obesity and income inequality

Distribution of selected characteristics of U.S. adults over 20 years of age between 19992016, National Health and Nutrition Examination Survey (n = 36,665). Income and inequality as determinants of mortality: An international cross-section analysis, Subramanian S.V., Blakely T., Kawachi I. Commentary: Income inequality as a public health concern: Where do we stand? For men, there is higher income inequality in the non-obese population (panel D). Thorpe R.J., Jr., Parker L.J., Cobb R.J., Dillard F., Bowie J. Any strategies to promote physical activity may help mitigate the obesity prevalence in men and women. We examined the association between income and obesity in adults ages 20 years and older and tested whether this relationship differs by sex in the United States. National Health and Nutrition Examination Survey. Obesity, income and gender: The changing global relationship These resulted in Model 3 and Model 4 as unadjusted and adjusted models for men, and Model 5 and Model 6 for women, respectively. collected a large body of studies on the association between income inequality and health outcomes in the US and at international levels [20]. Peeters A, Barendregt JJ, Willekens F, et al.. Obesity in adulthood and its consequences for life expectancy: a life-table analysis. Economists believe that those at the very top level of income can plunder the poor and middle classes [] by lobbying, by rewriting the rules [] by rewarding and being rewarded by their cronies in business and government [1,4]. : 0.006) experienced higher income inequality, and that BNH obese men experienced the highest income inequality (GC: 0.45, S.E. Most of the published articles on obesity and sex differences discussed the impact of geographical location [52], neighborhood factors [53], behavioral and physical activities [54,55] and income inequality [56,57]. Conducting more research focusing on gender differences. We used data from the 19992016 National Health and Nutrition Examination Surveys (NHANES) [27]. Because the interaction between income quintile and race was significant (p < 0.001), we stratified the analyses by race. They had a higher probability of being married, having higher education, being former smokers and drinkers, not being physically active, and having poor health conditions. Sturm R., Gresenz C.R. The number of participants who met the inclusion criteria for age and school . Study population characteristics.Table 1 compares the distribution of the samples characteristics. Between 19992016, BNH experienced the highest obesity increases: from 18.6% to 45.9%. Bethesda, MD 20894, Web Policies No of children the respondent cares for, the noof children between the ages of 0 and 2 that the respondent cares for, indicator variables for no job market skills, low job market skills, less than a high school education, more than a high school education, one of the respondents children has a physical or mental health problem, respondent is currently cohabitating with a husband or boyfriend, never married, age, wave 3, wave 4, respondent has a conviction for other than a traffic offence, and respondent has a learning disability. The association between the PIR and obesity operates differently for men and women. Almost all socioeconomic factors, including income, are influenced by race and ethnicity. Income inequality and health status in the United States: Evidence from the current population survey. and D.J.G. Sensitivity analysis results. Income inequality drives up obesity rates and associated diseases. Download .nbib Inequality as an Explanation for Obesity in the United States To understand more about these differences, we used Lorenz curves and Gini coefficients. As presented, BNH women and MA women suffered more from income inequality than WNH. Physical activities and obesity. Haithcoat T.L., Avery E.E., Bowers K.A., Hammer R.D., Shyu C.-R. Income inequality and health: Expanding our understanding of state-level effects by using a geospatial big data approach. Food swamps predict obesity rates better than food deserts in the United States. Gordon-Larsen P. Food availability/convenience and obesity. The social distribution of obesity has changed over time. We used STATA statistical software, version 16, to perform all analyses. The same association was not found for women. Income inequality and health: What have we learned so far? To our knowledge, this is the first study to examine the relationship of income inequality and obesity in a wide range of the NHANES data (19992016) and by sex. Unequal distribution of income may add an additional hazard to the health of people living in communities with unequally distributed income. In his paper, Michael Marmot mentioned that money is vital for those who have insufficient means to ensure social participation as well as adequate housing, nutrition, and clothing [45]. Bell C.N., Kerr J., Young J.L. In developing obesity-reducing policies, addressing these fundamental inequalities need essential attention [38]. Maternal education, area deprivation, maternal social class. Furthermore, obesity is problematic for vulnerable groups such as communities of color [40] and women because of structural inequality such as an income gap [2,3], occupational risk factors [41] and wage disparities [42]. Education, income inequality, and mortality: A multiple regression analysis. : 0.011). Income inequality impacts obesity in children - University of Auckland World Bank Publications; Washington DC, USA: 2009. Census: Historical Income Tables: Households (Last Revised: 29 August 2019) [(accessed on 15 May 2021)]; Khullar D., Chokshi D.A. In spite of a negative correlation between income inequalities and health outcomes, evidence shows that Americans underestimate the true level of income inequality or may not be completely aware of its impact on health [22]; therefore, it is important to bring it to the attention of policymakers. The results of the unadjusted model show that people on the top quintile (5th quintile) were less obese (PR: 0.85; CI: 0.800.91) than people on the first quintile; however, the association disappeared in the adjusted model (PR: 0.94; CI: 0.871.01). We examined the association between income and obesity using a Modified Poisson regression in a sample of 36,665 adults. * p < 0.05, ** p < 0.01, *** p < 0.001. Careers, Unable to load your collection due to an error. Health, income, & poverty: Where we are & what could help. This study investigated the relationship between obesity and PIR, and how this association changes between men and women of color (white NH, black NH, and Mexican Americans). Conceptualization: H.Z., R.J.T.J. The authors recognize the racial, cultural, and social limitations of BMI calculations. Based on the unadjusted model, women in the 3rd, 4th, and 5th PIR quintile group were less likely to be obese (PR: 0.92; CI: 0.850.99), (PR: 0.84; CI: 0.780.91) and (PR: 0.68; CI: 0.630.74), respectively. Table 1 details the information on men and women. We did not include pregnant women (1667) or missing observations for Poverty Income Ratio (PIR) in the analysis; this yielded an analytic sample of 36,665, including 17,303 white non-Hispanics (WNHs), 7475 black non-Hispanics (BNHs), and 6281 Mexican Americans (MAs). Specifically, for low-income, vulnerable communities, the resources need to combat obesity through access to fresh foods and CSA programs as nutritional interventions and not only promote access to healthy foods but also generate higher income for low-income communities and reduce income inequalities as a long-term sustainable strategy. Psychosocial and material pathways in the relation between income and health: A response to Lynch et al. In previous sections, we reported the results for men and women, adjusted by sex, while considering the significant interaction between the PIR quintiles and sex, and we stratified the analyses for men and women. Interestingly, there was a different pattern in the BNH population. Moreover, why should we be worried about income distribution and income inequality? Poverty negatively impacts structural wiring in children's brains Credit: iStock. (2019) reported that income was negatively associated with highly socially integrated mens weight status, but was positively associated with weight status among lower socially integrated men [17]. Addressing fundamental inequality. Figure 2b compares the GC between obese and non-obese WNH, BNH, and MA men. [(accessed on 15 May 2021)]; National Health and Nutrition Examination Survey 19992000 Data Documentation, Codebook, and Frequencies. Evidence shows that extent bias because of reverse causation is mainly indirect [59]. Van der Lippe T., De Ruijter J., De Ruijter E., Raub W. Persistent inequalities in time use between men and women: A detailed look at the influence of economic circumstances, policies, and culture. As a library, NLM provides access to scientific literature. In comparison with MNHs and MAs, BNHs were more likely to be physically inactive (49%); 13.4% of the population lived alone, with the highest rate for BNHs (16%), and the average population in a household was 5.8 people, with the largest household size for MAs. Association between discrimination and obesity in African-American men. Laaksonen M, Prttl R, Helasoja V, et al.. Income and health behaviours. Generally, children who grow up in poverty have a higher risk of obesity and score lower on tests of cognitive function than their peers in higher income neighborhoods and households. Socioeconomic groups with low personal capital, levels of education, and income have higher. Oksuzyan A., Juel K., Vaupel J.W., Christensen K. Men: Good health and high mortality. The stratified model by sex showed that the association between income and obesity was consistently significant among top PIR quintiles in WNH and BNH men, but not in MA men. For the first set of analysis, the mean and proportional differences between men and women for obesity, demographics, SES, health-related characteristics, and health behaviors were evaluated using unequal variances t-tests. [(accessed on 15 May 2021)]; Fast Facts: The Cost of Obesity. The authors declare that there is no conflict of interest. Notes: NH = Non-Hispanic; (1) We defined quintile based on the GC calculated from the ratio of family income to poverty; (2) Bonferroni correction (p < 0.002) shows the significant difference between men and women. Federal government websites often end in .gov or .mil. Lovasi G.S., Schwartz-Soicher O., Quinn J.W., Berger D.K., Neckerman K.M., Jaslow R., Lee K.K., Rundle A. He believes that half of the money spent in the healthcare system in the U.S. has nothing to do with population health. School of Public Health and Health Services. The NHANES data had some limitations regarding the income variable and did not report real income; instead, income was reported as a categorical variable. Using body mass index (BMI)derived by dividing weight in kilograms by height in meters squared (kg/m2)we created a binary variable to identify participants who were obese (if BMI 30) as the outcome variable [26]. Sex differences in the association of socioeconomic status with obesity. Our findings showed that individuals living in an economically diverse vs. an economically homogeneous geographic area were going to have an impact on obesity that was independent of the direct effect of the individuals family income on obesity. Is there anything wrong with people getting rich if no one else is harmed in the process? In 2018/19, the prevalence of obesity in children aged 10-11 was 27% in the most deprived areas and 13% in the least deprived areas. Diabetes and obesity are rising globally but some nations - Nature The .gov means its official. The Oxford Handbook of the Social Science of Obesity. Prevalence of Obesity Among Adults, by Household Income and Education In Table A1, we compare the prevalence of obesity across all study characteristics (See Table A1). The magnitude of this contribution increases with income inequality as measured by the Gini index (i.e., the CI of income with respect to income) and the elasticity of obesity with respect to income. Food Insecurity, Food Environment, and Obesity | STOP Obesity Alliance Mellor J.M., Milyo J. In treating obesity, policymakers should consider not only race/ethnicity and sex, but also strategies to reduce inequality in income. Based on the IRS Schedule H, non-profit hospitals must spend a justifiable amount of tax exemption credits to communities [56]. Health inequalities and obesity | RCP London [(accessed on 25 October 2021)]. For the demographic variables, we included age (years), racial/ethnic groups (White NH, Black NH, Mexican American, and other race) and marital status (1 = married, 0 = otherwise). Busch F. Gender segregation, occupational sorting, and growth of wage disparities between women. Our findings show that income inequality plays different roles between racial/ethnic groups and between men and women. For example, WNH men in the 4th (PR: 1.28, CI: 1.081.50) and 5th (PR: 1.20, CI: 1.021.42) PIR quintiles suffered more from obesity, with a similar pattern for BNH in the 4th (PR: 1.23, CI: 1.031.47) and 5th (PR: 1.28, CI: 1.081.52) PIR quintiles. Abstract. The household structure is an essential element in predicting individual/household income [32], so we used a binary variable to present living alone (1 = yes; 0 = no) and number of people in a household. The majority of the study sample had more than a high school education (60.0%), with a higher rate for WNHs (64.1%) and the lowest rate for MAs, of 31% with more than a high school diploma. McNutt L.-A., Wu C., Xue X., Hafner J.P. Estimating the relative risk in cohort studies and clinical trials of common outcomes. ; Validation: H.Z., R.J.T.J. An ecological study of obesity and income inequality. The report focused on the association between the number and . Low BMI can be an indicator for cancer or other severe poor health states that cause weight loss. Deaton A., Lubotsky D. Mortality, inequality and race in American cities and states. The spread of incomeincome inequalityopens a new argument that the distribution of income may not have an equal impact on rich and poor communities because of the concavity effect of income inequality and health outcomes. The alarming trends in income inequality raise questions: what is happing if income inequality stays high? Brophy S, Cooksey R, Gravenor MB, et al.. Risk factors for childhood obesity at age 5: analysis of the millennium cohort study, Socioeconomic disadvantage in childhood as a predictor of excessive gestational weight gain and obesity in midlife adulthood, Dollars and pounds: the impact of family income on childhood weight, Changes in family income status and the development of overweight and obesity from 2 to 15years: a longitudinal study, Why are poorer children at higher risk of obesity and overweight? (2018) reported that income inequality and lower poverty percentage are significantly associated with lower obesity rates in men [52]. National Center for Health Statistics. The results of the adjusted model (Model 2) indicate that the obese population comprised more women, Black NH, or Mexican Americans. Eating the right number of calories, meeting food group needs, and being physically active. In this approach, transferring an additional dollar from rich to poor improves the health status of poor communities more than rich communities [8]. This association may operate differently by men and women. Federal government websites often end in .gov or .mil. In the last four decades, the real annual earnings for the top 1% and bottom 90% increased 158% and 24%, respectively. ; Writingoriginal draft: H.Z. On average, one-third of the sample was obese, with a significant higher rate of obesity for women (p < 0.001). All authors have read and agreed to the published version of the manuscript. The standard errors for these estimators were very small and there was a significant difference between the GC in men and in women (p < 0.001). To understand more about these differences in men and women, we used Lorenz curves and Gini coefficients. Income Inequality and Obesity among US Adults 1999-2016: Does - PubMed Health, income, & poverty: Where we are & what could help. In biomedicine, thin is still in: Obesity surveillance among racialized, (Im) migrant, and female bodies. Income inequality, income and self rated health: A mutilevel analysis. It plays a significant role in several adverse health outcomes, including hypertension, strokes, heart attacks, and diabetes [12]. [(accessed on 15 May 2021)]; NIH: Assessing Your Weight and Health Risk National heart, Lung and Blood Institute. Obesity is concentrated among the rich in low-income countries and among the poor in high-income countries. We reported the results of the IV passion models for WNH in Appendix B. Von Hippel P., Benson R. Obesity and the natural environment across US counties. Ogden C.L., Carroll M.D., Fakhouri T.H., Hales C.M., Fryar C.D., Li X., Freedman D.S. The pattern in women was different. In Table 3, Models 5 and 6 present the association between the PIR and obesity in women. For the first set of analysis and by calculating GC and plotting the Lorenz Curve, we compared income inequality between obese men and obese women. Does obesity contribute as much to morbidity as poverty or smoking? Improving the health of the U.S. population by encouraging physical activities and promoting nutrition has come to the forefront of public attention. [(accessed on 15 May 2021)]; International Journal of Environmental Research and Public Health, https://creativecommons.org/licenses/by/4.0/, https://www.cdc.gov/nchs/nhanes/index.htm, https://www.census.gov/data/tables/time-series/demo/income-poverty/historical-income-households.html, https://www.wsj.com/articles/BL-REB-24473, https://www.cdc.gov/nchs/data/databriefs/db360-h.pdf, https://stop.publichealth.gwu.edu/sites/stop.publichealth.gwu.edu/files/documents/Fast%20Facts%20Cost%20of%20Obesity.pdf, https://www.apha.org/policies-and-advocacy/public-health-policy-statements/policy-database/2018/01/18/reducing-income-inequality-to-advance-health, https://www.cdc.gov/nchs/nhanes/about_nhanes.htm, https://www.cdc.gov/nchs/data/series/sr_01/sr01_056.pdf, https://wwwn.cdc.gov/nchs/data/nhanes/2011-2012/analyticguidelines/analytic_guidelines_11_16.pdf, https://www.nhlbi.nih.gov/health/educational/lose_wt/risk.htm, https://wwwn.cdc.gov/Nchs/Nhanes/1999-2000/BMX.htm#BMIWT, https://www.cdc.gov/obesity/adult/defining.html, https://docs.house.gov/billsthisweek/20181210/CRPT-115hrpt1072.pdf, Head of Household (Household reference person, Female). Age, sex, race, no of siblings, mothers education, mother works, father works, closeness to mother, closeness to father, school skipped, grade repeated, attention problem, watching TV (hours), playing sports, playing computer games, hanging out with friends, type of school, neighbourhood environment, mental health, general health, smoking, alcohol use, drug use, ever had sex. Does the state you live in make a difference? Stata.com IvpoissonPoisson Model with Continuous Endogenous Covariates. As presented in the regression results, there is a different association between obesity and income inequality in men and women. ; Writingoriginal draft: H.Z., D.R.G. Curse or Blessing? Obesity and Income-Related Inequality in - PubMed Studies have shown that racial composition plays a significant role in health outcomeseven more than income inequality. We found only a few articles to address income inequality in US adults. There is a negative association between the income inequality levels and obesity in women. For example, WNH women, BNH women, and MA women in higher-income groups experienced a lower probability of being obese. The same association was not found for women. One study has shown additional hazards to the health of people in communities with unequal distribution of income [].Studies have also reported a negative association between income inequality and poor health outcomes [7,8].Income influences health outcomes by decreasing the barriers to accessing care or by moderating environmental factors, living in healthier . Ethnic group, birth weight, enjoyment of physical activity, sedentary behaviour (watching TV), indoor activities, early introduction of solid food, smoking near child, mothers prepregnancy weight, education. We examined the association between income and obesity in U.S. adult men ages 20 years and older and tested racial and ethnic differences. FOIA Christafore D., Leguizamon S. Neighbourhood inequality spillover effects of gentrification. Using Body Mass Index (BMI)derived by dividing weight in kilograms by height in meters squared (kg/m2)we created a binary variable to identify participants who were obese (if BMI 30) as the outcome variable [30]. Obesity is a major public health problem that varies by income and sex, yet there is little evidence to determine the association between income inequality and obesity. The combination of low-income communities, minority groups, and high poverty creates an area with the most vulnerable populations; this is the area in which we can expect to find very high adverse health outcomes, including obesity. Income inequality and obesity prevalence among OECD countries (b) The Lorenz curves and Gini coefficients in men, 19992016. For example, Americans pay more than $147 billion to nearly $210 billion per year in the medical costs of adult obesity [13,14]. Excess weight (overweight/obesity), urbanization, and social and gender inequalities are closely interrelated growing global issues. Poverty negatively impacts structural wiring in children's brains Interestingly, the distribution on income inequality were different, e.g., WNHs were more likely to be on the fifth quintiles (42%), then BNHs (20%), followed by MAs (12%). NCHS Data Brief No. As expected, structural racism on the county-level is associated with obesity and obesogenic environments [16]. Campbell A.D., Baker E.H. Do income inequalities in higher weight status depend on social integration? Bethesda, MD 20894, Web Policies Thorpe R.J., Jr., Parker L.J., Cobb R.J., Dillard F., Bowie J. Overall, the sample age was 47.0 14.0 years, with a slightly more aging WNH population (48.6 11.3). Geographic Association Between Income Inequality and Obesity Among Adults in New York State Increased income inequality and lower poverty percentage were significantly linked to lower obesity rates across NYS counties for men. We excluded pregnant women (1667) or missing observations for Poverty Income Ratio (PIR) (1823 men and 2429 women), which yielded an analytic sample of 18,518, men and 18,147 women. This context increases the importance of understanding the relationship between income distribution and specific health conditions [4]. Income Distribution and Obesity. Comparing study sample characteristics between men and women, US Adults over 20 years of age in 19992016 National Health and Nutrition Examination Survey (N = 36,665). National Center for Health Statistics. Kim D., Subramanian S., Gortmaker S.L., Kawachi I. Does obesity influence labour market outcomes among working-age adults? Poverty causes obesity. Low-income families need to be better off to Oxford univ press Inc journals dept, 2001 evans RD, cary, NC 27513 USA. The GC is defined as A/(A + B): A is the area between the line of perfect equality (45-degree line) and the Lorenz Curve; B is the area between Lorenz Curve x- and y-axis, if A equal zero, then GC will be zero, which means perfect equality and if B was zero then the GC will be one, which means complete inequality [28]. [(accessed on 25 October 2021)]; NHANES Analytic Guidelines, 20112014 and 20152016 (14 December 2018). NHANES: Analytic Guidelines, 20112014 and 20152016 (14 December 2018). For this study, we included participants who were 20 years old and older. Age, sex, race, marital status, education, health insurance, smoking, region of residence, survey year. Income inequality alone is associated with 16 and 35 percent of the variations in male and female obesity rates, respectively, across OECD countries in 2010. For example, Subramanian et al. In addition to race/ethnicity and environment, sex also plays a role in obesity. Being physically non-active was positively associated with obesity in WNH and MA but not in BNH. The Economics of Obesity: Poverty, Income Inequality, and Health Three variables measured health behavior: smoking (never smoked, a former smoker, or current smoker), drinking (never drink, former drinker, or current drinker), and physical activity (a binary variable showed that an individual had not participated in vigorous activities (1 = yes; 0 = no) during a typical week. A nutrition assessment is a process of determining an individuals nutritional status [55]; the depth of assessment depends on the individual and on the presenting situation. The effect of stress on mens food selection. Ljungvall ., Gerdtham U.-G. More equal but heavier: A longitudinal analysis of income-related obesity inequalities in an adult Swedish cohort. Gender differences. Addressing socioeconomic inequalities in obesity: Democratising access to resources for achieving and maintaining a healthy weight Jean Adams x Published: July 28, 2020 https://doi.org/10.1371/journal.pmed.1003243 Article Authors Metrics Comments Media Coverage References Reader Comments ; Software: H.Z. National Center for Health Statistics. Policymakers should consider the different strategies for men and women when obtaining obesity-reducing policies [35]. Persistent poverty areas are those where, for the past 30 years, 20% or more of the population has lived below the federal poverty line. The Authors declare no conflict of interest. 2014. [(accessed on 15 May 2021)]; The Analysis of Household Surveys: A Microeconometric Approach to Development Policy. The rest of the PIR was acquired by the top 25% of the population. Low income was defined as having a household income less than or equal to 200% of the federal poverty threshold, and low access to grocery stores was defined as living more than 1.6 km (1 mile) from a supermarket or grocery store in an urban area or more than 16 km (10 miles) in a rural area.
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