Socioeconomic inequalities and body mass index in Västerbotten County, Sweden: a longitudinal study of life course influences over two decades

International Journal for Equity in Health

Margareta Norberg¹  Mojgan Padyab² 

[1] Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden;Centre for Population Studies, Ageing and Living Conditions Programme, Umeå University, Umeå, Sweden

关键词: Northern Sweden;    Longitudinal study;    Body mass index;    Life course;    Socioeconomic inequality;   

Others  :  802480
DOI  :  10.1186/1475-9276-13-35

 received in 2014-01-24, accepted in 2014-04-18,  发布年份 2014

【 摘 要 】

Introduction

Life course socioeconomic inequalities in heart disease, stroke and all-cause mortality are well studied in Sweden. However, few studies have sought to explain the mechanism for such associations mainly due to lack of longitudinal data with multiple measures of socioeconomic status (SES) across the life course. Given the population health concern about how socioeconomic inequality is related to poorer health, we aim to tackle obesity as one of the prime suspects that could explain the association between SES inequality and cardiovascular disease and consequently premature death. The aim of this study is to test which life course model best describes the association between socioeconomic disadvantage and obesity among 60 year old inhabitants of Västerbotten County in Northern Sweden.

Methods

A birth cohort consisting of 3340 individuals born between 1930 and 1932 was studied. Body mass index (BMI) at the age of 60 and information on socioeconomic status at three stages of life (ages 40, 50, and 60 years) was collected. Independent samples t-test was used to compare BMI between advantaged and disadvantaged groups and one-way ANOVA was used to compare BMI among eight SES trajectories. We applied a structured modeling approach to examine three different hypothesized life course SES models (accumulation, critical period, and social mobility) in relation to BMI.

Results

We found sex differences in the way that late adulthood socioeconomic disadvantage is associated with BMI among inhabitants of Northern Sweden. Our study suggests that social adversity in all stages of late adulthood is a particularly important indicator for addressing the social gradients in BMI among women in Northern Sweden and that unhealthy behaviors in terms of smoking and physical inactivity are insufficient to explain the relationships between social and lifestyle inequalities and BMI.

Conclusion

In order for local authorities to develop informed preventive efforts, we suggest further research to identify modifiable risk factors across the life course which could explain this health inequality.

【 授权许可】

   
2014 Padyab and Norberg; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Caballero B: The global epidemic of obesity: an overview. Epidemiol Rev 2007, 29:1-5.
• [2]Neovius M, Janson A, Rossner S: Prevalence of obesity in Sweden. Obes Rev 2006, 7:1-3.
• [3]Norberg M, Lindvall K, Stenlund H, Lindahl B: The obesity epidemic slows among the middle-aged population in Sweden while the socioeconomic gap widens. Glob Health Action 2010, 3:5149.
• [4]Power C, Graham H, Due P, Hallqvist J, Joung I, Kuh D, Lynch J: The contribution of childhood and adult socioeconomic position to adult obesity and smoking behaviour: an international comparison. Int J Epidemiol 2005, 34:335-344.
• [5]Lahmann PH, Lissner L, Gullberg B, Berglund G: Sociodemographic factors associated with long-term weight gain, current body fatness and central adiposity in Swedish women. Int J Obes Relat Metab Disord 2000, 24:685-694.
• [6]Senese LC, Almeida ND, Fath AK, Smith BT, Loucks EB: Associations between childhood socioeconomic position and adulthood obesity. Epidemiol Rev 2009, 31:21-51.
• [7]Murray ET, Mishra GD, Kuh D, Guralnik J, Black S, Hardy R: Life course models of socioeconomic position and cardiovascular risk factors: 1946 birth cohort. Ann Epidemiol 2011, 21:589-597.
• [8]Padyab M, Malmberg G, Norberg M, Blomstedt Y: Life course socioeconomic position and mortality: a population register based study from Sweden. Scand J Public Health 2013, 41:785-791.
• [9]DaveySmith G, Hart C, Blane D, Gillis C, Hawthorne V: Lifetime socioeconomic position and mortality: prospective observational study. Br Med J 1997, 314:547-552.
• [10]Lakatta EG: Age-associated cardiovascular changes in health: impact on cardiovascular disease in older persons. Heart Fail Rev 2002, 7:29-49.
• [11]Williamson DF, Kahn HS, Remington PL, Anda RF: The 10-year incidence of overweight and major weight gain in US adults. Arch Intern Med 1990, 150:665-672.
• [12]Pérez Pérez A, Ybarra Muñoz J, Blay Cortés V, de Pablos Velasco P: Obesity and cardiovascular disease. Public Health Nutr 2007, 10:1156-1163.
• [13]Mackenbach JP, Kunst AE, Cavelaars AEJM, Groenhof F, Geurts JJM: Socioeconomic inequalities in morbidity and mortality in western Europe. Lancet 1997, 349:1655-1659.
• [14]Rosengren A, Wedel H, Wilhelmsen L: Coronary heart-disease and mortality in middle-aged men from different occupational classes in Sweden. Br Med J 1988, 297:1497-1500.
• [15]Tiikkaja S, Hemstrom O: Does intergenerational social mobility among men affect cardiovascular mortality? A population-based register study from Sweden. Scand J Public Health 2008, 36:619-628.
• [16]Tiikkaja S, Hemström O, Vågerö D: Intergenerational class mobility and cardiovascular mortality among Swedish women: a population-based register study. Soc Sci Med 2009, 68:733-739.
• [17]Cano-Serral G, Azlor E, Rodriguez-Sanz M, Pasarin MI, Martinez JM, Puigpinos R, Muntaner C, Borrell C: Socioeconomic inequalities in mortality in Barcelona: a study based on census tracts (MEDEA Project). Health Place 2009, 15:186-192.
• [18]Edvinsson S, Lundevaller EH, Malmberg G: Do unequal societies cause death among the elderly? A study of the health effects of inequality in Swedish municipalities in 2006. Glob Health Action 2013, 6:1-9.
• [19]Weinehall L, Hellsten G, Boman K, Hallmans G: Prevention of cardiovascular disease in Sweden: the Norsjö community intervention programme—motives, methods and intervention components. Scand J Public Health 2001, 29:13-20.
• [20]Stenlund H, Lonnberg G, Jenkins P, Norberg M, Persson M, Messner T, Boman K, Pearson T, Wall S, Nystrom L, Weinehall L: Fewer deaths from cardiovascular disease than expected from the Systematic Coronary Risk Evaluation chart in a Swedish population. Eur J Cardiovasc Prev Rehabil 2009, 16:321-324.
• [21]Singh-Manoux A, Ferrie JE, Chandola T, Marmot M: Socioeconomic trajectories across the life course and health outcomes in midlife: evidence for the accumulation hypothesis? Int J Epidemiol 2004, 33:1072-1079.
• [22]Pollitt RA, Rose KM, Kaufman JS: Evaluating the evidence for models of life course socioeconomic factors and cardiovascular outcomes: a systematic review. BMC Public Health 2005, 5:7. BioMed Central Full Text
• [23]Mishra G, Nitsch D, Black S, De Stavola B, Kuh D, Hardy R: A structured approach to modelling the effects of binary exposure variables over the life course. Int J Epidemiol 2009, 38:528-537.
• [24]Malmberg G, Nilsson LG, Weinehall L: Longitudinal data for interdisciplinary ageing research. Design of the Linnaeus Database. Scand J Public Health 2010, 38:761-767.
• [25]Norberg M, Wall S, Boman K, Weinehall L: The Vasterbotten Intervention Programme: background, design and implications. Glob Health Action 2010, 3:4643.
• [26]Peters T, Brage S, Westgate K, Franks PW, Gradmark A, Diaz MJT, Huerta JM, Bendinelli B, Vigl M, Boeing H, Wendel-Vos W, Spijkerman A, Benjaminsen-Borch K, Valanou E, Guillain Bde L, Clavel-Chapelon F, Sharp S, Kerrison N, Langenberg C, Arriola L, Barricarte A, Gonzales C, Grioni S, Kaaks R, Key T, Khaw KT, May A, Nilsson P, Norat T, Overvad K, et al.: Validity of a short questionnaire to assess physical activity in 10 European countries. Eur J Epidemiol 2012, 27:15-25.
• [27]Gustafsson PE, Persson M, Hammarström A: Socio-economic disadvantage and body mass over the life course in women and men: results from the Northern Swedish cohort. Eur J Publ Health 2012, 22:322-327.
• [28]Mishra GD, Chiesa F, Goodman A, De Stavola B, Koupil I: Socio-economic position over the life course and all-cause, and circulatory diseases mortality at age 50–87 years: results from a Swedish birth cohort. Eur J Epidemiol 2013, 28:139-147.
• [29]Clayton D, Hills M: Statistical Models in Epidemiology. Oxford: Oxford University Press; 1993.
• [30]Kittleson MM, Meoni LA, Wang NY, Chu AY, Ford DE, Klag MJ: Association of childhood socioeconomic status with subsequent coronary heart disease in physicians. Arch Intern Med 2006, 166:2356-2361.
• [31]Lawlor DA, Batty GD, Morton SMB, Clark H, Macintyre S, Leon DA: Childhood socioeconomic position, educational attainment, and adult cardiovascular risk factors: the Aberdeen children of the 1950s cohort study. Am J Public Health 2005, 95:1245-1251.
• [32]Power C, Manor O, Matthews S: Child to adult socioeconomic conditions and obesity in a national cohort. Int J Obes 2003, 27:1081-1086.
• [33]Finkelstein EA, Ruhm CJ, Kosa KM: Economic causes and consequences of obesity. Annu Rev Public Health 2005, 26:239-257.
• [34]Kravdal Ø, Rindfuss RR: Changing relationships between education and fertility: a study of women and men born 1940 to 1964. Am Sociol Rev 2008, 73:854-873.
• [35]UN: World Population Monitoring, 2003: Population, Education and Development. New York: United Nations; 2005.
• [36]Bjorklund A: Does family policy affect fertility? Lessons from Sweden. J Popul Econ 2006, 19:3-24.
• [37]Gunderson E, Murtaugh M, Lewis C, Quesenberry C, West DS, Sidney S: Excess gains in weight and waist circumference associated with childbearing: the Coronary Artery Risk Development in Young Adults study (CARDIA). Int J Obes 2004, 28:525-535.
• [38]Sandström G: The mid-twentieth century baby boom in Sweden–changes in the educational gradient of fertility for women born 1915–1950. Hist Fam 2014, 19:120-140.
• [39]Su DJ, Esqueda OA, Li LF, Pagan JA: Income inequality and obesity prevalence among oecd countries. J Biosoc Sci 2012, 44:417-432.
• [40]Allaz AF, Bernstein M, Rouget P, Archinard M, Morabia A: Body weight preoccupation in middle-age and ageing women: a general population survey. Int J Eat Disord 1998, 23:287-294.
• [41]Averett S, Korenman S: The economic reality of the beauty myth. J Hum Resour 1996, 31:304-330.
• [42]Cawley J: Body Weight and Women’s Labor Market Outcomes. Cambridge, MA: National Bureau of Economic Research; 2000.
• [43]Ng N, Soderman K, Norberg M, Ohman A: Increasing physical activity, but persisting social gaps among middle-aged people: trends in Northern Sweden from 1990 to 2007. Glob Health Action 2011, 4:6347.
• [44]Norberg M, Lundqvist G, Nilsson M, Gilljam H, Weinehall L: Changing patterns of tobacco use in a middle-aged population–the role of snus, gender, age, and education. Glob Health Action 2011, 4:5613.