Department of Political and Social Sciences, Research Group on Health Inequalities, Environment, Employment Conditions Knowledge Network (GREDS-EMCONET), Universitat Pompeu Fabra, Barcelona, Spain.
Johns Hopkins University - Pompeu Fabra University Public Policy Center (UPF-BSM), Universitat Pompeu Fabra, Barcelona, Spain.
J Urban Health. 2022 Dec;99(6):1091-1103. doi: 10.1007/s11524-022-00689-5. Epub 2022 Nov 10.
While income gradients and gender inequalities in excess weight have been noted elsewhere, data from Latin American cities is lacking. We analyzed gender-specific associations between city-level women's empowerment and income inequality with individual-level overweight/obesity, assessing how these associations vary by individual education or living conditions within cities in Latin America. Data came from national surveys and censuses, and was compiled by the SALURBAL project (Urban Health in Latin America). The sample included 79,422 individuals (58.0% women), living in 538 sub-cities, 187 cities, and 8 countries. We used gender-stratified Poisson multilevel models to estimate the Prevalence Rate Ratios (PRR) for overweight/obesity (body mass index ≥ 25 kg/m) per a unit change in city-level women's empowerment (proxied by a score that measures gender inequalities in employment and education) and income inequality (proxied by income-based Gini coefficient). We also tested whether individual education or sub-city living conditions modified such associations. Higher city labor women's empowerment (in women) and higher city Gini coefficient (in men) were associated with a lower prevalence of overweight/obesity (PRR = 0.97 (95%CI 0.94, 0.99) and PRR = 0.94 (95%CI 0.90, 0.97), respectively). The associations varied by individual education and sub-city living conditions. For labor women's empowerment, we observed weakened associations towards the null effect in women with lower education and in residents of sub-cities with worse living conditions (men and women). For the Gini coefficient, the association was stronger among men with primary education, and a negative association was observed in women with primary education. Our findings highlight the need for promoting equity-based policies and interventions to tackle the high prevalence of excess weight in Latin American cities.
虽然在其他地方已经注意到超重的收入梯度和性别不平等，但拉丁美洲城市的数据却缺乏。我们分析了城市层面的妇女赋权和收入不平等与个体层面超重/肥胖之间的性别特异性关联，评估了这些关联如何因城市内个体教育或生活条件而异。数据来自国家调查和人口普查，由 SALURBAL 项目（拉丁美洲城市卫生）汇编。样本包括 79422 名个体（58.0%为女性），居住在 538 个分区、187 个城市和 8 个国家。我们使用性别分层泊松多水平模型来估计城市层面妇女赋权（通过衡量就业和教育方面性别不平等的得分来衡量）和收入不平等（通过基于收入的基尼系数来衡量）每单位变化与超重/肥胖（身体质量指数≥25kg/m）之间的患病率比值（PRR）。我们还测试了个体教育或分区生活条件是否改变了这种关联。更高的城市劳动力妇女赋权（在女性中）和更高的城市基尼系数（在男性中）与较低的超重/肥胖患病率相关（PRR=0.97（95%CI 0.94，0.99）和 PRR=0.94（95%CI 0.90，0.97））。这些关联因个体教育和分区生活条件而异。对于劳动力妇女赋权，我们观察到在教育程度较低的女性和生活条件较差的分区居民（男性和女性）中，关联向无效方向减弱。对于基尼系数，在受小学教育的男性中关联更强，而在受小学教育的女性中观察到负关联。我们的研究结果强调了需要制定基于公平的政策和干预措施，以解决拉丁美洲城市中超重的高患病率问题。
