Hiilamo Aapo, Lallukka Tea, Mänty Minna, Kouvonen Anne
Department of Social Research, University of Helsinki, Helsinki, Finland.
Department of Public Health, University of Helsinki, Helsinki, Finland.
BMC Public Health. 2017 Oct 24;17(1):842. doi: 10.1186/s12889-017-4865-8.
The two-way relationship between obesity and socioeconomic disadvantage is well established but previous studies on social and economic consequences of obesity have primarily focused on relatively young study populations. We examined whether obesity is associated with socioeconomic disadvantage through the 10-12-year follow-up, and how obesity-related socioeconomic inequalities develop during midlife among women.
Baseline data were derived from the female population of the Helsinki Health Study cohort, comprising 40-60 -year-old employees of the City of Helsinki, Finland in 2000-2002 (n = 6913, response rate 69%). The follow-up surveys were carried out in 2007 (n = 5810) and 2012 (n = 5400). Socioeconomic disadvantage was measured by five dichotomous measures. Repeated logistic regression analyses utilising generalized estimating equations (GEE) were used to test the association between baseline self-reported obesity and the likelihood of socioeconomic disadvantage through all phases. The effect of time on the development of inequalities was examined by time interaction terms in random effect logistic regression models.
After adjustment for educational level, baseline obesity was associated with repeated poverty (OR = 1.23; 95% CI; 1.05-1.44), frequent economic difficulties (OR = 1.74; 95% CI; 1.52-1.99), low household net income (OR = 1.23; 95% CI; 1.07-1.41), low household wealth (OR = 1.90; 95% CI; 1.59-2.26) and low personal income (OR = 1.22; 95% CI; 1.03-1.44). The differences in poverty rate and low personal income between the participants with obesity and participants with normal weight widened during the follow-up. Living without a partner and early exit from paid employment explained the widening of inequalities.
Weight status inequalities in socioeconomic disadvantage persisted or widened during the late adulthood.
肥胖与社会经济劣势之间的双向关系已得到充分证实，但先前关于肥胖的社会和经济后果的研究主要集中在相对年轻的研究人群上。我们通过10至12年的随访研究了肥胖是否与社会经济劣势相关，以及肥胖相关的社会经济不平等在中年女性中是如何发展的。
基线数据来自赫尔辛基健康研究队列中的女性人群，该队列包括2000年至2002年芬兰赫尔辛基市40至60岁的员工（n = 6913，应答率69%）。随访调查分别在2007年（n = 5810）和2012年（n = 5400）进行。社会经济劣势通过五项二分法指标进行衡量。使用广义估计方程（GEE）进行重复逻辑回归分析，以检验基线自我报告的肥胖与各阶段社会经济劣势可能性之间的关联。通过随机效应逻辑回归模型中的时间交互项来检验时间对不平等发展的影响。
在调整教育水平后，基线肥胖与反复贫困（比值比[OR]=1.23；95%置信区间[CI]：1.05 - 1.44）、频繁的经济困难（OR = 1.74；95% CI：1.52 - 1.99）、低家庭净收入（OR = 1.23；95% CI：1.07 - 1.41）、低家庭财富（OR = 1.90；95% CI：1.59 - 2.26）和低个人收入（OR = 1.22；95% CI：1.03 - 1.44）相关。在随访期间，肥胖参与者与正常体重参与者之间的贫困率和低个人收入差异有所扩大。没有伴侣以及过早退出有偿就业解释了不平等的扩大。
在成年后期，社会经济劣势方面的体重状况不平等持续存在或有所扩大。
