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Measuring and Decomposing Socioeconomic Inequalities in Adult Obesity in Western Iran

  • Najafi, Farid (Research Center for Environmental Determinants of Health, Kermanshah University of Medical Sciences) ;
  • Pasdar, Yahya (Department of Nutrition, Faculty of Nutritional Sciences and Food Technology, Kermanshah University of Medical Sciences) ;
  • Hamzeh, Behrooz (Research Center for Environmental Determinants of Health, Kermanshah University of Medical Sciences) ;
  • Rezaei, Satar (Research Center for Environmental Determinants of Health, Kermanshah University of Medical Sciences) ;
  • Nazar, Mehdi Moradi (Research Center for Environmental Determinants of Health, Kermanshah University of Medical Sciences) ;
  • Soofi, Moslem (Research Center for Environmental Determinants of Health, Kermanshah University of Medical Sciences)
  • Received : 2018.03.05
  • Accepted : 2018.10.11
  • Published : 2018.11.30

Abstract

Objectives: Obesity is a considerable and growing public health concern worldwide. The present study aimed to quantify socioeconomic inequalities in adult obesity in western Iran. Methods: A total of 10 086 participants, aged 35-65 years, from the Ravansar Non-communicable Disease Cohort Study (2014-2016) were included in the study to examine socioeconomic inequalities in obesity. We defined obesity as a body mass index ${\geq}30kg/m^2$. The concentration index and concentration curve were used to illustrate and measure wealth-related inequality in obesity. Additionally, we decomposed the concentration index to identify factors that explained wealth-related inequality in obesity. Results: Overall, the prevalence of obesity in the total sample was 26.7%. The concentration index of obesity was 0.04; indicating that obesity was more concentrated among the rich (p<0.001). Decomposition analysis indicated that wealth, place of residence, and marital status were the main contributors to the observed inequality in obesity. Conclusions: Socioeconomic-related inequalities in obesity among adults warrant more attention. Policies should be designed to reduce both the prevalence of obesity and inequalities in obesity by focusing on those with higher socioeconomic status, urban residents, and married individuals.

Keywords

References

  1. Alaba O, Chola L. Socioeconomic inequalities in adult obesity prevalence in South Africa: a decomposition analysis. Int J Environ Res Public Health 2014;11(3):3387-3406. https://doi.org/10.3390/ijerph110303387
  2. Hajizadeh M, Campbell MK, Sarma S. Socioeconomic inequalities in adult obesity risk in Canada: trends and decomposition analyses. Eur J Health Econ 2014;15(2):203-221. https://doi.org/10.1007/s10198-013-0469-0
  3. Ng M, Fleming T, Robinson M, Thomson B, Graetz N, Margono C, et al. Global, regional, and national prevalence of overweight and obesity in children and adults during 1980-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet 2014;384(9945):766-781. https://doi.org/10.1016/S0140-6736(14)60460-8
  4. Wells JC, Marphatia AA, Cole TJ, McCoy D. Associations of economic and gender inequality with global obesity prevalence: understanding the female excess. Soc Sci Med 2012;75(3):482-490. https://doi.org/10.1016/j.socscimed.2012.03.029
  5. Little M, Humphries S, Patel K, Dewey C. Factors associated with BMI, underweight, overweight, and obesity among adults in a population of rural south India: a cross-sectional study. BMC Obes 2016;3:12. https://doi.org/10.1186/s40608-016-0091-7
  6. World Health Organization. Obesity and overweight; 2018 [cited 2018 Nov 1]. Available from: http://www.who.int/en/news-room/fact-sheets/detail/obesity-and-overweight.
  7. Hajizadeh M, Sia D, Heymann SJ, Nandi A. Socioeconomic inequalities in HIV/AIDS prevalence in sub-Saharan African countries: evidence from the Demographic Health Surveys. Int J Equity Health 2014;13:18. https://doi.org/10.1186/1475-9276-13-18
  8. Jafari-Adli S, Jouyandeh Z, Qorbani M, Soroush A, Larijani B, Hasani-Ranjbar S. Prevalence of obesity and overweight in adults and children in Iran; a systematic review. J Diabetes Metab Disord 2014;13(1):121. https://doi.org/10.1186/s40200-014-0121-2
  9. Neupane S, Prakash KC, Doku DT. Overweight and obesity among women: analysis of demographic and health survey data from 32 Sub-Saharan African countries. BMC Public Health 2016;16:30.
  10. Dee A, Kearns K, O'Neill C, Sharp L, Staines A, O'Dwyer V, et al. The direct and indirect costs of both overweight and obesity: a systematic review. BMC Res Notes 2014;7:242. https://doi.org/10.1186/1756-0500-7-242
  11. Klarenbach S, Padwal R, Chuck A, Jacobs P. Population-based analysis of obesity and workforce participation. Obesity (Silver Spring) 2006;14(5):920-927. https://doi.org/10.1038/oby.2006.106
  12. Robroek SJ, van den Berg TI, Plat JF, Burdorf A. The role of obesity and lifestyle behaviours in a productive workforce. Occup Environ Med 2011;68(2):134-139. https://doi.org/10.1136/oem.2010.055962
  13. Janghorbani M, Amini M, Willett WC, Mehdi Gouya M, Delavari A, Alikhani S, et al. First nationwide survey of prevalence of overweight, underweight, and abdominal obesity in Iranian adults. Obesity (Silver Spring) 2007;15(11):2797-2808. https://doi.org/10.1038/oby.2007.332
  14. Nikooyeh B, Abdollahi Z, Salehi F, Nourisaeidlou S, Hajifaraji M, Zahedirad M, et al. Prevalence of obesity and overweight and its associated factors in urban adults from West Azerbaijan, Iran: the National Food and Nutritional Surveillance Program (NFNSP). Nutr Food Sci Res 2016;3(2):21-26. https://doi.org/10.18869/acadpub.nfsr.3.2.21
  15. Rahmani A, Sayehmiri K, Asadollahi K, Sarokhani D, Islami F, Sarokhani M. Investigation of the prevalence of obesity in Iran: a systematic review and meta-analysis study. Acta Med Iran 2015;53(10):596-607.
  16. Pasdar Y, Darbandi M, Niazi P, Alghasi S, Roshanpour F. The prevalence and the affecting factors of obesity in women of Kermanshah. Jorjani Biomed J 2015;3(1):82-97 (Persian).
  17. Emamian MH, Fateh M, Hosseinpoor AR, Alami A, Fotouhi A. Obesity and its socioeconomic determinants in Iran. Econ Hum Biol 2017;26:144-150. https://doi.org/10.1016/j.ehb.2017.03.005
  18. Mowafi M, Khadr Z, Kawachi I, Subramanian SV, Hill A, Bennett GG. Socioeconomic status and obesity in Cairo, Egypt: a heavy burden for all. J Epidemiol Glob Health 2014;4(1):13-21. https://doi.org/10.1016/j.jegh.2013.09.001
  19. Costa-Font J, Gil J. What lies behind socio-economic inequalities in obesity in Spain? A decomposition approach. Food Policy 2008;33(1):61-73. https://doi.org/10.1016/j.foodpol.2007.05.005
  20. Nikolaou A, Nikolaou D. Income-related inequality in the distribution of obesity among Europeans. J Public Health 2008; 16(6):403-411. https://doi.org/10.1007/s10389-008-0185-x
  21. Djalalinia S, Peykari N, Qorbani M, Larijani B, Farzadfar F. Inequality of obesity and socioeconomic factors in Iran: a systematic review and meta-analyses. Med J Islam Repub Iran 2015;29:241.
  22. Poustchi H, Eghtesad S, Kamangar F, Etemadi A, Keshtkar AA, Hekmatdoost A, et al. Prospective epidemiological research studies in Iran (the PERSIAN Cohort Study): rationale, objectives, and design. Am J Epidemiol 2018;187(4):647-655. https://doi.org/10.1093/aje/kwx314
  23. Rarani MA, Rashidian A, Arab M, Khosravi A, Abbasian E. Inequality in under-five mortality in Iran: a national and subnational survey data analysis. Glob J Health Sci 2016;9(3):215.
  24. Liu X, Gao W, Yan H. Measuring and decomposing the inequality of maternal health services utilization in western rural China. BMC Health Serv Res 2014;14:102. https://doi.org/10.1186/1472-6963-14-102
  25. Chalasani S. Understanding wealth-based inequalities in child health in India: a decomposition approach. Soc Sci Med 2012; 75(12):2160-2169. https://doi.org/10.1016/j.socscimed.2012.08.012
  26. Vyas S, Kumaranayake L. Constructing socio-economic status indices: how to use principal components analysis. Health Policy Plan 2006;21(6):459-468. https://doi.org/10.1093/heapol/czl029
  27. Kjellsson G, Gerdtham UG. On correcting the concentration index for binary variables. J Health Econ 2013;32(3):659-670. https://doi.org/10.1016/j.jhealeco.2012.10.012
  28. Wagstaff A. The bounds of the concentration index when the variable of interest is binary, with an application to immunization inequality. Health Econ 2005;14(4):429-432. https://doi.org/10.1002/hec.953
  29. Wagstaff A, Paci P, van Doorslaer E. On the measurement of inequalities in health. Soc Sci Med 1991;33(5):545-557. https://doi.org/10.1016/0277-9536(91)90212-U
  30. O'Donnell O, van Doorslaer E, Wagstaff A, Lindelow M. Analyzing health equity usinghousehold survey data: a guide to techniques and their implementation; 2008 [cited 2018 Nov 1]. Available from: http://web.worldbank.org/archive/website01411/WEB/IMAGES/HEALTHEQ.PDF.
  31. Erreygers G. Correcting the concentration index. J Health Econ 2009;28(2):504-515. https://doi.org/10.1016/j.jhealeco.2008.02.003
  32. Costa-Font J, Hernandez-Quevedo C, Jimenez-Rubio D. Income inequalities in unhealthy life styles in England and Spain. Econ Hum Biol 2014;13:66-75. https://doi.org/10.1016/j.ehb.2013.03.003
  33. Gonzalo-Almorox E, Urbanos-Garrido RM. Decomposing socioeconomic inequalities in leisure-time physical inactivity: the case of Spanish children. Int J Equity Health 2016;15(1):106. https://doi.org/10.1186/s12939-016-0394-9
  34. Solmi F, Von Wagner C, Kobayashi LC, Raine R, Wardle J, Morris S. Decomposing socio-economic inequality in colorectal cancer screening uptake in England. Soc Sci Med 2015;134:76-86. https://doi.org/10.1016/j.socscimed.2015.04.010
  35. Yiengprugsawan V, Lim LL, Carmichael GA, Sidorenko A, Sleigh AC. Measuring and decomposing inequity in self-reported morbidity and self-assessed health in Thailand. Int J Equity Health 2007;6:23. https://doi.org/10.1186/1475-9276-6-23
  36. Wagstaff A, van Doorslaer E, Watanabe N. On decomposing the causes of health sector inequalities with an application to malnutrition inequalities in Vietnam. J Econom 2003;112(1): 207-223. https://doi.org/10.1016/S0304-4076(02)00161-6
  37. Ljungvall A, Gerdtham UG. More equal but heavier: a longitudinal analysis of income-related obesity inequalities in an adult Swedish cohort. Soc Sci Med 2010;70(2):221-231. https://doi.org/10.1016/j.socscimed.2009.10.014
  38. Hwang J. Decomposing socioeconomic inequalities in the use of preventive eye screening services among individuals with diabetes in Korea. Int J Public Health 2016;61(5):613-620. https://doi.org/10.1007/s00038-016-0804-1
  39. Kunna R, San Sebastian M, Stewart Williams J. Measurement and decomposition of socioeconomic inequality in single and multimorbidity in older adults in China and Ghana: results from the WHO study on global AGEing and adult health (SAGE). Int J Equity Health 2017;16(1):79. https://doi.org/10.1186/s12939-017-0578-y
  40. Gwatkin DR, Rutstein S, Johnson K, Suliman E, Wagstaff A, Amouzou A. Socio-economic differences in health, nutrition, and population within developing countries: an overview; 2007 [cited 2018 Nov 1]. Available from: https://siteresources.worldbank.org/INTPAH/Resources/IndicatorsOverview.pdf.

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