Dataset Information

Do burdens of underweight and overweight coexist among lower socioeconomic groups in India?

ABSTRACT:

Background

The coexistence of underweight and overweight in rapidly developing economies is well recognized. However, less is known about the socioeconomic patterning of underweight and overweight as economies move through the epidemiologic transition.

Objective

The objective was to assess whether burdens of underweight and overweight coexist among lower socioeconomic groups in India.

Design

Repeated cross-sectional analyses were conducted in nationally representative samples of 76,514 and 80,054 women aged 15-49 y drawn from the 1998-1999 and 2005-2006 Indian National Family Health Survey, respectively. Body mass index (in kg/m(2)) was used to measure weight status. We also calculated a ratio of the number of underweight women (<18.5) divided by the number of overweight women (>24.9). Indicators of socioeconomic status (SES) included wealth and education.

Results

Although the ratio of underweight to overweight women decreased from 3.3 in 1998-1999 to 2.2 in 2005-2006, there were still considerably more underweight women than overweight women. It was only in the top wealth quintile and in groups with higher education that there was a slight excess of overweight women as compared with underweight women. There was a strong positive relation between SES and body mass index at both time points and across urban and rural areas. A positive relation between SES and body mass index was also observed for men in 2005-2006.

Conclusions

The distribution of underweight and overweight in India remains socially segregated. Despite rapid economic growth, India has yet to experience a situation in which underweight and overweight coexist in the low-SES groups.

SUBMITTER: Subramanian SV

PROVIDER: S-EPMC2709313 | biostudies-literature | 2009 Aug

REPOSITORIES: biostudies-literature

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Publications

Do burdens of underweight and overweight coexist among lower socioeconomic groups in India?

Subramanian S V SV Perkins Jessica M JM Khan Kashif T KT

The American journal of clinical nutrition 20090610 2

<h4>Background</h4>The coexistence of underweight and overweight in rapidly developing economies is well recognized. However, less is known about the socioeconomic patterning of underweight and overweight as economies move through the epidemiologic transition.<h4>Objective</h4>The objective was to assess whether burdens of underweight and overweight coexist among lower socioeconomic groups in India.<h4>Design</h4>Repeated cross-sectional analyses were conducted in nationally representative sampl ...[more]

PMID: 19515733

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Project description:ObjectiveTo analyze socioeconomic inequalities in the prevalence of underweight and overweight or obesity in women from low and middle-income countries (LMICs).MethodsUsing the last available Demographic Health Survey between 2010 and 2016 from 49 LMICs, we estimated the prevalence of underweight (BMI < 18.5 kg/m2) and overweight or obesity combined (BMI ≥ 25 kg/m2) for women aged 20-49 years. We used linear regression to explore the associations between the two outcomes and gross national income (GNI). We assess within-country socioeconomic inequalities using wealth deciles. The slope index of inequality (SII) and the inequality pattern index (IPI) were calculated for each outcome. Negative values of the latter express bottom inequality (when inequality is driven by the poorest deciles) while positive values express top inequality (driven by the richest deciles).ResultsIn total, 931,145 women were studied. The median prevalence of underweight, overweight or obesity combined, and obesity were 7.3% (range 0.2-20.5%), 31.5% (8.8-85.3%), and 10.2% (1.9-48.8%), respectively. Pearson correlation coefficients with log GNI were -0.33 (p = 0.006) for underweight, 0.72 (p < 0.001) for overweight or obesity, and 0.66 (p < 0.001) for obesity. For underweight, the SII was significantly negative in 38 of the 49 countries indicating a higher burden among poor women. There was no evidence of top or bottom inequality. Overweight or obesity increased significantly with wealth in 44 of the 49 countries. Top inequality was observed in low-prevalence countries, and bottom inequality in high-prevalence countries.ConclusionUnderweight remains a problem among the poorest women in poor countries, but overweight and obesity are the prevailing problem as national income increases. In low-prevalence countries, overweight or obesity levels are driven by the higher prevalence among the richest women; as national prevalence increases, only the poorest women are relatively preserved from the epidemic.

Project description:BackgroundTribal peoples are among the most marginalised groups worldwide. Evidence on birth outcomes in these groups is scant. We describe inequalities in Stillbirth Rate (SBR), Neonatal Mortality Rate (NMR), and uptake of maternal and newborn health services between tribal and less disadvantaged groups in eastern India, and examine the contribution of poverty and education to these inequalities.MethodsWe used data from a demographic surveillance system covering a 1 million population in Jharkhand State (March 2017 - August 2019) to describe SBR, NMR, and service uptake. We used logistic regression analysis combined with Stata's adjrr-command to estimate absolute and relative inequalities by caste/tribe (comparing Particularly Vulnerable Tribal Groups (PVTG) and other Scheduled Tribes (ST) with the less marginalised Other Backward Class (OBC)/none, using the Indian government classification), and by maternal education and household wealth.ResultsPVTGs had a higher NMR (59/1000) than OBC/none (31/1000) (rate ratio (RR): 1.92, 95%CI: 1.55-2.38). This was partly explained by wealth and education, but inequalities remained large after adjustment (adjusted RR: 1.59, 95%CI: 1.28-1.98). NMR was also higher among other STs (44/1000), but disparities were smaller (RR: 1.47, 95%CI: 1.23-1.75). There was a systematic gradient in NMR by maternal education and household wealth. SBRs were only higher in poorer groups (RRpoorest vs. least poor:1.56, 95%CI: 1.14-2.13). Uptake of facility-based services was low among PVTGs (e.g. institutional birth: 25% vs. 69% in OBC/none) and among poorer and less educated women. However, 65% of PVTG women with an institutional birth used a maternity vehicle vs. 34% among OBC/none. Visits from frontline workers (Accredited Social Health Activists [ASHAs]) were similar across groups, and ASHA accompaniment of institutional births was similar across caste/tribe groups, and higher among poorer and less educated women. Attendance in participatory women's groups was similar across caste/tribe groups, and somewhat higher among richer and better educated women.ConclusionsPVTGs are highly disadvantaged in terms of birth outcomes. Targeted interventions that reduce geographical barriers to facility-based care and address root causes of high poverty and low education in PVTGs are a priority. For population-level impact, they are to be combined with broader policies to reduce socio-economic mortality inequalities. Community-based interventions reach disadvantaged groups and have potential to reduce the mortality gap.

Dataset Information

Do burdens of underweight and overweight coexist among lower socioeconomic groups in India?

Background

Objective

Design

Results

Conclusions

Publications

Do burdens of underweight and overweight coexist among lower socioeconomic groups in India?

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