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Socioeconomic inequalities in obesity: modelling future trends in Australia.

ABSTRACT: OBJECTIVES:To develop a model to predict future socioeconomic inequalities in body mass index (BMI) and obesity. DESIGN:Microsimulation modelling using BMI data from adult participants of Australian Health Surveys, and published data on the relative risk of mortality in relation to BMI and socioeconomic position (SEP), based on education. SETTING:Australia. PARTICIPANTS:74?329 adults, aged 20 and over from Australian Health Surveys, 1995-2015. PRIMARY AND SECONDARY OUTCOME MEASURES:The primary outcomes were BMI trajectories and obesity prevalence by SEP for four birth cohorts, born 10 years apart, centred on 1940, 1950, 1960 and 1970. RESULTS:Simulations projected persistent or widening socioeconomic inequality in BMI and obesity over the adult life course, for all birth cohorts. Recent birth cohorts were predicted to have greater socioeconomic inequality by middle age, compared with earlier cohorts. For example, among men, there was no inequality in obesity prevalence at age 60 for the 1940 birth cohort (low SEP 25% (95% CI 17% to 34%); high SEP 26% (95% CI 19% to 34%)), yet for the 1970 birth cohort, obesity prevalence was projected to be 51% (95% CI 43% to 58%) and 41% (95% CI 36% to 46%) for the low and high SEP groups, respectively. Notably, for more recent birth cohorts, the model predicted the greatest socioeconomic inequality in severe obesity (BMI >35?kg/m2) at age 60. CONCLUSIONS:Lower SEP groups and more recent birth cohorts are at higher risk of obesity and severe obesity, and its consequences in middle age. Prevention efforts should focus on these vulnerable population groups in order to avoid future disparities in health outcomes. The model provides a framework for further research to investigate which interventions will be most effective in narrowing the gap in socioeconomic disparities in obesity in adulthood.

SUBMITTER: Hayes A

PROVIDER: S-EPMC6475338 | biostudies-literature | 2019 Mar

REPOSITORIES: biostudies-literature

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Socioeconomic inequalities in obesity: modelling future trends in Australia.

Hayes Alison A Tan Eng Joo EJ Killedar Anagha A Lung Thomas T

BMJ open 20190330 3

<h4>Objectives</h4>To develop a model to predict future socioeconomic inequalities in body mass index (BMI) and obesity.<h4>Design</h4>Microsimulation modelling using BMI data from adult participants of Australian Health Surveys, and published data on the relative risk of mortality in relation to BMI and socioeconomic position (SEP), based on education.<h4>Setting</h4>Australia.<h4>Participants</h4>74 329 adults, aged 20 and over from Australian Health Surveys, 1995-2015.<h4>Primary and secondar ...[more]

PMID: 30928953

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Project description:BackgroundSmoking inequalities in Turkey were previously demonstrated in an early stage of the smoking epidemic model. This paper aimed to assess the trends for socioeconomic inequalities in smoking in Turkey over the years in the context of the smoking epidemic model using data from the Global Adult Tobacco Survey (GATS) Turkey 2008-2012-2016.MethodsCross-sectional data were analyzed to calculate the association of smoking with, wealth, education, occupation and place of residence using age-standardized prevalence rates, odds ratios, relative index of inequality (RII) and slope index of inequality (SII). The analysis was performed separately for age groups (younger: 20-39 years/older: 40 and above years) and sex.ResultsYounger women with higher wealth and older women with higher wealth and education smoked more. For both age groups, smoking was increased for working class and urban women. Relative wealth inequalities in smoking narrowed and then showed a reversal for younger women (RII2008 = 3.37; 95% CI:1.64-3.40; RII2012 = 2.19; 95% CI:1.48-3.24; RII2016 = 0.80; 95% CI:0.58-1.10, p-for trend < 0.0001). Relative educational inequalities in smoking for older women also showed a narrowing (RII2008 = 21.45; 95% CI:11.74-39.19; RII2012 = 15.25; 95% CI:9.10-25.55; and RII2016 = 5.48; 95% CI:3.86-7.78, p-for trend < 0.0001). For older women, a similar narrowing was observed for wealth (RII2008 = 3.94; 95% CI:2.38-6.53; RII2012 = 2.79; 95% CI:1.80-4.32; and RII2016 = 1.34; 95% CI:0.94-1.91, p-for trend = 0.0001). The only significant trend for absolute inequalities was for younger women by wealth. This trend showed a narrowing and then a reversal (SII2008 = 0.14; 95% CI:0.09-1.20; SII2012 = 0.12; 95% CI:0.06-0.18; and SII2016 = -0.05; 95% CI:-0.12-0.02, p-for trend = 0.0001). Unlike women, smoking in men showed inverse associations for wealth and education, although not statistically confirmed for all years. Smoking was increased in working classes and unemployed men in 2012 and 2016. Inequalities did not show a trend in relative and absolute terms for men.ConclusionsFor smoking inequalities in Turkey, a transition to the next stage was observed, although the previously defined Southern European pattern also existed. Low socioeconomic women deserve special attention as well as stressors at work and drivers of smoking at urban settings.

Project description:BackgroundSocioeconomic disparities in life expectancy are well-documented in various contexts, including Chile. However, there is a lack of research examining trends in life expectancy inequalities and lifespan variation over time. Addressing these gaps can provide crucial insights into the dynamics of health inequalities.MethodsThis study utilizes data from census records, population surveys, and death certificates to compare the life expectancy and the lifespan variation at age 26 of individuals according to their rank in the distribution of years of education within their own birth cohort. The analysis spans three periods (1991, 2002, and 2017) and focuses on two educational groups: individuals in the first (lowest) quintile and tenth (highest) decile of educational attainment. Changes in life expectancy are disaggregated by major causes of death to elucidate their contributions to overall trends.ResultsConsistent with existing literature, our findings confirm that individuals with lower education levels experience lower life expectancy and higher lifespan variation compared to their more educated counterparts. Notably, by 2017, life expectancy for individuals in the lowest quintile of education has caught up with that of the top decile in 1991, albeit with contrasting trends between genders. Among women, the gap has reduced, while it has increased for males. Moreover, lifespan variation decreased (increased) over time for individuals in the tenth decile (first quintile). The leading causes of death that explain the increase in life expectancy in women and men in the tenth decile as well as women in the first quintile are cardiovascular, cancer, respiratory and digestive diseases. In the case of males in the first quintile, few gains have been made in life expectancy resulting from cancer and a negative contribution is associated with digestive conditions.ConclusionsThis study underscores persistent socioeconomic disparities in life expectancy in Chile, emphasizing the importance of ongoing monitoring of health inequalities across different demographic segments. The gender-specific and educational gradient trends highlight areas for targeted interventions aimed at reducing health disparities and improving overall population health outcomes. Further research is warranted to delve into specific causes of death driving life expectancy differentials and to inform evidence-based policy interventions.

Project description:IntroductionThe socio-economic circumstances and health of people with disabilities has been relatively ignored in public health research, policy and practice in Australia and internationally. This is despite emerging evidence that the socio-economic circumstances that people with disabilities live in contributes to their poorer health. Compared to other developed countries, Australians with disabilities are more likely to live in disadvantaged circumstances, despite being an economically prosperous country; it is therefore likely that the socio-economic disadvantage experienced by Australians with disabilities makes a significant contribution to their health. Despite the importance of this issue Australia does not routinely monitor the socio-economic inequalities for people with disabilities. This paper addresses this gap by describing time trends in socio-economic conditions for Australians with and without disabilities according to the severity of the disability and sex.MethodsCross-sectional analyses of the Australian Bureau of Statistics Survey of Disability, Ageing and Carers were carried out at three time points (1998, 2003 and 2009) to estimate the proportions of women and men (aged between 25 and 64 years) who were living on low incomes, had not completed year 12, were not in paid work, living in private rental and experiencing multiple disadvantage (three or more of the indicators).ResultsPeople with disabilities are less likely to have completed year 12, be in paid work and are more likely to be living on low incomes and experiencing multiple disadvantage. These conditions worsened with increasing severity of disability and increased or persisted over time, with most of the increase between 1998 and 2003. While women with milder disabilities tended to fare worse than men, the proportions were similar for those with moderate and severe/profound disabilities.ConclusionPeople with disabilities experience high levels of socio-economic disadvantage which has increased or persisted over time and these are likely to translate into poorer health outcomes. A large proportion experience multiple forms of disadvantage, reinforcing the need to tackle disadvantage in a coordinated way across sectors.People with disabilities should be a priority population group for public health. Monitoring socio-economic conditions of people with disabilities is critical for informing policy and assessing the impact of disability reforms.

Project description:ObjectiveTo explore trends in prevalence and socioeconomic inequalities in underweight and obesity in 5-year-old schoolchildren in Scotland between 2011/2012 and 2017/2018.DesignA population-based, repeated cross-sectional study.SettingLocal authority primary schools in Scotland.Participants373 189 5-year-old schoolchildren in Scotland between 2011/2012 and 2017/2018.MethodologyTrends in prevalence and inequalities in underweight and obesity were examined across seven school years (2011/2012-2017/2018) for 373 189 5-year-old schoolchildren in Scotland. Body mass index SD scores were calculated, and epidemiological cut-offs relative to the UK 1990 references categorised underweight and obesity. Slope/relative indices of inequality (SII/RII) were calculated for underweight and obesity by school year using the area-based Scottish Index of Multiple Deprivation.ResultsThe prevalence of obesity rose slightly overall during the study period (9.8% in 2011/2012; 10.1% in 2017/2018). However, this masked a widening of inequalities, with children from the most deprived areas experiencing a greater risk of obesity in 2017/2018 than in 2011/2012 (risk ratio=1.14, 95% CI 1.04 to 1.25) compared with an unchanged risk in children from the least deprived areas (risk ratio=0.95, 95% CI 0.82 to 1.11). SII and RII indicate widening inequalities for obesity, with RII rising from 1.95 (95% CI 1.71 to 2.22) in 2011/2012 to 2.22 (95% CI 1.93 to 2.56) in 2017/2018. The prevalence of underweight was consistently low (compared with the UK 1990 references) and remained unchanged over the study period (1.2% in 2011/2012; 1.1% in 2017/2018), with no consistent evidence of social patterning over time.ConclusionsInequalities in obesity in schoolchildren in Scotland are large and have widened from 2011, despite only a slight rise in overall prevalence. In contrast there has been little change in underweight prevalence or inequalities during the study period. Extra resources for policy implementation and measures which do not widen inequalities and focus on reaching the most deprived children are required to tackle the high prevalence and growing inequalities in childhood obesity in Scotland.

Project description:BackgroundIndia experienced a rapid economic boom between 1991 and 2007. However, this economic growth has not translated into improved nutritional status among young Indian children. Additionally, no study has assessed the trends in social disparities in childhood undernutrition in the Indian context. We examined the trends in social disparities in underweight and stunting among Indian children aged less than three years using nationally representative data.MethodsWe analyzed data from the three cross-sectional rounds of National Family Health Survey of India from 1992, 1998 and 2005. The social factors of interest were: household wealth, maternal education, caste, and urban residence. Using multilevel modeling to account for the nested structure and clustering of data, we fit multivariable logistic regression models to quantify the association between the social factors and the binary outcome variables. The final models additionally included age, gender, birth order of child, religion, and age of mother. We analyzed the trend by testing for interaction of the social factor and survey year in a dataset pooled from all three surveys.ResultsWhile the overall prevalence rates of undernutrition among Indian children less than three decreased over the 1992-2005 period, social disparities in undernutrition over these 14 years either widened or stayed the same. The absolute rates of undernutrition decreased for everyone regardless of their social status. The disparities by household wealth were greater than the disparities by maternal education. There were no disparities in undernutrition by caste, gender or rural residence.ConclusionsThere was a steady decrease in the rates of stunting in the 1992-2005 period, while the decline in underweight was greater between 1992 and 1998 than between 1998 and 2005. Social disparities in childhood undernutrition in India either widened or stayed the same during a time of major economic growth. While the advantages of economic growth might be reaching everyone, children from better-off households, with better educated mothers appear to have benefited to a greater extent than less privileged children. The high rates of undernutrition (even among the socially advantaged groups) and the persistent social disparities need to be addressed in an urgent and comprehensive manner.

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Socioeconomic inequalities in obesity: modelling future trends in Australia.

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Socioeconomic inequalities in obesity: modelling future trends in Australia.

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