Dataset Information

Socioeconomic inequality in morbid obesity with body mass index more than 40 kg/m2 in the United States and England.

ABSTRACT: This study evaluated socioeconomic inequality in morbid obesity (body mass index, BMI ?40 kg/m2) through an analysis of population health survey data in the United States (US) and England (UK).We analysed data for the National Health and Nutrition Examination Survey and the Health Survey for England for 2011 to 2014. Age-adjusted odds ratios (AOR) were used to evaluate income- and education-inequality.There were 26,898 eligible UK and 10,628 US participants. Morbid obesity was more frequent in women than men, and higher in the US than the UK (men: US, 4.8%; UK, 1.7%; women US, 9.6%; UK, 3.7%). In the UK, morbid obesity showed graded income-inequality in both genders (AOR, for lowest income quintile: men, 1.83, 95% confidence interval 1.16 to 2.88; women, 2.18, 1.55 to 3.07), as well as education-inequality (AOR for no school qualifications, men 2.57, 1.64 to 4.02; women, 2.18, 1.55 to 3.07). In the US, morbid obesity showed a consistent gradient only for income in women (AOR for lowest income quintile 1.97, 1.19 to 3.25). When compared with all other US groups, having college education (AOR, men, 0.56, 0.29 to 1.08; women, 0.36, 0.22 to 0.60) or household income ?$75 000 (AOR, men 0.52, 0.27 to 0.98; women, 0.51, 0.33 to 0.80) appeared to protect against morbid obesity.Morbid obesity is associated with lower socioeconomic status in men and women in the UK. In the US, morbid obesity was twice as prevalent, but less strongly associated with socioeconomic status, suggesting that morbid obesity may now have spread to all but the highest socioeconomic groups.

SUBMITTER: Booth HP

PROVIDER: S-EPMC5769007 | biostudies-other | 2017 Dec

REPOSITORIES: biostudies-other

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Socioeconomic inequality in morbid obesity with body mass index more than 40 kg/m<sup>2</sup> in the United States and England.

Booth Helen P HP Charlton Judith J Gulliford Martin C MC

SSM - population health 20161228

<h4>Introduction</h4>This study evaluated socioeconomic inequality in morbid obesity (body mass index, BMI ≥40 kg/m<sup>2</sup>) through an analysis of population health survey data in the United States (US) and England (UK).<h4>Methods</h4>We analysed data for the National Health and Nutrition Examination Survey and the Health Survey for England for 2011 to 2014. Age-adjusted odds ratios (AOR) were used to evaluate income- and education-inequality.<h4>Results</h4>There were 26,898 eligible UK a ...[more]

PMID: 29349213

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Project description:BackgroundLow socioeconomic position is consistently associated with increased risk of premature death. The aim of this study is to measure the aggregate scale of inequality in premature mortality for the whole population of England.MethodsWe used mortality records from the UK Office for National Statistics to study all 2 465 285 premature deaths (defined as those before age 75 years) in England between Jan 1, 2003, and Dec 31, 2018. Socioeconomic position was defined using deciles of the Index of Multiple Deprivation: a measure of neighbourhood income, employment, education levels, crime, health, availability of services, and local environment. We calculated the number of expected deaths by applying mortality in the least deprived decile to other deciles, within the strata of age, sex, and time. The mortality attributable to socioeconomic inequality was defined as the difference between the observed and expected deaths. We also used life table modelling to estimate years-of-life lost attributable to socioeconomic inequality.Findings35·6% (95% CI 35·3-35·9) of premature deaths were attributable to socioeconomic inequality, equating to 877 082 deaths, or one every 10 min. The biggest contributors were ischaemic heart disease (152 171 excess deaths), respiratory cancers (111 083) and chronic obstructive pulmonary disease (83 593). The most unequal causes of death were tuberculosis, opioid use, HIV, psychoactive drugs use, viral hepatitis, and obesity, each with more than two-thirds attributable to inequality. Inequality was greater among men and peaked in early childhood and at age 40-49 years. The proportion of deaths attributable to inequality increased during the study period, particularly for women, because mortality rates among the most deprived women (excluding cardiovascular diseases) plateaued, and for some diseases increased. A mean of 14·4 months of life before age 75 years are lost due to socioeconomic inequality.InterpretationOne in three premature deaths are attributable to socioeconomic inequality, making this our most important public health challenge. Interventions that address upstream determinants of health should be prioritised.FundingNational Institute of Health Research; Wellcome Trust.

Dataset Information

Socioeconomic inequality in morbid obesity with body mass index more than 40 kg/m2 in the United States and England.

Publications

Socioeconomic inequality in morbid obesity with body mass index more than 40 kg/m<sup>2</sup> in the United States and England.

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