Socioeconomic inequalities and body mass index in Västerbotten County, Sweden: a longitudinal study of life course influences over two decades

Abstract

IntroductionLife course socioeconomic inequalities in heart disease, stroke and all-cause mortality are well studied in Sweden. However, few studies have sought to explain the mechanism for such associations mainly due to lack of longitudinal data with multiple measures of socioeconomic status (SES) across the life course. Given the population health concern about how socioeconomic inequality is related to poorer health, we aim to tackle obesity as one of the prime suspects that could explain the association between SES inequality and cardiovascular disease and consequently premature death. The aim of this study is to test which life course model best describes the association between socioeconomic disadvantage and obesity among 60 year old inhabitants of Västerbotten County in Northern Sweden.MethodsA birth cohort consisting of 3340 individuals born between 1930 and 1932 was studied. Body mass index (BMI) at the age of 60 and information on socioeconomic status at three stages of life (ages 40, 50, and 60 years) was collected. Independent samples t-test was used to compare BMI between advantaged and disadvantaged groups and one-way ANOVA was used to compare BMI among eight SES trajectories. We applied a structured modeling approach to examine three different hypothesized life course SES models (accumulation, critical period, and social mobility) in relation to BMI.ResultsWe found sex differences in the way that late adulthood socioeconomic disadvantage is associated with BMI among inhabitants of Northern Sweden. Our study suggests that social adversity in all stages of late adulthood is a particularly important indicator for addressing the social gradients in BMI among women in Northern Sweden and that unhealthy behaviors in terms of smoking and physical inactivity are insufficient to explain the relationships between social and lifestyle inequalities and BMI.ConclusionIn order for local authorities to develop informed preventive efforts, we suggest further research to identify modifiable risk factors across the life course which could explain this health inequality.

Disparities in self-rated health across generations and through the life course

“…Power and Elliott, 2006; Kuh et al, 2011) and several Scandinavian countries (e.g. Padyab and Norberg, 2014) the populations studied were largely homogeneous with respect to race. Here we describe a study that prospectively assesses social conditions, cognitive abilities, and emerging health as life course processes that may be involved in the generation of health inequalities by race and SES in the adult life.…”

Diet inequality prevails among consumers interested and knowledgeable in nutrition

“…A positive relationship between the compliance of diets to official nutritional recommendations (henceforth: diet quality) and diet cost among the general population is well established through previous studies: A higher diet cost is associated with lower energy density and/or higher intake of key nutrients ( 1 – 3 ), higher consumption of fruit and vegetables ( 1 , 4 – 6 ), higher consumption of fish ( 1 , 5 ), and higher nutritional density ( 1 , 2 , 5 , 7 ). Furthermore, studies have shown better diet quality among high socioeconomic status (SES) households ( 8 , 9 ) and a higher risk for diet-related illnesses among low SES individuals in Sweden ( 10 – 12 ) and elsewhere ( 13 – 16 ). Foods that are more nutrient rich, more energy poor, and generally classified as ‘healthy’ are often more expensive than alternatives ( 17 – 21 ).…”

Women, weight, poverty and menopause: understanding health practices in a context of chronic disease prevention

“…With respect to middle‐aged women, a life course characterised by lack of resources and adversity also leads to increased risk of obesity (Gustafsson et al . , Padyab and Norberg ) and higher biological risks of metabolic syndrome, a condition highly related to the development of chronic diseases (Gustafsson and Hammarstrom ). While life course approaches in qualitative sociology have used socioeconomic variables to explain poor health outcomes (Stansfeld et al .…”

“…Various causes such as adverse life circumstances, repeated personal experiences of failure, and long‐term exposure to low economic, cultural or social capital, have been identified to negatively influence weight and health, and to increase the risks of chronic diseases in middle‐aged women (Gustafsson et al . , Gustafsson and Hammarstrom , Padyab and Norberg ). Despite research on the preventive function of health practices (exercise, healthy eating and weight management), few studies have specifically focused on the health and lifestyle concerns of underprivileged women after the menopausal transition.…”