generalised and abdominal overweight and obesity increased consistently between 1993 and 2008. There were significant differences in the four outcomes between the two socioeconomic position (SEP) groups in men and women, except for generalised and abdominal overweight with social class in men. The prevalence of obesity and overweight across the whole period was higher in subgroups with lower SEP (differences of 0.2% to 9.5%). There was no significant widening of the socioeconomic gradient of most indicators of greater body fat since the early 1990s, except for educational gradient in generalised obesity in men and women (P = 0.001). CONCLUSIONS Substantial social class and education gradients in obesity and overweight are still present in both sexes. However, there is limited evidence that these socioeconomic inequalities have changed since 1993.
Collapse
Affiliation(s)
- Denise Howel
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Elaine Stamp
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Thomas J. Chadwick
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Ashley J. Adamson
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, United Kingdom
- Human Nutrition Research Centre, Newcastle University, Newcastle upon Tyne, United Kingdom
- Fuse, UKCRC Centre for Translational Research in Public Health, Newcastle upon Tyne, United Kingdom
| | - Martin White
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, United Kingdom
- Human Nutrition Research Centre, Newcastle University, Newcastle upon Tyne, United Kingdom
- Fuse, UKCRC Centre for Translational Research in Public Health, Newcastle upon Tyne, United Kingdom
| |
Collapse
|
18
|
Menvielle G, Rey G, Jougla E, Luce D. Diverging trends in educational inequalities in cancer mortality between men and women in the 2000s in France. BMC Public Health 2013; 13:823. [PMID: 24015917 PMCID: PMC3847008 DOI: 10.1186/1471-2458-13-823] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2013] [Accepted: 09/03/2013] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Socioeconomic inequalities in cancer mortality have been observed in different European countries and the US until the end of the 1990s, with changes over time in the magnitude of these inequalities and contrasted situations between countries. The aim of this study is to estimate relative and absolute educational differences in cancer mortality in France between 1999 and 2007, and to compare these inequalities with those reported during the 1990s. METHODS Data from a representative sample including 1% of the French population were analysed. Educational differences among people aged 30-74 were quantified with hazard ratios and relative indices of inequality (RII) computed using Cox regression models as well as mortality rate difference and population attributable fraction. RESULTS In the period 1999-2007, large relative inequalities were found among men for total cancer and smoking and/or alcohol related cancers mortality (lung, head and neck, oesophagus). Among women, educational differences were reported for total cancer, head and neck and uterus cancer mortality. No association was found between education and breast cancer mortality. Slight educational differences in colorectal cancer mortality were observed in men and women. For most frequent cancers, no change was observed in the magnitude of relative inequalities in mortality between the 1990s and the 2000s, although the RII for lung cancer increased both in men and women. Among women, a large increase in absolute inequalities in mortality was observed for all cancers combined, lung, head and neck and colorectal cancer. In contrast, among men, absolute inequalities in mortality decreased for all smoking and/or alcohol related cancers. CONCLUSION Although social inequalities in cancer mortality are still high among men, an encouraging trend is observed. Among women though, the situation regarding social inequalities is less favourable, mainly due to a health improvement limited to higher educated women. These inequalities may be expected to further increase in future years.
Collapse
Affiliation(s)
- Gwenn Menvielle
- Inserm U1018, Center for Epidemiology and Population Health, Occupational and social determinants of health, Bat 15/16 Hôpital Paul Brousse, 16 ave Paul Vaillant Couturier, Villejuif Cedex 94807, France
- University of Versailles Saint Quentin, UMRS 1018, France
| | | | | | - Danièle Luce
- Inserm U1018, Center for Epidemiology and Population Health, Occupational and social determinants of health, Bat 15/16 Hôpital Paul Brousse, 16 ave Paul Vaillant Couturier, Villejuif Cedex 94807, France
- University of Versailles Saint Quentin, UMRS 1018, France
- Inserm U1085, Irset, Pointe-à-Pitre, Guadeloupe, French West Indies
| |
Collapse
|
19
|
Regional trends in obesity and overweight among Austrian adults between 1973 and 2007. Wien Klin Wochenschr 2012; 124:363-9. [DOI: 10.1007/s00508-012-0175-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2012] [Accepted: 05/02/2012] [Indexed: 10/28/2022]
|
20
|
Hotchkiss JW, Davies CA, Gray L, Bromley C, Capewell S, Leyland A. Trends in cardiovascular disease biomarkers and their socioeconomic patterning among adults in the Scottish population 1995 to 2009: cross-sectional surveys. BMJ Open 2012; 2:e000771. [PMID: 22619264 PMCID: PMC3364451 DOI: 10.1136/bmjopen-2011-000771] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2011] [Accepted: 04/05/2012] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES To examine secular and socioeconomic changes in biological cardiovascular disease risk factor and biomarker prevalences in the Scottish population. This could contribute to an understanding of why the decline in coronary heart disease mortality in Scotland has recently stalled along with persistence of associated socioeconomic inequalities. DESIGN Cross-sectional surveys. SETTING Scotland. PARTICIPANTS Scottish Health Surveys: 1995, 1998, 2003, 2008 and 2009 (6190, 6656, 5497, 4202 and 4964 respondents, respectively, aged 25-64 years). PRIMARY OUTCOME MEASURES Gender-stratified, age-standardised prevalences of obesity, hypertension, hypercholesterolaemia and low high-density lipoprotein cholesterol blood concentration as well as elevated fibrinogen and C reactive protein concentrations according to education and social class groupings. Inequalities were assessed using the slope index of inequality, and time trends were assessed using linear regression. RESULTS The prevalence of obesity, including central obesity, increased between 1995 and 2009 among men and women, irrespective of socioeconomic position. In 2009, the prevalence of obesity (defined by body mass index) was 29.8% (95% CI 27.9% to 31.7%) for men and 28.2% (26.3% to 30.2%) for women. The proportion of individuals with hypertension remained relatively unchanged between 1995 and 2008/2009, while the prevalence of hypercholesterolaemia declined in men from 79.6% (78.1% to 81.1%) to 63.8% (59.9% to 67.8%) and in women from 74.1% (72.6% to 75.7%) to 66.3% (62.6% to 70.0%). Socioeconomic inequalities persisted over time among men and women for most of the biomarkers and were particularly striking for the anthropometric measures when stratified by education. CONCLUSIONS If there are to be further declines in coronary heart disease mortality and reduction in associated inequalities, then there needs to be a favourable step change in the prevalence of cardiovascular disease risk factors. This may require radical population-wide interventions.
Collapse
Affiliation(s)
| | - Carolyn Anne Davies
- Measuring Health, MRC/CSO Social and Public Health Sciences Unit, Glasgow, UK
| | - Linsay Gray
- Measuring Health, MRC/CSO Social and Public Health Sciences Unit, Glasgow, UK
| | | | - Simon Capewell
- Division of Public Health, University of Liverpool, Liverpool, UK
| | - Alastair Leyland
- Measuring Health, MRC/CSO Social and Public Health Sciences Unit, Glasgow, UK
| |
Collapse
|
21
|
Großschädl F, Stronegger WJ. Long-term trends in obesity among Austrian adults and its relation with the social gradient: 1973–2007. Eur J Public Health 2012; 23:306-12. [PMID: 22539632 DOI: 10.1093/eurpub/cks033] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Affiliation(s)
- Franziska Großschädl
- Institute of Social Medicine and Epidemiology, Universitätsstraße 6/I, 8010 Graz, Austria
| | | |
Collapse
|
22
|
Food preferences and aversions in human health and nutrition: how can pigs help the biomedical research? Animal 2012; 6:118-36. [DOI: 10.1017/s1751731111001315] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
|
23
|
Socio-economic inequalities in overweight among adults in Turkey: a regional evaluation. Public Health Nutr 2011; 15:58-66. [DOI: 10.1017/s1368980011001972] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractObjectivePatterns of socio-economic inequalities in obesity and overweight have not been documented for Turkey. The present study aimed to describe educational and wealth-related inequalities for overweight in Turkey, taking a regional perspective.DesignCross-sectional self-reported data of the World Health Survey 2002 for Turkey were used. BMI ≥ 25·00 kg/m2 was considered as overweight. Respondents were classified according to education years and a wealth score derived from the availability of household assets. Logistic regression analysis was applied to assess the relationship between overweight and socio-economic factors. Analyses were stratified by sex and region (West, Mediterranean, Middle, Black Sea and East).SettingTurkey.SubjectsAmong the respondents 20 years and older, 3790 women and 4057 men had data on self-reported height and weight.ResultsAge-adjusted overweight prevalence was 48·4 % for women and 46·1 % for men. For men, education was not systematically related to overweight while overweight was significantly increased among the highest wealth groups. For women, the prevalence of overweight was highest for low-educated and middle-wealth groups. The size of the inequalities in overweight showed only small regional variations. In the East, however, overweight prevalence was more related to higher socio-economic position than in the other regions.ConclusionsSocio-economic inequalities for overweight in Turkey are at a similar level as in most European countries, and especially comparable to Southern Europe. The smaller inequalities in the East correspond to the low level of socio-economic development in this part of the country. Prevention of overweight should focus on lower educational groups throughout the entire country and especially on low-educated women.
Collapse
|
24
|
Faeh D, Braun J, Bopp M. Prevalence of obesity in Switzerland 1992-2007: the impact of education, income and occupational class. Obes Rev 2011; 12:151-66. [PMID: 20673278 DOI: 10.1111/j.1467-789x.2010.00793.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Prevalence of excess weight varies substantially by socioeconomic position (SEP). SEP can be defined with different indicators. The strength of the association of SEP with excess weight differs by SEP indicator, between populations and over time. We examined the prevalence of overweight and obesity (body mass index 25-29.9 and ≥30 kg m(-2) ) in Switzerland by educational level, household income tertile and occupational class (three categories for each indicator). Self-reported data stem from four cross-sectional population surveys including 53 588 persons aged between 25 and 74 years. The overall prevalence of overweight increased between 1992 and 2007 from 37.4% to 41.4% in men and from 18.8% to 21.9% in women. Obesity prevalence increased from 7.2% to 9.7% in men and from 5.4% to 8.6% in women. Inequalities were calculated with multivariable logistic regression. Inequalities were larger in women than in men and for obesity than for overweight. However, overweight and obesity inequalities did not significantly change over time, despite overall increasing prevalence. Although all SEP indicators were independently associated with excess weight, the association was strongest with education, particularly in women. Programmes and policies aimed at preventing excess weight should target individuals with low education early in life.
Collapse
Affiliation(s)
- D Faeh
- Institute of Social and Preventive Medicine (ISPM), University of Zurich, Zurich, Switzerland
| | | | | |
Collapse
|
25
|
Singh-Manoux A, Gourmelen J, Ferrie J, Silventoinen K, Guéguen A, Stringhini S, Nabi H, Kivimaki M. Trends in the association between height and socioeconomic indicators in France, 1970-2003. ECONOMICS AND HUMAN BIOLOGY 2010; 8:396-404. [PMID: 20400383 PMCID: PMC2914812 DOI: 10.1016/j.ehb.2010.03.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2009] [Revised: 03/23/2010] [Accepted: 03/23/2010] [Indexed: 05/29/2023]
Abstract
Average physical stature has increased dramatically during the 20th century in many populations across the world with few exceptions. It remains unclear if social inequalities in height persist despite improvements in living standards in the welfare economies of Western Europe. We examined trends in the association between height and socioeconomic indicators in adults over three decades in France. The data were drawn from the French Decennial Health Surveys: a multistage, stratified, random survey of households, representative of the population, conducted in 1970, 1980, 1991, and 2003. We categorised age into 10-year bands, 25-34, 35-44, 45-54 and 55-64 years. Education and income were the two socioeconomic measures used. The slope index of inequality (SII) was used as a summary index of absolute social inequalities in height. The results show that average height increased over this period; men and women aged 25-34 years were 171.9 and 161.2 cm tall in 1970 and 177.0 and 164.0 cm in 2003, respectively. However, education-related inequalities in height remained unchanged over this period and in men were 4.48 cm (1970), 4.71 cm (1980), 5.58 cm (1991) and 4.69 cm (2003), the corresponding figures in women were 2.41, 2.37, 3.14 and 2.96 cm. Income-related inequalities in height were smaller and much attenuated after adjustment for education. These results suggest that in France, social inequalities in adult height in absolute terms have remained unchanged across the three decades under examination.
Collapse
Affiliation(s)
- Archana Singh-Manoux
- INSERM, U1018, Centre for Research in Epidemiology and Population Health, Hôpital Paul Brousse, Bât 15/16, 16 Avenue Paul Vaillant Couturier, 94807 Villejuif Cedex, France.
| | | | | | | | | | | | | | | |
Collapse
|
26
|
Yu ZB, Han SP, Guo XR. A response to the comments by Dr Chaput on our paper 'Intelligence in relation to obesity: a systematic review and meta-analysis'. Obes Rev 2010; 11:686-7. [PMID: 20663067 DOI: 10.1111/j.1467-789x.2010.00792.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
27
|
Kreier F. To be, or not to be obese – That’s the challenge: A hypothesis on the cortical inhibition of the hypothalamus and its therapeutical consequences. Med Hypotheses 2010; 75:214-7. [DOI: 10.1016/j.mehy.2010.02.024] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2010] [Accepted: 02/21/2010] [Indexed: 11/28/2022]
|
28
|
Dugravot A, Sabia S, Stringhini S, Kivimaki M, Westerlund H, Vahtera J, Guéguen A, Zins M, Goldberg M, Nabi H, Singh-Manoux A. Do socioeconomic factors shape weight and obesity trajectories over the transition from midlife to old age? Results from the French GAZEL cohort study. Am J Clin Nutr 2010; 92:16-23. [PMID: 20484455 PMCID: PMC2884319 DOI: 10.3945/ajcn.2010.29223] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Obesity is a contemporary epidemic that does not affect all age groups and sections of society equally. OBJECTIVE The objective was to examine socioeconomic differences in trajectories of body mass index (BMI; in kg/m(2)) and obesity between the ages of 45 and 65 y. DESIGN A total of 13,297 men and 4532 women from the French GAZEL (Gaz de France Electricité de France) cohort study reported their height in 1990 and their weight annually over the subsequent 18 y. Changes in BMI and obesity between ages 45 and 49 y, 50 and 54 y, 55 and 59 y, and 60 and 65 y as a function of education and occupational position (at age 35 y) were modeled by using linear mixed models and generalized estimating equations. RESULTS BMI and obesity rates increased between the ages of 45 and 65 y. In men, BMI was higher in unskilled workers than in managers at age 45 y; this difference in BMI increased from 0.82 (95% CI: 0.66, 0.99) at 45 y to 1.06 (95% CI: 0.85, 1.27) at 65 y. Men with a primary school education compared with those with a high school degree at age 45 y had a 0.75 (95% CI: 0.51, 1.00) higher BMI, and this difference increased to 1.32 (95% CI: 1.03,1.62) at age 65 y. Obesity rates were 3.35% and 7.68% at age 45 y and 9.52% and 18.10% at age 65 y in managers and unskilled workers, respectively; the difference in obesity increased by 4.25% (95% CI: 1.87, 6.52). A similar trend was observed in women. CONCLUSIONS Weight continues to increase in the transition between midlife and old age; this increase is greater in lower socioeconomic groups.
Collapse
Affiliation(s)
- Aline Dugravot
- INSERM U1018 Centre for Research in Epidemiology and Population Health, Villejuif, France.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
29
|
Menvielle G, Leclerc A, Chastang JF, Luce D. Socioeconomic inequalities in cause specific mortality among older people in France. BMC Public Health 2010; 10:260. [PMID: 20482836 PMCID: PMC2881100 DOI: 10.1186/1471-2458-10-260] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2009] [Accepted: 05/19/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND European comparative studies documented a clear North-South divide in socioeconomic inequalities with cancer being the most important contributor to inequalities in total mortality among middle aged men in Latin Europe (France, Spain, Portugal, Italy). The aim of this paper is to investigate educational inequalities in mortality by gender, age and causes of death in France, with a special emphasis on people aged 75 years and more. METHODS We used data from a longitudinal population sample that includes 1% of the French population. Risk of death (total and cause specific) in the period 1990-1999 according to education was analysed using Cox regression models by age group (45-59, 60-74, and 75+). Inequalities were quantified using both relative (ratio) and absolute (difference) measures. RESULTS Relative inequalities decreased with age but were still observed in the oldest age group. Absolute inequalities increased with age. This increase was particularly pronounced for cardiovascular diseases. The contribution of different causes of death to absolute inequalities in total mortality differed between age groups. In particular, the contribution of cancer deaths decreased substantially between the age groups 60-74 years and 75 years and more, both in men and in women. CONCLUSIONS This study suggests that the large contribution of cancer deaths to the excess mortality among low educated people that was observed among middle aged men in Latin Europe is not observed among French people aged 75 years and more. This should be confirmed among other Latin Europe countries.
Collapse
Affiliation(s)
- Gwenn Menvielle
- Inserm U1018, Epidemiology of occupational and social determinants of health, Center for Research in Epidemiology and Population Health, Inserm, Villejuif, France.
| | | | | | | |
Collapse
|