IJE Advance Access published online on November 19, 2009
International Journal of Epidemiology, doi:10.1093/ije/dyp329
Comparative appraisal of educational inequalities in overweight and obesity among adults in 19 European countries
1Department of Public Health, Erasmus Medical Center, Rotterdam, The Netherlands.
2Scientific Institute of Public Health, Epidemiology Unit, Brussels, Belgium.
3Faculty of Public Health, Kaunas University of Medicine, Kaunas, Lithuania.
4Department of Preventive Medicine and Public Health, Universidad Complutense de Madrid, Ciudad Universitaria s/n, Madrid, Spain.
5Center for Social Policy Research, University of Bremen, Bremen, Germany.
6IRDES Research and Information Institute for Health Economics, Paris, France.
7Department of Social Geography and Regional Development, Charles University, Prague, Czech Republic.
8Present address: Statistics Netherlands (CBS), The Hague, The Netherlands.
9A list of additional participants to the study can be found in a supplementary file at IJE online.
* Corresponding author. Statistics Netherlands (CBS), Dept. SRS/SAV, Building B6, 2490 HA, The Hague, The Netherlands. E-mail: albertjanroskam{at}hotmail.com
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Abstract |
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Background In Western societies, a lower educational level is often associated with a higher prevalence of overweight and obesity. However, there may be important international differences in the strength and direction of this relationship, perhaps in respect of differing levels of socio-economic development. We aimed to describe educational inequalities in overweight and obesity across Europe, and to explore the contribution of level of socio-economic development to cross-national differences in educational inequalities in overweight and obese adults in Europe.
Methods Cross-sectional data, based on self-reports, were derived from national health interview surveys from 19 European countries (N = 127 018; age range = 25–44 years). Height and weight data were used to calculate the body mass index (BMI). Multivariate regression analysis was employed to measure educational inequalities in overweight and obesity, based on BMI. Gross domestic product (GDP) per capita was used as a measure of level of socio-economic development.
Results Inverse educational gradients in overweight and obesity (i.e. higher education, less overweight and obesity) are a generalized phenomenon among European men and even more so among women. Baltic and eastern European men were the exceptions, with weak positive associations between education and overweight and obesity. Educational inequalities in overweight and obesity were largest in Mediterranean women. A 10 000-euro increase in GDP was related to a 3% increase in overweight and obesity for low-educated men, but a 4% decrease for high-educated men. No associations with GDP were observed for women.
Conclusion In most European countries, people of lower educational attainment are now most likely to be overweight or obese. An increasing level of socio-economic development was associated with an emergence of inequalities among men, and a persistence of these inequalities among women.
Keywords Socio-economic inequalities, overweight, obesity, international overview, socio-economic development
Accepted 30 September 2009