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    • Age adjusted odds ratios AOR of morbid obesity

    2018-10-24

    Age-adjusted odds ratios (AOR) of morbid obesity by income and by education are presented in Tables 2 and 3. These estimates confirm a graded association of morbid obesity with income and education category in both English men and women. In the lowest category of income, compared with the highest, the relative odds of morbid obesity were 1.83 (95% confidence interval 1.16 to 2.88) in men and 2.92 (2.07 to 4.12) in women. In the lowest category of education, compared with the highest, the relative odds of morbid obesity were 2.57 (1.64 to 4.02) in men and 2.61 (1.95 to 3.48) in women. In US women, there was evidence of a gradient in morbid obesity related to income, with relative odds for the lowest income category of 1.97 (1.19 to 3.25). In US men, the greatest odds of morbid obesity were for the second highest category of income (AOR 2.65, 1.08 to 6.53). In both US men and women, the greatest odds of morbid obesity were for the second highest category of education (some college education or associate degree, men 2.31, 1.13 to 4.69; women, 3.11, 1.83 to 5.28). Inspection of estimates in Fig. 1 suggested that, in the US, people with highest level of education or income might have some protection against morbid obesity, when compared with all other groups. Table 4 presents a comparison of the prevalence of morbid obesity in those from the highest income (greater than £52 000 or $75 000) or education (degree or college) categories in both settings, compared with all others. The likelihood of morbid obesity for US men in the highest category of income was approximately half that of the remainder of the Cy3 hydrazide manufacturer (AOR 0.53, 0.27 to 0.98). A similar pattern was observed for US women, for both the highest category of income (AOR 0.51, 0.33 to .80 and the highest category of education (AOR 0.36, 0.22 to 0.60). This finding was not statistically significant for education as a predictor in US men (AOR 0.56, 0.29 to 1.08). UK men were less likely to be morbidly obese if they were in the highest education category (AOR 0.46, 0.31 to 0.66), but not if they were in the highest income category (AOR 0.73, 0.50 to 1.06). In the UK data, the association was stronger in women than men (AOR for income 0.42, 0.31 to 0.57; AOR for education 0.48, 0.37 to 0.61). Adjusting for ethnicity did not alter the results.
    Discussion
    Conclusions Occupying the highest socioeconomic positions appeared to offer protection against the development of morbid obesity in both England and the US. This is consistent with known graded association between socioeconomic status and health, and reinforces the importance of social factors in determining health (Commission on Social Determinants of Health, 2008). A more explicit understanding of how high socioeconomic position confers protection against morbid obesity may offer insights that might inform policies and interventions for prevention and treatment. Further work should focus on ensuring obesity interventions are accessible and effective across all social strata, and investigating whether the health consequences and costs in people with morbid obesity are socially patterned.
    Competing interests
    Funding Professor Gulliford is funded by the BIHR Biomedical Research Centre at Guy\'s and St Thomas’ NHS Foundation Trust. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
    Contributorship
    Introduction Reducing maternal and child mortality remains a priority of the international development community as demonstrated by the 2015 launch of the Global Strategy for Women’s, Children’s and Adolescents’ Health (Kuruvilla et al., 2016). Despite recent increases in the use of maternal health services as well as recent improvements in maternal and child health, reaching targeted coverage for key health services such as deliveries or early antenatal care remains challenging in many countries (The World Health Organization & UNICEF, 2014; United Nations, 2014). According to the most recent Demographic and Health Survey data from Sub-Saharan Africa data, only 50% of women received the recommended four ANC visits per pregnancy, and 42% of children were not delivered at a health facility (ICF International, 2012). The situation is similar in rural Burkina Faso, where 69% of women did not receive four or more antenatal visits and almost 40% of women gave birth at home as of 2010 (ICF International, 2012).