The .gov means its official. Conceptualization: H.Z. Thorpe R.J., Jr., Parker L.J., Cobb R.J., Dillard F., Bowie J. PDF Discussion Brief: Costs of inequality and exclusion and transmitted securely. We calculated the Gini coefficient (GC) for the second set of analyses to measure income inequality. Neighborhood safety and green space as predictors of obesity among preschool children from low-income families in New York City. The concern increases when we include neighborhood and racial/ethnic minorities elements, and minority populations who are more likely to live in areas with the highest poverty rates, lowest financial and environmental resources, and higher rates of single mothers [15]. This figure compares GC between obese and non-obese women with different skin colors (Figure 2a) and obese and non-obese men with different skin colors (Figure 2b), and obese and non-obese populations by sex. Income inequality has sharply increased in recent years. Excess weight (overweight/obesity), urbanization, and social and gender inequalities are closely interrelated growing global issues. Educational attainment, labour market experience, age of youngest child and age. Is the Gender Pay Gap Closing or Has Progress Stalled? "The obesity premium is large, equivalent to the effect of a 60 percent increase in borrower self-reported income in the experiment," or an additional asset like ownership of a car, the study . To plot these curves, we used average GC with jackknife standard errors. In this approach, transferring an additional dollar from rich to poor improves the health status of poor communities more than rich communities [8]. Almost all socioeconomic factors, including income, are influenced by race and ethnicity. In fact, the rate of obesity has increased the fastest among low-income Americans. To our knowledge, it is the first study to examine the relationship between income inequality and obesity between men and women based on their race/ethnicity with a wide range of NHANES data (19992016). 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. 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]. Income inequality alone is associated with 16 and 35 percent of the variations in male and female obesity rates, respectively, across OECD countries in 2010. International Journal of Obesity - Socioeconomic inequalities in the prevalence of underweight, overweight, and obesity among women aged 20-49 in low- and middle-income countries Notes: We have defined quintile based on the GC calculated from ratio of family income to poverty. Growing Up Poor May Rewire a Child's Brain: Study The rest of the PIR was acquired by the top 25% of the population. The other half benefits major pharmaceutical and insurance companies, device manufactures, hospitals and physicians; meanwhile, the richest Americans live in a world in which public goodsincluding public health careare irrelevant [1]. Examining occupational health and safety disparities using national data: A cause for continuing concern. Any strategies to promote physical activity may help mitigate the obesity prevalence in men and women. Finally, obesity was associated positively with the size of a household in WNH. 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 there anything wrong with people getting rich if no one else is harmed in the process? Using body mass index (BMI)derived by dividing weight in kilograms by height in meters squared (kg/m2)we created a binary variable to identify participants who were obese (if BMI 30) as the outcome variable [26]. Kim K.-T. Accessibility Trogdon J.G., Finkelstein E.A., Hylands T., Dellea P.S., Kamal-Bahl S. Indirect costs of obesity: A review of the current literature. Additionally, the NHANES has some limitations with the income variable and did not report the real income instead of a categorical variable; otherwise, using household income as a continuous variable could give us a better opportunity to find the impact of income differences instead of a proxy variable PIR. Bell et al. Obesity has been postulated to be a consequence of economic disadvantage. Between 19992016, BNH experienced the highest obesity increases: from 18.6% to 45.9%. Statistics show that the top one percent of the population is capturing a much larger share of total income growth. When inequality is large enough, wealthy people live in a very different society from everyone else. Kim D., Wang F., Arcan C. Peer reviewed: Geographic association between income inequality and obesity among adults in New York State. 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). National Health and Nutrition Examination Survey: Plan and Operations, 19992010. Maternal BMI, initial weight-for-height z-score, gender, race, maternal education, marital status, cognitive score, emotional score. Zhang Q., Wang Y. : 0.011). Our findings from a similar study [18] showed a different association between obesity in men and women. Khullar D., Chokshi D.A. IV Poisson estimates the parameters of a Poisson regression model in which some of the covariates are endogenous. The original sample between 1999 and 2016 was 42,584 individuals and 50.6% of the study population were female. Main Independent Variable. (2) Variance in the number of observations is due to some missing data. 9th Edition. A potential source of bias are missing values (e.g., Zhong 2009 ), which respectively amount to 8.96% and 4.01% for the PIR and BMI variables in . In Table A1, we compare the prevalence of obesity across all study characteristics (See Table A1). In 2019, an estimated 38.2 million children under the age of 5 years were overweight or obese. Additionally, we calculated the Gini coefficient (GC) as a measure of income inequality to plot income inequality between obese and non-obese populations. Aggregation and the measurement of income inequality: Effects on morbidity. We used data from the 19992016 National Health and Nutrition Examination Surveys (NHANES) [27]. Deaton A., Lubotsky D. Mortality, inequality and race in American cities and states. Zare H., Gaskin D.D., Thorpe R.J. Income Inequality and Obesity among US Adults 19992016: Does Sex Matter? See Table 1 for detailed information and race/ethnicity groups. The .gov means its official. School of Public Health and Health Services. We used the 1999-2016 National Health and Nutrition . An official website of the United States government. (b) The Lorenz curves and Gini coefficients in men, 19992016. (a) The Lorenz curves and Gini coefficients in women, 19992016. In developing obesity-reducing policies, addressing these fundamental inequalities need essential attention [38]. Pampel F.C., Krueger P.M., Denney J.T. It plays a significant role in several adverse health outcomes, including hypertension, strokes, heart attacks, and diabetes [12]. Income Inequality and Obesity among US Adults 1999-2016: Does - MDPI ; Edit and review of the final products: H.Z., D.R.G., C.C., M.A., D.J.G. ; Writingoriginal draft: H.Z. Food swamps predict obesity rates better than food deserts in the United States. Sex differences in health and aging. Despite a little progress, the income gap between men and women has also been demonstrated, where men earn higher wages than women; for example, in 2012 median earnings for full-time men ages 15 and older were $49,398 but $37,791 for women [2,3]. Geographic Association Between Income Inequality and Obesity - PubMed Long-term, multi-level, community-level interventions should reduce obesity, specifically for men in all levels of income. Bias in meta-analysis detected by a simple, graphical test, Esc: effect size computation for meta-analysis, The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. 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. Weight Bias in the workplace: a literature review, Causation or selection examining the relation between education and overweight/obesity in prospective observational studies: a meta-analysis, Education, income, and occupational class cannot be used interchangeably in social epidemiology. Age and gender dependent profile of food choice. Neighborhood safety and green space as predictors of obesity among preschool children from low-income families in New York city. Health, income, & poverty: Where we are & what could help. Soobader M.-J., LeClere F.B. To understand more about these differences, we used Lorenz curves and Gini coefficients. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6198674/. Hales C.M., Carrol M.D., Fryar C.D., Ogden C.L. Conceptualization: H.Z., R.J.T.J. We adjusted the models according to age, racial/ethnic groups, marital status, education, health behaviors, health insurance, self-reported health, and household structure. NHANES: Analytic Guidelines, 20112014 and 20152016 (14 December 2018). A negative association between income inequality and poor health outcomes has been documented in several studies [7,8]. We also ran Model 3 with an interaction term of PIR quintile and sex. Inclusion in an NLM database does not imply endorsement of, or agreement with, 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. Representatives Ho: House of Representatives, 115th Congress Agricultural Improvement Act of 2018. The majority of the study sample had more than a high school education (60.0%), with a higher rate for WNHs (64.1%) and the lowest rate for MAs, of 31% with more than a high school diploma. One study showed that, after controlling for socio-environmental elements, the likelihood of being obese stays the same for black and white men [50]. Meta-analyses revealed that lower income is associated with subsequent obesity (OR 1.27, 95% CI 1.10 to 1.47; risk ratio 1.52, 95% CI 1.08 to 2.13), though the statistical significance vanished once adjusted for publication bias. Deriving ethnic-specific BMI cutoff points for assessing diabetes risk. There are also strengths to this study. Inequality as an Explanation for Obesity in the United States Abstract Over the past several decades, there has been a sharp increase in obesity across all population groups in the United States. Zou G. A modified poisson regression approach to prospective studies with binary data. Analysis of the income inequality hypothesis with market and disposable gini indicators. The same association was not found for women. In this study, we investigated the relationship between obesity and income measured by the PIR and how this association changes between men and women. Kirby J.B., Kaneda T. Neighborhood socioeconomic disadvantage and access to health care. There is a massive gap between the income-to-poverty ratio between 19992016. For this study, we included participants who were 20 years old and older. The adjusted models show that in all racial/ethnic groups, the obese population was more women, high school graduates, and former drinkers with poor or fair health. FOIA Once considered a high-income country problem, overweight and obesity are now on the rise in low- and middle-income countries, particularly in urban settings. In addition to race/ethnicity and environment, sex also plays a role in obesity. 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. 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. In 20172018, the prevalence of obesityone of the well-known health outcome measureswas 42.4% in US adults; between 1999 and 2018, the age-adjusted prevalence of obesity increased from 30.5% to 42.4% [14] and the medical cost of adult obesity in the US was estimated from $147 billion to nearly $210 billion per year [15,16]. Association between discrimination and obesity in African-American men. Publishers Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations. For men, there is higher income inequality in the non-obese population (panel D). 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. PR = prevalence ratio. They had a higher probability of being married, having higher education, being former smokers and drinkers, not being physically active, and having poor health conditions. "Wealth and income inequality are accelerating in the U.S.," said co-corresponding author Scott Marek, an assistant professor of radiology and of psychiatry."We and others are starting to . Income inequality and health status in the United States: Evidence from the current population survey. 240-760-6600. The worldwide prevalence of obesity nearly tripled between 1975 and 2016. ; Data curation: H.Z. Age, race, marital status, time from latest pregnancy to the interview, education of the parents, AFQTscore, self-esteem, years of employment, participated in on-the-job training, area of residence, unemployment rate in the residential unit, no of private businesses at state level, average income by state, consumer price index, education, occupation, occupation requiring social interaction. Indeed, this study is unique for including all of these elements together. 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. Kim et al. The GC moved from 0.333 (SE: 0.003) in obese men to 0.348 (SE: 0.002) in non-obese men. Lovasi G.S., Schwartz-Soicher O., Quinn J.W., Berger D.K., Neckerman K.M., Jaslow R., Lee K.K., Rundle A. Most of the published articles on obesity and sex differences discussed the impact of geographical location [52], neighborhood factors [53], behavioral and physical activities [54,55] and income inequality [56,57]. and transmitted securely. As presented, obese women between the 5th and 10th percentile of the population suffered more from income inequality (panel C); the GC in obese women moved between 0.337 (SE: 0.003) to 0.351 (0.002) in non-obese women. National Health and Nutrition Examination Survey: Plan and Operations, 19992010. Available online: Centers for Disease Control Prevention. Dietary Guidelines for Americans, 20202025. For example, among obese men, lower than 25% of the population acquired only 7.1% of PIR and 53% of PIR was acquired by 75% of the population. The authors declare that there is no conflict of interest. To control for health status, we used self-reported general health status (excellentvery good, goodfair, and poor). The primary independent variable of interest was the Poverty Income Ratiothe ratio of family income to the poverty threshold. The above statement may be true in the market as a general term, but how does income inequality impact health industries and, most importantly, health outcomes. The PIR was positively associated with the prevalence of obesity in men in the higher quintile of PIR but negatively associated with womens obesity in the same group. Using the income quintile approach, we defined a categorical variable with five quintiles from low to high. Notes: NH = Non-Hispanic; (1) We defined quintile based on the GC calculated from the ratio of family income to poverty; (2) Bonferroni correction (p < 0.002) shows the significant difference between men and women. Conducting more research focusing on gender differences. Mellor J.M., Milyo J. Note. [(accessed on 15 May 2021)]; National Health and Nutrition Examination Survey 19992000 Data Documentation, Codebook, and Frequencies. Specifically for low-income people, maintaining a healthy diet requires money and an ease-of-access to healthy foods. In women, PIR was negatively related to the prevalence of obesity. Income inequalities and racial disparities can create psychosocial stress directly harmful to health [24], with more impact from racial composition than income inequality. The Economics of Obesity: Poverty, Income Inequality, and Health Income and Wealth Inequality and Obesity | SpringerLink After controlling for potential covariates, there is little evidence to determine the association between income and obesity and how obesity may be moderated by sex and family income. NH = non-Hispanic. 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. In biomedicine, thin is still in: Obesity surveillance among racialized, (Im) migrant, and female bodies. The alarming trends in income inequality raise questions: what is happing if income inequality stays high? In the last four decades, the actual annual earnings for the top 1% and bottom 90% increased 158% and 24%, respectively, with wider gaps between men and women [2,3]. Zumbrun J. Does the state you live in make a difference? government site. Results of GC in obese women showed that in comparison with WNHs (GC: 0.34, S.E. Study population characteristics.Table 1 compares the distribution of the samples characteristics. Mother smoking during pregnancy, length of breast feeding, maternal BMI, early introduction to solid foods, childs gender, physical activity (frequency of sport, active playing with parent, use of a playground, use of a bike), sedentary behaviour (watching TV, PC use), bedtime, fruit portion per day, skipping breakfast, sweet drinks consumption. We examined the association between income and obesity in U.S. adults aged 20 years and older, and tested whether this relationship differs by race or ethnicity groups. In the following paragraphs, we discuss more about these findings and policy recommendations. Health, income, & poverty: Where we are & what could help. Among obese women, these distributions changed to 6% and 48% of the first 25% and 75% of the population and 52% of PIR acquired by the top 25% of the population. This effect was stronger in counties with greater income inequality and less mobile residents. For the first set of analyses, we used a modified Poisson regression in a sample of 36,665 adults, with an almost equal number of men and women (womens ratio was 50.6%), including 17,303 white non-Hispanics (WNH), 7475 black non-Hispanics (BNHs), and 6281 Mexican Americans. Overall, the sample age was 47.0 14.0 years, with a slightly more aging WNH population (48.6 11.3). There is a negative association between the income inequality levels and obesity in women. Background: Obesity among the elderly imposes a significant health and economic burden. Download .nbib Meta-analyses revealed that lower income is associated with subsequent obesity (OR 1.27, 95% CI 1.10 to 1.47; risk ratio 1.52, 95% CI 1.08 to 2.13), though the statistical significance vanished once adjusted for publication bias. Persistent poverty areas are those where, for the past 30 years, 20% or more of the population has lived below the federal poverty line. 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). Association of Food Deserts and Food Swamps With Obesity-Related Cancer In obese women, WNHs lower 25% of the population observed 8.1% of income, BNH followed 6.2% of income, and MA observed 6.4% of income. The research, published in Cell . Muller A. National Health and Nutrition Examination Survey: Analytic Guidelines, 20112014 and 20152016. Model 2 was an adjusted Model 1 including sex (=1 if female) as a covariate. Sex differences in the association of socioeconomic status with obesity. See Table 4 for more details. Higher levels of income inequality in the 2005-2010 period were associated with a more rapid increase in obesity prevalence from 2002. Eating the right number of calories, meeting food group needs, and being physically active. For this analysis, we used data from the 19992016 National Health and Nutrition Examination Surveys (NHANES). Gender differences. 8600 Rockville Pike Socioeconomic status in relation to obesity and abdominal obesity in Korean adults: A focus on sex differences. National Library of Medicine Several aspects of the present study deserve comment. Race, neighborhood economic status, income inequality and mortality. the contents by NLM or the National Institutes of Health. The importance of income inequalities is not just about its direct or indirect impact on health outcomes. Studies have shown that racial composition plays a significant role in health outcomeseven more than income inequality. One study has shown additional hazards to the health of people in communities with unequal distribution of income [6]. Most importantly, policymakers may develop policies such as a minimum wage to address fundamental inequality such as income gaps [2] and wage disparities [58]. Men in higher income groups experienced higher probability of being obese, which may be explained by lower physical activities. FOIA See Table 2 for more details on the GC across race/ethnicity and sex.

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