Shibre Gebretsadik, Zegeye Betregiorgis, Woldeamanuiel Gashaw Garedew, Negash Wassie, Lemma Gorems, Taderegew Mitku Mamo
Department of Reproductive, Family and Population Health, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia.
HaSET Maternal and Child Health Research Program, Shewarobit Field Office, Shewarobit, Ethiopia.
Arch Public Health. 2021 Jul 23;79(1):133. doi: 10.1186/s13690-021-00658-5.
While the prevalence of obesity is increasing worldwide, the growing rates of overweight and obesity in developing countries are disquieting. Obesity is widely recognized as a risk factor for non-communicable diseases (NCDs), including diabetes, cancer and cardiovascular diseases. Available evidence on whether obesity has been more prevalent among higher or lower socioeconomic groups, across regions and urban-rural women's are inconsistent. This study examined magnitude of and trends in socioeconomic, urban-rural and sub-national region inequalities in obesity prevalence among non-pregnant women in Chad.
Using cross-sectional data from Chad Demographic and Health Surveys (DHSs) conducted in 1996, 2004 and 2014; we used the World Health Organization (WHO) Health Equity Assessment Toolkit (HEAT) to analyze socio-economic, urban-rural and regional inequalities in obesity prevalence among non-pregnant women aged 15-49 years. Inequalities were assessed using four equity stratifiers namely wealth index, educational level, place of residence and subnational region. We presented inequalities using simple and complex as well as relative and absolute summary measures such as Difference (D), Population Attributable Risk (PAR), Population Attributable Fraction (PAF) and Ratio (R).
Though constant pattern overtime, both wealth-driven and place of residence inequality were observed in all three surveys by Difference measure and in the first and last surveys by Ratio measure. Similarly, including the recent survey (D = -2.80, 95% CI:-4.15, - 1.45, R = 0.37, 95% CI: 0.23, 0.50) absolute (in 1996 & 2014 survey) and relative (in all three surveys) educational status inequality with constant pattern were observed. Substantial absolute (PAR = -2.2, 95% CI: - 3.21, - 1.34) and relative (PAF = - 91.9, 95% CI: - 129.58, - 54.29) regional inequality was observed with increasing and constant pattern by simple (D) and complex (PAR, PAF) measures.
The study showed socioeconomic and area-based obesity inequalities that disfavored women in higher socioeconomic status and residing in urban areas. Prevention of obesity prevalence should be government and stakeholders' priority through organizing the evidence, health promotion and prevention interventions for at risk population and general population.
虽然全球肥胖症患病率在上升，但发展中国家超重和肥胖症的增长速度令人担忧。肥胖被广泛认为是非传染性疾病（如糖尿病、癌症和心血管疾病）的一个风险因素。关于肥胖症在不同社会经济群体、不同地区以及城乡女性中是否更为普遍的现有证据并不一致。本研究调查了乍得非孕妇群体中肥胖症患病率的社会经济、城乡及国家以下区域不平等的程度和趋势。
利用1996年、2004年和2014年乍得人口与健康调查（DHS）的横断面数据；我们使用世界卫生组织（WHO）健康公平评估工具包（HEAT）来分析15 - 49岁非孕妇群体中肥胖症患病率的社会经济、城乡和区域不平等情况。使用财富指数、教育水平、居住地点和国家以下区域这四个公平分层变量来评估不平等。我们使用简单和复杂以及相对和绝对的汇总指标（如差值（D）、人群归因风险（PAR）、人群归因分数（PAF）和比值（R））来呈现不平等情况。
尽管随时间推移模式不变，但通过差值测量法在所有三次调查中以及通过比值测量法在第一次和最后一次调查中均观察到了财富驱动和居住地点不平等。同样，包括最近一次调查（D = -2.80，95%置信区间：-4.15，-1.45，R = 0.37，95%置信区间：0.23，0.50），观察到了绝对（在1996年和2014年调查中）和相对（在所有三次调查中）教育状况不平等且模式不变。通过简单（D）和复杂（PAR，PAF）测量法观察到了显著的绝对（PAR = -2.2，95%置信区间：-3.21，-1.34）和相对（PAF = -91.9，95%置信区间：-129.58，-54.29）区域不平等，且呈增加和不变的模式。
该研究表明了社会经济和基于地区的肥胖不平等现象，这些不平等对社会经济地位较高和居住在城市地区的女性不利。预防肥胖症患病率应成为政府和利益相关者的优先事项，通过整理证据、对高危人群和普通人群开展健康促进和预防干预措施来实现。
