Disparity Indices and Overweight: Frame of Reference.

Wendell C Taylor,Casey P Durand,Gregory Knell

doi:10.1089/heq.2019.0064

Wendell C Taylor, Casey P Durand + Show 1 more

Open Access

https://doi.org/10.1089/heq.2019.0064

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Abstract

Purpose: The purpose of this study was to compare state rankings of body mass index (BMI) among three different indices of income disparities (i.e., low-, middle-, and high-income thresholds) and BMI. One measure of disparities was based on national standards and the other measure was based on state-specific data.Methods: Data were from the 2016 Behavioral Risk Factor Surveillance System and analyzed in 2018. To assess differences between the two indices, Spearman Rank Order Correlation coefficient with a Bonferroni adjustment and kappa statistic were used.Results: Spearman rank-order correlation coefficient with a Bonferroni adjustment found that the two indices had a very weak monotonic relationship (ρ=0.11, p=0.46). The kappa value [κ (df=48)=0.02, p-value=0.43] revealed the indices were not concordant. The rankings of states based on national and state-specific disparity indices were distinctly different.Conclusion: Our study highlights the importance of choosing disparity indices. To analyze state similarities and differences, findings and interpretations are different when using a national standard applied to all states versus state-specific data as the frame of reference for the disparity index. Future research is needed to confirm the generalizability of our findings. In addition to income, our approach can be used with other sociodemographic variables such as age, race/ethnicity, sex, and education. The overall goal is to present a comprehensive and nuanced perspective of disparities contributing to the overweight/obesity epidemic.

Highlights

One measure of overweight and obesity is thresholds or categories of body mass index (BMI) calculated as weight in kilograms divided by height in meters squared, rounded to one decimal place
Overweight is defined as 25.0–29.9 and obesity in adults is defined as BMI of ‡30.1 In 2015–2016, the prevalence of overweight/obesity among U.S adults was 39.8%1; another study reported that 5% of U.S citizens are morbidly obese.[2]
Data source Data were from the 2016 Behavioral Risk Factor Surveillance System (BRFSS)

Summary

Introduction

One measure of overweight and obesity is thresholds or categories of body mass index (BMI) calculated as weight in kilograms divided by height in meters squared, rounded to one decimal place. Overweight is defined as 25.0–29.9 and obesity in adults is defined as BMI of ‡30.1 In 2015–2016, the prevalence of overweight/obesity among U.S adults was 39.8%1; another study reported that 5% of U.S citizens are morbidly obese.[2] Overweight/obesity is a major contributor to type 2 diabetes, hypertension, and coronary heart disease, as well as other chronic conditions.[3]. Health disparities are health differences associated with social, economic, and/or environmental disadvantage and adversely affect people who typically experience greater obstacles to achieving and sustaining optimal health.[4] There are demographic and socioeconomic disparities (e.g., race and/or ethnicity, education, income, gender, and geographic location) that characterize the overweight/obesity epidemic.[5] An Institute of Medicine’s objective is to eliminate disparities related

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