; Funding acquisition: D.D.G., R.J.T.J. Income inequality and health status in the United States: Evidence from the current population survey. Note. The combination of income inequality and racial composition creates additional complexity. Comparing Obesity Prevalence between Men and Women in US Adults over 20 years of age in 19992016 National Health and Nutrition Examination Survey (N = 36,665). The association between income inequality and racial/ethnicity showed that BNHs and MAs suffered more from obesity than WNHs. National Health and Nutrition Examination Survey: Analytic Guidelines, 20112014 and 20152016. The original sample between 19962016 was 40,917 individuals, with a womens ratio of 50.6%. Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion. Background This study explores the relationship between BMI and national-wealth and the cross-level interaction effect of national-wealth and individual household-wealth using multilevel analysis. We used the 19992016 National Health and Nutrition Examination Survey (NHANES). ; Formal analysis: H.Z. One study has shown additional hazards to the health of people in communities with unequal distribution of income [].Studies have also reported a negative association between income inequality and poor health outcomes [7,8].Income influences health outcomes by decreasing the barriers to accessing care or by moderating environmental factors, living in healthier . Having health insurance coverage also was associated with obesity in MA, but not in WNH and BNH. Differences between men and women can be explained by lower physical activities by men or may be because of better intake of food by women. Because the interaction between income quintile and race was significant (p < 0.001), we stratified the analyses by race. Income influences health outcomes by shaping health behaviors to reduce behavioral risk factors, decreasing the barriers to accessing care, moderating environmental factors, or reducing inequalities [10]. Our literature search showed that despite a fair number of publications regarding income inequality and health [25,39,40,41,42,43], little is known about the impact of income inequality and obesity in men and women, specifically men and women of color. For example, being married has been positively associated with obesity in BNH and MA but not in WNH. We ran sets of weighted modified Poisson regression analyses. Pampel F.C., Krueger P.M., Denney J.T. We did not include pregnant women (1667) or missing observations for Poverty Income Ratio (PIR) in the analysis; this yielded an analytic sample of 36,665, including 17,303 white non-Hispanics (WNHs), 7475 black non-Hispanics (BNHs), and 6281 Mexican Americans (MAs). Indeed, this study is unique for including all of these elements together. Across the United States, the degree of income inequality is associated with a wide range of factors that may influence health, with greater income inequality associated with higher unemployment, higher proportions of people without health insurance, lower per capita medical spending, and lower rates of high school graduation. As presented in panel B, obese BNH women suffered less from income inequality than non-obese (GC: 0.380 vs. 0.392). Is there anything wrong with people getting rich if no one else is harmed in the process? We defined obesity if the body mass index was 30 kg/m2, and calculated the Gini coefficient (GC) to measure income inequality by using the Poverty Income Ratio. (2) Variance in the number of observations is due to some missing data. Income and Wealth Inequality and Obesity Tahereh Alavi Hojjat Chapter First Online: 21 August 2021 840 Accesses 1 Altmetric Abstract Many developing countries have experienced a sharp rise in income inequality in the last four decades. ; Edit and review the final products; H.Z., D.D.G., R.J.T.J. This context increases the importance of understanding the relationship between income distribution and specific health conditions [4]. Introduction In addition to economic factors and geographic area poverty, area income inequality the extent to which income is distributed in an uneven manner across a population has been found to influence health outcomes and obesity. Weight and weight concerns: are they associated with reported depressive symptoms in adolescents? America has experienced sharp increases in income inequality in recent decades. In biomedicine, thin is still in: Obesity surveillance among racialized,(Im) migrant, and female bodies. (b) The Lorenz curves and Gini coefficients in men, 19992016. On average, 35% of the population were obese; in comparison, black NHs with 45.5% had higher obesity rates than MA (40%) and white NHs (35%). We used STATA statistical software version 15 to perform all analyses. For men, there is higher income inequality in the non-obese population (panel D). Income and inequality as determinants of mortality: An international cross-section analysis, Subramanian S.V., Blakely T., Kawachi I. Commentary: Income inequality as a public health concern: Where do we stand? Association between income inequality and obesity in US men and women. ; Data curation: H.Z. Mexican Americans had a 19.5%-point increase in obesity from 17.4% to 36.9%, and the lowest increase was for WNH by 11.3 percentage points: from 21.3% to 32.6% in WNH (see Figure 1, panels A and B). It plays a significant role in several adverse health outcomes, including hypertension, strokes, heart attacks, and diabetes [12]. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6198674/. For the first set of analysis and by calculating GC and plotting the Lorenz Curve, we compared income inequality between obese men and obese women. and D.J.G. Our results suggest that policymakers should consider strategies to reduce structural inequality and encourage access to healthy foods and community-supported agricultural programs as nutritional interventions in low-income population settings. [(accessed on 25 October 2021)]; NHANES Analytic Guidelines, 20112014 and 20152016 (14 December 2018). Page Last Reviewed: 7 June 2021. Zhang Q., Wang Y. In fact, the United States has one of the highest rates of obesity compared to other countries throughout the world. ; Resources: D.D.G., R.J.T.J. The effect of stress on mens food selection. The household structure is an essential element in predicting individual/household income [32], so we used a binary variable to present living alone (1 = yes; 0 = no) and number of people in a household. Abstract. Thorpe Jr R.J., Kelley E., Bowie J.V., Griffith D.M., Bruce M., LaVeist T. Explaining racial disparities in obesity among men: Does place matter? The Lorenz curve is a graphical technique to estimate how income is distributed among a population; that is, a higher distance from the line of perfect equality means a smaller percentage of the population receives most of the wealth, and the countrys income distribution is uneven. Obesity rates in the United States continue to worsen in parallel with income inequality. and transmitted securely. There is no association between PIR and obesity for Mexican American men. National income and income inequality impacts on the body size of children and adolescents according to new research from the University of Auckland. However, epidemiological studies failed to demonstrate a consistent link between income and body fat indicators. In states where the median income was below $45,000 (34,500) a year, obesity levels were more than 35%, whereas in states where median income was above $65,000 a year obesity levels were. (2019) reported that income was negatively associated with highly socially integrated mens weight status, but was positively associated with weight status among lower socially integrated men [17]. In previous sections, we reported the results for men and women, adjusted by sex, while considering the significant interaction between the PIR quintiles and sex, and we stratified the analyses for men and women. Conceptualization: H.Z., R.J.T.J. In addition to race/ethnicity and environment, sex also plays a role in obesity. The Oxford Handbook of the Social Science of Obesity. Comparing study sample characteristics between men and women, US Adults over 20 years of age in 19992016 National Health and Nutrition Examination Survey (N = 36,665). There are aspects of the study that deserve comment. For this analysis, we used data from the 19992016 National Health and Nutrition Examination Surveys (NHANES). Kim et al. Income has direct and indirect effects on health by facilitating an opportunity to control life circumstances and to promote social participation [7]. Dinsa GD, Goryakin Y, Fumagalli E, et al.. Obesity and socioeconomic status in developing countries: a systematic review, Socioeconomic status and obesity: a review of the literature, The influence of income on health: views of an epidemiologist, An ecological study of the relationship between social and environmental determinants of obesity. Statistics show that the top one percent of the population is capturing a much larger share of total income growth. Our findings show that income inequality plays different roles between racial/ethnic groups and between men and women. : 0.004) and MAs (GC: 0.41, S.E. Centers for Disease Control and Prevention. The standard errors for these estimators were very small and there was a significant difference between the GC in men and in women (p < 0.001). ; Writingoriginal draft: H.Z. WNH in the 3rd, 4th, and 5th PIR quintiles suffered 22%, 34%, and 29% times more than the population in the first PIR quintile. This association may operate differently by men and women. It is one of the main reasons why the gap between the richest and poorest threatens communities and public health. We must note that the Lorenz curves are unaffected by the mean of the distribution, and they cannot be used to rank distributions in terms of social welfare, only in terms of inequality [60]. To capture more variances, we should control our models based on the geographical variables such as urban and rural areas and neighborhoods or at the county levelthe next step in our study. We considered p-values <0.05 as statistically significant and all tests were two-sided. School of Public Health and Health Services. Handbook on Poverty+ Inequality. Income Distribution and Obesity. Inequality Aversion, Health Inequalities, and Health Achievement. The Lorenz curves (Figure 2) show the Gini coefficient (GC) for the income to poverty ratio in mens and womens populations in the US between 1999 and 2016. Neighborhood safety and green space as predictors of obesity among preschool children from low-income families in New York city. Women are more obese in low- and middle-income countries, but the gender gap disappears in high-income economies. Zellner D.A., Saito S., Gonzalez J. Approximately half of the world's population lives in urban areas [ 1 ], and about 39% of the world's adult population was living with overweight or obesity in 2015 [ 2 ]. https://www.dietaryguidelines.gov/sites/default/files/2020-12/Dietary_Guidelines_for_Americans_2020-2025.pdf, https://www.irs.gov/pub/irs-prior/i990sh--2017.pdf. One study has shown additional hazards to the health of people in communities with unequal distribution of income [6]. (2018) reported that income inequality and a lower poverty percentage were significantly associated with lower obesity rates in men [51]. Using data from the National Health and Nutrition Examination Survey (NHANES), CDC analyzed obesity prevalence among adults (aged 20 years) by three levels of household income, based on percentage (130%, >130% to 350%, and >350%) of the federal poverty level (FPL) and individual education level (high school graduate or less, some college, and. Is the Gender Pay Gap Closing or Has Progress Stalled? The purpose of this study was to measure the obesity prevalence and income-related inequality among older adults in China and to explore the determinants of the inequity. (2018) reported that income inequality and lower poverty percentage are significantly associated with lower obesity rates in men [52]. In panel I, we compared the income inequality between WNH, BNH, and MA obese men. It varies by multiple factors, including but not limited to income and sex. sharing sensitive information, make sure youre on a federal We examined the association between income and obesity in adults ages 20 years and older and tested whether this relationship differs by sex in the United States. Studies have shown that racial composition plays a significant role in health outcomeseven more than income inequality. Income inequality and health: What have we learned so far? Our subset analysis on GC showed that obese Black Non-Hispanics with GC 0.380 (SE:0.004) experienced higher income inequality than White-NH (GC 0.301, SE: 0.004). The association between PIR and obesity in white NH, black NH, and MA is reported in Table 3. (a) The Lorenz curves and Gini coefficients in women, 19992016. In the last four decades, the real annual earnings for the top 1% and bottom 90% increased 158% and 24%, respectively. The stratified analysis of income across sex indicated that men in middle- and upper-income quintiles were more likely to be obese. Notes: Values show the prevalence ratio for adjusted model 4 and 6 (see Table 3 for more details. We also used a binary variable to present living alone (1 = yes; 0 = no) and female-headed household (1 = yes; 0 = no). [(accessed on 25 October 2021)]; NIH Assessing Your Weight and Health Risk. Available online: Trogdon J.G., Finkelstein E.A., Hylands T., Dellea P.S., Kamal-Bahl S. Indirect costs of obesity: A review of the current literature. Policymakers should consider a combination of local and federal policies similar to farm bill policies [61] as short- and long-term strategies to improve health outcomes and to better distribute the income. https://creativecommons.org/licenses/by/4.0/, https://www.cdc.gov/nchs/nhanes/index.htm, https://www.wsj.com/articles/BL-REB-24473, https://www.cdc.gov/nchs/data/databriefs/db360-h.pdf, https://stop.publichealth.gwu.edu/sites/stop.publichealth.gwu.edu/files/documents/Fast%20Facts%20Cost%20of%20Obesity.pdf, https://www.cdc.gov/nchs/nhanes/about_nhanes.htm, https://www.cdc.gov/nchs/data/series/sr_01/sr01_056.pdf, https://wwwn.cdc.gov/nchs/data/nhanes/2011-2012/analyticguidelines/analytic_guidelines_11_16.pdf, https://www.nhlbi.nih.gov/health/educational/lose_wt/risk.htm, https://www.stata.com/manuals/rivpoisson.pdf. Specifically for low-income people, maintaining a healthy diet requires money and an ease-of-access to healthy foods. Socioeconomic disparities in health behaviors. Obesity is a major public health problem that varies by income and sex, yet there is little evidence to determine the association between income inequality and obesity. We considered p-values < 0.05 as statistically significant, and all tests were two-sided. Afzal S, Tybjaerg-Hansen A, Jensen GB, et al.. Change in body mass index associated with lowest mortality in Denmark, 19762013, Conducting meta-analyses in R with the metafor package, Trim and fill: A simple funnel-plot-based method of testing and adjusting for publication bias in meta-analysis. Comparing Gini coefficient across racial/ethnical groups and sex in U.S. adults in the 19992016. For instance, income inequality is negatively associated with weight status in men who are highly socially integrated, but is positively associated with weight status among men who have low social integration [21]. Notes: We have defined quintile based on the GC calculated from ratio of family income to poverty. Income inequality drives up obesity rates and associated diseases. To control for health status, we used self-reported general health status (excellentvery good, goodfair, and poor). This study investigated the relationship between obesity and PIR, and how this association changes between men and women of color (white NH, black NH, and Mexican Americans). Psychosocial and material pathways in the relation between income and health: A response to Lynch et al. Low BMI can be an indicator for cancer or other severe poor health states that cause weight loss. In Table A1, we compare the prevalence of obesity across all study characteristics (See Table A1). Age, presence of small children in the household, migration status, area of residence, marital status, non-wage/spouse income, home ownership, education, smoking behaviour, drinking behaviour. This work was supported by the NIMHD-U54MD000214-6865. Kirby J.B., Kaneda T. Neighborhood socioeconomic disadvantage and access to health care. Model 2 was an adjusted Model 1 including sex (=1 if female) as a covariate. Policymakers and social activists may think about using the non-profit hospitals resources to provide life changes education and healthy food to communities, prioritizing low-income populations, pregnant women, elderly, and single-parent households [18]. Obesity was determined using Body Mass Index 30 kg/m2; the Gini coefficient (GC) was calculated to measure income inequality using the Poverty Income Ratio (PIR). Variance in the number of observations is due to some missing data. Peeters A, Barendregt JJ, Willekens F, et al.. Obesity in adulthood and its consequences for life expectancy: a life-table analysis. The site is secure. US state-and county-level social capital in relation to obesity and physical inactivity: A multilevel, multivariable analysis. The report focused on the association between the number and . FOIA 2 million participants, Association of all-cause mortality with overweight and obesity using standard body mass index categories: a systematic review and meta-analysis, The morbidity and mortality associated with overweight and obesity in adulthood: a systematic review. Study population characteristics.Table 1 compares the distribution of the samples characteristics. The association of PIR levels and obesity in the sample of men is displayed in Table 3. Received 2021 Sep 3; Accepted 2021 Oct 23. ; Data curation: H.Z. A study of over 200,000 children in 36 countries including New Zealand, Australia and the United Kingdom has found rates of obesity can be affected by the income levels, with adolescent girls . In our sample, the prevalence of obesity was greater than 10%; therefore, we used a weighted modified Poisson regression analysis [29,30,31] that produced prevalence ratios (PR) and corresponding 95% confidence intervals (CI) [29,30]. In this approach, transferring an additional dollar from rich to poor improves the health status of poor communities more than rich communities [8]. Education, parental status, work experience, occupation, race, socioeconomic background (1997), household income, mothers education, fathers education), health limitations, (Armed Services Vocational Aptitude Battery). The blue line stays over the red line for about 30% of the population and closer to the perfect equality line, which means lesser income inequality within non-obese (GC: 0.269) and greater inequality within obese women (GC: 0.301). The authors declare that there is no conflict of interest. Zare H., Gaskin D.D., Thorpe R.J. Income Inequality and Obesity among US Adults 19992016: Does Sex Matter? 240-760-6600. NHANES: Analytic Guidelines, 20112014 and 20152016 (14 December 2018). Evidence shows that extent bias because of reverse causation is mainly indirect [59]. Addressing socioeconomic inequalities in obesity: Democratising access to resources for achieving and maintaining a healthy weight Jean Adams x Published: July 28, 2020 https://doi.org/10.1371/journal.pmed.1003243 Article Authors Metrics Comments Media Coverage References Reader Comments National Center for Health Statistics. As stated by NHANES, all body measures were obtained by trained health technicians in the body measures room for each of the Mobile Examination Centers [27]. Specifically, for low-income, vulnerable communities, the resources need to combat obesity through access to fresh foods and CSA programs as nutritional interventions and not only promote access to healthy foods but also generate higher income for low-income communities and reduce income inequalities as a long-term sustainable strategy. Bell C.N., Kerr J., Young J.L. McNutt L.-A., Wu C., Xue X., Hafner J.P. Estimating the relative risk in cohort studies and clinical trials of common outcomes. [(accessed on 15 May 2021)]; National Health and Nutrition Examination Survey 19992000 Data Documentation, Codebook, and Frequencies. Yoon Y.S., Oh S.W., Park H.S. The results of the adjusted model (Model 2) indicate that the obese population comprised more women, Black NH, or Mexican Americans. Studies have focused on an ecological association of income distribution and mortality as a main health outcome [5,6]. [(accessed on 25 October 2021)]; Syed I.U. The evidence indicated that the extent of bias due to reverse causation was largely indirect [58]. See Table 1 for detailed information and race/ethnicity groups. Does obesity influence labour market outcomes among working-age adults? : 0.006) experienced higher income inequality, and that BNH obese men experienced the highest income inequality (GC: 0.45, S.E. If B was zero, then the GC will be one, which means absolute inequality [31]; the Lorenz curve represents the actual distribution of income in a given society [19]. "Wealth and income inequality are accelerating in the U.S.," said co . The researchers also found that childhood obesity and lower cognitive function may explain, at least partially, poverty's influence on white matter differences. An ecological study of obesity and income inequality. An official website of the United States government. [(accessed on 25 October 2021)]; USDA U.S. Department of Agriculture and U.S. Department of Health and Human Services. Lochner K., Pamuk E., Makuc D., Kennedy B.P., Kawachi I. State-level income inequality and individual mortality risk: A prospective, multilevel study. If nothing else is done in the United States beyond what is being done now, simulated growth trajectories that model today's children show that over half (59% of today's . Neighborhood safety and green space as predictors of obesity among preschool children from low-income families in New York City. It could be because of higher drinking behavior for men [19] or higher exercise activities for women [20], eating more healthy foods, or higher probability of women visiting a health care provider [21,22,23]. Zipf G., Chiappa M., Porter K.S., Ostchega Y., Lewis B.G., Dostal J. Results of GC in obese women showed that in comparison with WNHs (GC: 0.34, S.E. Additionally, sex plays a role in obesity; a few international studies showed that lower socioeconomic status increased the risk of becoming obese in women compared to that in men. ; Software: H.Z. Careers, Unable to load your collection due to an error. Obesity is a major public health problem that varies by income and sex, yet there is little evidence to determine the association between income inequality and obesity. Obesity rates in the United States continue to worsen in parallel with income inequality. Long-term, multi-level, community-level interventions should reduce obesity, specifically for men in all levels of income. Scholars have disputed the reasons for this rise of income inequality. U.S. Departmnet of Health and Human Services. For the regression models, we defined a categorical variable with five quintiles: lowest quintile (PIR < 0.08), second quintile (0.811.36), middle quintile (1.372.33), fourth quintile (2.344.10), and fifth quintile (4.115.00). Cohen S.A., Cook S.K., Kelley L., Foutz J.D., Sando T.A. We used STATA statistical software, version 16, to perform all analyses. The same association was not found for women. Sturm R., Gresenz C.R. The last panel (Panel D) compares income inequality between obese WNH, BNH, and MA; overall, BNH women suffered more from obesity than WNH and MA obese women. World Bank Publications; Washington DC, USA: 2009. Poverty is concerning, but what is the problem if some people make more money than others? To make our estimates representative of the national US civilian population, all analyses were weighted using the NHANES individual-level sampling weights for 19992016 (8 waves of data) [32]. Additionally, developing nutritional intervention programs such as community CSAswith prioritization of low-income communitiesmay improve access to healthy foods with lower cost [43], reduce obesity, and ensure income equity in low-income communities. The models included age, racial/ethnic groups, marital status, education, health behaviors (smoking and drinking status and physical activities), health insurance coverage, self-reported health, and household structure (live alone and size of household). Geographic Association Between Income Inequality and Obesity Among Adults in New York State Increased income inequality and lower poverty percentage were significantly linked to lower obesity rates across NYS counties for men.
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obesity and income inequality
