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Disentangling effects of socioeconomic status on obesity: A cross-sectional study of the Spanish adult population

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  • Merino Ventosa, María
  • Urbanos-Garrido, Rosa M.maria.merino.ven@gmail.com

Abstract

This paper complements previous estimations regarding socioeconomic inequalities in obesity for Spanish adults, and provides new evidence about the mechanisms through which socioeconomic status (SES) affects obesity. Microdata from the Spanish National Health Survey (SNHS) 2011–2012 are analysed. Corrected concentration indices (CCI) are calculated to measure inequality. Path analysis is employed to disentangle direct and indirect effects of SES on obesity, where dietary patterns, physical activity and sleep habits act as mediator variables. Multivariate logistic models are used to select those exogenous variables to be included in the path diagram. Men and women are analysed separately. Our results show significant pro-rich inequality in the distribution of obesity (the poorer the more obese), particularly for women (CCI=−0.070 for men, CCI=−0.079 for women). The indirect effects of SES on obesity (those transmitted via mediator variables) are quite modest (3.3% for males, 2.4% for females) due to three reasons. Firstly, dietary habits do not show a significant mediating effect. Secondly, the mediating effect of physical activity in leisure time, although significant (14% for males, 11.1% for females), is offset by that related to main activity. Finally, sleep habits contribution to total effect of SES on obesity is statistically significant but small (roughly 1%). Our results indicate that promoting physical activity in leisure time for those with a low SES, particularly for men, would contribute to prevent obesity and to reduce health inequalities. Promotion of adequate sleep habits for women with a low SES might have a similar effect. However, interventions aimed to reduce sedentarism related to main activity, although useful to prevent obesity, would amplify the obesity socioeconomic gradient. Since effects of SES are different for men and women, socioeconomic health inequalities should be addressed also from a gender perspective.

Suggested Citation

  • Merino Ventosa, María & Urbanos-Garrido, Rosa M.maria.merino.ven@gmail.com, 2016. "Disentangling effects of socioeconomic status on obesity: A cross-sectional study of the Spanish adult population," Economics & Human Biology, Elsevier, vol. 22(C), pages 216-224.
    • Handle: RePEc:eee:ehbiol:v:22:y:2016:i:c:p:216-224
    DOI: 10.1016/j.ehb.2016.05.004
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    1. Costa-Font, Joan & Gil, Joan, 2008. "What lies behind socio-economic inequalities in obesity in Spain A decomposition approach," Food Policy, Elsevier, vol. 33(1), pages 61-73, February.
    2. Erreygers, Guido, 2009. "Correcting the Concentration Index: A reply to Wagstaff," Journal of Health Economics, Elsevier, vol. 28(2), pages 521-524, March.
    3. Guido Erreygers & Tom Van Ourti, 2011. "Putting the cart before the horse. A comment on Wagstaff on inequality measurement in the presence of binary variables," Health Economics, John Wiley & Sons, Ltd., vol. 20(10), pages 1161-1165, October.
    4. Mohammad Hajizadeh & M. Karen Campbell & Sisira Sarma, 2014. "Socioeconomic inequalities in adult obesity risk in Canada: trends and decomposition analyses," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 15(2), pages 203-221, March.
    5. Costa-Font, Joan & Hernández-Quevedo, Cristina & Jiménez-Rubio, Dolores, 2014. "Income inequalities in unhealthy life styles in England and Spain," Economics & Human Biology, Elsevier, vol. 13(C), pages 66-75.
    6. Wagstaff, Adam, 2009. "Correcting the concentration index: A comment," Journal of Health Economics, Elsevier, vol. 28(2), pages 516-520, March.
    7. Anoop Shankar & Shirmila Syamala & Sita Kalidindi, 2010. "Insufficient Rest or Sleep and Its Relation to Cardiovascular Disease, Diabetes and Obesity in a National, Multiethnic Sample," PLOS ONE, Public Library of Science, vol. 5(11), pages 1-8, November.
    8. Kjellsson, Gustav & Gerdtham, Ulf-G., 2013. "On correcting the concentration index for binary variables," Journal of Health Economics, Elsevier, vol. 32(3), pages 659-670.
    9. Wagstaff, Adam & van Doorslaer, Eddy & Watanabe, Naoko, 2003. "On decomposing the causes of health sector inequalities with an application to malnutrition inequalities in Vietnam," Journal of Econometrics, Elsevier, vol. 112(1), pages 207-223, January.
    10. Cavaco, Sandra & Eriksson, Tor & Skalli, Ali, 2014. "Life cycle development of obesity and its determinants in six European countries," Economics & Human Biology, Elsevier, vol. 14(C), pages 62-78.
    11. repec:dau:papers:123456789/9988 is not listed on IDEAS
    12. Kinge, Jonas Minet & Morris, Stephen, 2014. "Variation in the relationship between BMI and survival by socioeconomic status in Great Britain," Economics & Human Biology, Elsevier, vol. 12(C), pages 67-82.
    13. Franco Sassi, 2010. "Obesity and the Economics of Prevention," Books, Edward Elgar Publishing, number 14244.
    14. Wagstaff, Adam & Paci, Pierella & van Doorslaer, Eddy, 1991. "On the measurement of inequalities in health," Social Science & Medicine, Elsevier, vol. 33(5), pages 545-557, January.
    15. Adam Wagstaff, 2011. "The concentration index of a binary outcome revisited," Health Economics, John Wiley & Sons, Ltd., vol. 20(10), pages 1155-1160, October.
    16. Adam Wagstaff, 2005. "The bounds of the concentration index when the variable of interest is binary, with an application to immunization inequality," Health Economics, John Wiley & Sons, Ltd., vol. 14(4), pages 429-432, April.
    17. Gil, Joan & Mora, Toni, 2011. "The determinants of misreporting weight and height: The role of social norms," Economics & Human Biology, Elsevier, vol. 9(1), pages 78-91, January.
    18. Ehsan Latif, 2014. "The Impact Of Macroeconomic Conditions On Obesity In Canada," Health Economics, John Wiley & Sons, Ltd., vol. 23(6), pages 751-759, June.
    19. Erreygers, Guido, 2009. "Correcting the Concentration Index," Journal of Health Economics, Elsevier, vol. 28(2), pages 504-515, March.
    20. Van de Poel, Ellen & Van Doorslaer, Eddy & O’Donnell, Owen, 2012. "Measurement of inequity in health care with heterogeneous response of use to need," Journal of Health Economics, Elsevier, vol. 31(4), pages 676-689.
    21. Kakwani, Nanak & Wagstaff, Adam & van Doorslaer, Eddy, 1997. "Socioeconomic inequalities in health: Measurement, computation, and statistical inference," Journal of Econometrics, Elsevier, vol. 77(1), pages 87-103, March.
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    2. Otilia Vanessa Cordero-Ahiman & Eduardo Santellano-Estrada & Alberto Garrido, 2018. "Food Access and Coping Strategies Adopted by Households to Fight Hunger among Indigenous Communities of Sierra Tarahumara in Mexico," Sustainability, MDPI, vol. 10(2), pages 1-14, February.
    3. Triaca, Lívia Madeira & dos Santos, Anderson Moreira Aristides & Tejada, Cesar Augusto Oviedo, 2020. "Socioeconomic inequalities in obesity in Brazil," Economics & Human Biology, Elsevier, vol. 39(C).
    4. Athina Raftopoulou & Joan Gil Trasfi, 2024. "Income-related inequality in obesity and its determinants in Spain: What happens beyond the obesity threshold?," International Journal of Health Economics and Management, Springer, vol. 24(1), pages 135-153, March.
    5. Pablo Moya Martínez & Raúl del Pozo Rubio & Pablo Ruiz Palomino, 2024. "The Risk For Mobility Limitation In Older Adults: A Cross-Sectional European Study," Hacienda Pública Española / Review of Public Economics, IEF, vol. 249(2), pages 65-81, June.
    6. Aránzazu Hernández-Yumar & Maria Wemrell & Ignacio Abásolo-Alessón & Beatriz González López-Valcárcel & Juan Merlo, 2023. "Impact of the Economic Crisis on Body Mass Index in Spain: An Intersectional Multilevel Analysis Using a Socioeconomic and Regional Perspective," Population Research and Policy Review, Springer;Southern Demographic Association (SDA), vol. 42(4), pages 1-31, August.
    7. Antelo, Manel & Magdalena, Pilar & Reboredo, Juan C., 2017. "Obesity: A major problem for Spanish minors," Economics & Human Biology, Elsevier, vol. 24(C), pages 61-73.
    8. Pasqualini, M. & Lanari, D. & Minelli, L. & Pieroni, L. & Salmasi, L., 2017. "Health and income inequalities in Europe: What is the role of circumstances?," Economics & Human Biology, Elsevier, vol. 26(C), pages 164-173.
    9. Aránzazu Hernández-Yumar & Maria Wemrell & Ignacio Abásolo Alessón & Beatriz González López-Valcárcel & George Leckie & Juan Merlo, 2018. "Socioeconomic differences in body mass index in Spain: An intersectional multilevel analysis of individual heterogeneity and discriminatory accuracy," PLOS ONE, Public Library of Science, vol. 13(12), pages 1-23, December.

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