Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, 3215 Market Street, 5th Floor, Philadelphia, PA, 19104, USA.
Drexel Urban Health Collaborative, Drexel University, 3600 Market Street, 7th Floor, Philadelphia, PA, 19104, USA.
Int J Obes (Lond). 2021 Mar;45(3):599-608. doi: 10.1038/s41366-020-00724-y. Epub 2020 Dec 18.
Children belonging to the same birth cohort (i.e., born in the same year) experience shared exposure to a common obesity-related milieu during the critical early years of development-e.g., secular beliefs and feeding practices, adverse chemical exposures, food access and nutrition assistance policies-that set the stage for a shared trajectory of obesity as they mature. Fundamental cause theory suggests that inequitable distribution of recent efforts to stem the rise in child obesity may exacerbate cohort-based disparities over time.
Data were from electronic health records spanning 2007-2016 linked to birth records for children ages 2-19 years. We used hierarchical age-period-cohort models to investigate cohort effects on disparities in obesity related to maternal education. We hypothesized that maternal education-based disparities in prevalence of obesity would be larger among more recent birth cohorts.
Sex-stratified models adjusted for race/ethnicity showed substantial obesity disparities by maternal education that were evident even at young ages: prevalence among children with maternal education < high school compared to maternal college degree was approximately three times as high among girls and twice as high among boys. For maternal education < high school, disparities compared to maternal college degree were higher in more recent birth cohorts. Among girls, this disparity cohort effect was evident at younger ages (at age 4, the disparity increased by 4 [0.1-8] percentage points per 5 birth years), while among boys it was larger at older ages (at age 16, the disparity increased by 7 [1-14] percentage points per 5 birth years).
There may be widening maternal education-based disparities in child obesity by birth cohort at some ages.
同一出生队列（即同年出生）的儿童在成长的关键早期会共同经历与肥胖相关的环境，例如，世俗观念和喂养习惯、不良的化学暴露、食物获取和营养援助政策，这些都为他们肥胖的共同轨迹奠定了基础。根本原因理论表明，最近遏制儿童肥胖率上升的努力在不同群体中的分配不均，可能会随着时间的推移加剧基于队列的差异。
数据来自 2007 年至 2016 年的电子健康记录，与 2-19 岁儿童的出生记录相链接。我们使用分层年龄-时期-队列模型来研究队列效应对与母亲教育相关的肥胖差异的影响。我们假设，在最近的出生队列中，母亲教育水平与肥胖相关的差异会更大。
按性别分层并调整了种族/族裔因素的模型显示，母亲教育水平与肥胖存在显著差异，即使在年幼时也很明显：与母亲拥有大学学历的孩子相比，母亲教育程度较低（未完成高中学业）的孩子中，女孩肥胖的比例大约高出三倍，男孩则高出两倍。对于母亲教育程度较低的孩子，与母亲拥有大学学历的孩子相比，最近出生的队列中差异更大。在女孩中，这种差异的队列效应在较年轻时就显现出来（在 4 岁时，每增加 5 年的出生年份，差异增加 4 [0.1-8]个百分点），而在男孩中，这种差异在较年长时更大（在 16 岁时，差异增加 7 [1-14]个百分点）。
在某些年龄，儿童肥胖的母亲教育程度的差异可能会随着出生队列的增加而扩大。
