Subramanian S V, Kawachi Ichiro, Smith George Davey
Department of Society, Human Development and Health, Harvard School of Public Health, Boston, MA 02115-6096, USA.
J Epidemiol Community Health. 2007 Sep;61(9):802-9. doi: 10.1136/jech.2006.053801.
Developing countries are increasingly characterised by the simultaneous occurrence of under- and overnutrition. This study examined the association between contextual income inequality and the double burden of under- and overnutrition in India.
A population-based multilevel study of 77,220 ever married women, aged 15-49 years, from 26 Indian states, derived from the 1998-99 Indian National Family Health Survey data. The World Health Organization recommended categories of body mass index constituted the outcome, and the exposure was contextual measure of state income inequality based on the Gini coefficient of per capita consumption expenditure. Covariates included a range of individual demographic, socioeconomic, behavioural and morbidity measures and state-level economic development.
In adjusted models, for each standard deviation increase in income inequality, the odds ratio for being underweight increased by 19% (p = 0.02) and the odds ratio for being obese increased by 21% (p<0.0001). Income inequality had a similar effect on the risk of being overweight as it did on the risk of obesity (p = 0.01), and state income inequality increased the risk of being pre-overweight by 9% (p = 0.01). While average levels of state economic development were strongly associated with degrees of overnutrition, no association was found with the risk of being underweight.
Rapidly developing economies, besides experiencing paradoxical health patterns, are typically characterised by increased levels of income inequality. This study suggests that the twin burden of undernutrition and overnutrition in India is more likely to occur in high-inequality states. Focusing on economic equity via redistribution policies may have a substantial impact in reducing the prevalence of both undernutrition and overnutrition.
发展中国家的一个日益显著的特征是营养不良和营养过剩同时存在。本研究调查了印度地区收入不平等与营养不良和营养过剩双重负担之间的关联。
一项基于人群的多层次研究，研究对象为来自印度26个邦的77220名年龄在15至49岁之间的已婚妇女，数据来源于1998 - 1999年印度全国家庭健康调查。以世界卫生组织推荐的体重指数类别作为结果变量，暴露因素是基于人均消费支出基尼系数的邦收入不平等的情境测量指标。协变量包括一系列个体人口统计学、社会经济、行为和发病率测量指标以及邦级经济发展情况。
在调整后的模型中，收入不平等每增加一个标准差，体重过轻的比值比增加19%（p = 0.02），肥胖的比值比增加21%（p<0.0001）。收入不平等对超重风险的影响与对肥胖风险的影响相似（p = 0.01），邦收入不平等使超重前期风险增加9%（p = 0.01）。虽然邦经济发展的平均水平与营养过剩程度密切相关，但未发现与体重过轻风险存在关联。
快速发展的经济体除了呈现出矛盾的健康模式外，通常还具有收入不平等加剧的特点。本研究表明，印度营养不良和营养过剩的双重负担在高不平等的邦更有可能出现。通过再分配政策关注经济公平可能对降低营养不良和营养过剩的患病率产生重大影响。
