Chung Woojin, Kim Jaeyeun, Lim Seung-Ji, Lee Sunmi
Department of Health Policy, Graduate School of Public Health, Yonsei University, Seoul, Republic of Korea.
Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea.
PLoS One. 2018 Jan 3;13(1):e0190499. doi: 10.1371/journal.pone.0190499. eCollection 2018.
No study of obesity risk for people in developed countries has conducted a multi-dimensional analysis of the association of socioeconomic status with obesity. In this paper, we investigated if education functions as either a confounder or an effect modifier in the association of another socioeconomic status indicator with obesity.
This cross-sectional study analyzed data of an adult population sample (10,905 men and 14,580 women) from the Korea National Health and Nutrition Examination Survey (2010-2014). The study performed multivariate logistic regression analyses for three education levels and four indicators of socioeconomic status (i.e., marital status, residential area, occupation, and income).
The overall prevalence of obesity was 38.1% in men and 29.1% in women (p < 0.001). In men, while education functioned as an effect modifier in the association between marital status and obesity (p for interaction = 0.006), it functioned as both a confounder (p < 0.001) and an effect modifier (p for interaction < 0.001) in the association between residential area and obesity. In contrast, in women, education functioned as a confounder in the association of residential area with obesity (p = 0.010). However, it functioned as both a confounder (p < 0.001) and an effect modifier (p for interaction = 0.012) in the association between income and obesity. A prediction showed that unlike in women, education was positively associated with obesity risk for some socioeconomic indicator groups in men; for example, in a rural resident group, a higher level of education increased the probability of being obese by 19.7%.
The present study suggests the need to examine sex-specific studies regarding the role of education on the association between other socioeconomic status indicators and obesity. This should be considered in planning education policies to reduce the risk of obesity.
在发达国家，尚未有研究对社会经济地位与肥胖症风险之间的关联进行多维度分析。在本文中，我们探究了教育在另一个社会经济地位指标与肥胖症的关联中，是起到混杂因素还是效应修饰因素的作用。
这项横断面研究分析了韩国国家健康与营养检查调查（2010 - 2014年）中成年人口样本（10905名男性和14580名女性）的数据。该研究针对三个教育水平以及四个社会经济地位指标（即婚姻状况、居住地区、职业和收入）进行了多变量逻辑回归分析。
男性肥胖症的总体患病率为38.1%，女性为29.1%（p < 0.001）。在男性中，教育在婚姻状况与肥胖症的关联中起到效应修饰因素的作用（交互作用p = 0.006），而在居住地区与肥胖症的关联中，它既起到混杂因素的作用（p < 0.001），又起到效应修饰因素的作用（交互作用p < 0.001）。相比之下，在女性中，教育在居住地区与肥胖症的关联中起到混杂因素的作用（p = 0.010）。然而，在收入与肥胖症的关联中，它既起到混杂因素的作用（p < 0.001），又起到效应修饰因素的作用（交互作用p = 0.012）。一项预测表明，与女性不同，对于男性的某些社会经济指标组，教育与肥胖症风险呈正相关；例如，在农村居民组中，较高的教育水平使肥胖的概率增加了19.7%。
本研究表明有必要针对教育在其他社会经济地位指标与肥胖症关联中的作用开展性别特异性研究。在制定降低肥胖症风险的教育政策时应考虑到这一点。
