Socioeconomic Gradient in Childhood Obesity and Hypertension: A Multilevel Population-Based Study in a Chinese Community

Abstract

BackgroundThis study aims to assess evidence for any socioeconomic gradients in childhood obesity and hypertension in a population-representative sample in Hong Kong, China.MethodsThe data of a stratified random sampled growth survey collected in 2005–2006 was matched with a population by-census. Obesity was defined using the International Obesity Task Force standard and hypertension was defined using the Hong Kong norm table. Family socioeconomic status (SES) was measured by maternal education level. Neighbourhood SES was measured by median household income of the neighbourhood. Multilevel Poisson regression models with robust standard error were used to test the association. Body mass indices of children’s parents were included as potential confounders. Intra-school/neighbourhood correlations were adjusted using random factors.ResultsTotally 14842 children (age 6–19 years) included in the analysis, in which 16.6% of them were overweight or obese. Children whose mother only completed secondary school or below had higher risk of childhood obesity (RR 1.41, 95% CI 1.13–1.76, p = 0.003) and hypertension (RR 1.18, 95% CI 1.01–1.36, p = 0.03). Meanwhile, children in the lowest neighbourhood SES group had higher risk of childhood underweight (RR 1.61, 95% CI 1.04–2.49, p = 0.03), overweight (RR 1.35, 95% CI 1.05–1.72, p = 0.02), and obesity (RR 2.07, 95% CI 1.11–3.88, p = 0.02).ConclusionsSocioeconomic gradient in childhood obesity and hypertension existed in Hong Kong, one of the most developed cities in China. These results have implications for policymakers and public health experts and highlight the need to monitor trends in other parts of China.

Family Income Gradients in Adolescent Obesity, Overweight and Adiposity Persist in Extremely Deprived and Extremely Affluent Neighbourhoods but Not in Middle-Class Neighbourhoods: Evidence from the UK Millennium Cohort Study

“…In this study, equivalised family income was chosen as the indicator for individual-level socioeconomic status because it provided information about the combined status of the household and represents the buying power for families, including income that is used for food purchases. That said, studies that used highest level of maternal and/or paternal academic qualifications as indicators of socioeconomic status have found similar socioeconomic gradients in the risk of child obesity and overweight [13,29,30]. Several studies that used neighbourhood characteristics as indicators for socioeconomic class have reported inequalities in the risk of adolescent obesity and overweight at the geographic level, which is consistent with our findings in the England subpopulation [31][32][33].…”

Multilevel Correlates of Healthy BMI Maintenance and Return to a Healthy BMI among Children in Massachusetts

“…30 Similar findings have been reported in China. 31 Although we did not explore potential reasons why higher neighborhood socioeconomic indicators influence children's BMI trends, factors may include cultural norms or increased opportunities for healthy eating and physical activity.…”

Prevalence of sustained hypertension and obesity among urban and rural adolescents: a school-based, cross-sectional study in North India

“…Previous studies have reported varying prevalence of hypertension in children ranging from <1% to 16.2% and the prevalence of obesity ranging from 12% to 19%, which may be due to varying age groups selected for the study and the different criteria adopted for defining hypertension and obesity 3–9. In addition, dietary and cultural factors and significant variation in the prevalence of point and sustained hypertension could influence the varying prevalence of high BP 10–14.…”