Socioeconomic inequalities in co-morbidity of overweight, obesity and mental ill-health from adolescence to mid-adulthood in two national birth cohort studies.

Amal R Khanolkar,Praveetha Patalay

doi:10.1016/j.lanepe.2021.100106

Abstract

AimTo examine socioeconomic inequalities in comorbidity risk for overweight (including obesity) and mental ill-health in two national cohorts. We investigated independent effects of childhood and adulthood socioeconomic disadvantage on comorbidity from childhood to mid-adulthood, and differences by sex and cohort.MethodsData were from 1958 National Child Development Study (NCDS58) and 1970 British Cohort Study (BCS70) [total N=30,868, 51% males] assessed at ages 10, 16, 23/26, 34 and 42 years. Socioeconomic indicators included childhood and adulthood social class and educational level. Risk for i. having healthy BMI and mental ill-health, ii. overweight and good mental health, and iii. overweight and mental ill-health was analysed using multinomial logistic regression.FindingsSocioeconomic disadvantage was consistently associated with greater risk for overweight-mental ill-health comorbidity at all ages (RRR 1.43, 2.04, 2.38, 1.64 and 1.71 at ages 10, 16, 23, 34 and 42 respectively for unskilled/skilled vs. professional/managerial class). The observed inequalities in co-morbidity were greater than those observed for either condition alone (overweight; RRR 1.39 and 1.25, mental ill-health; 1.36 and 1.22 at ages 16 and 42 respectively, for unskilled/skilled vs. professional/managerial class). In adulthood, both childhood and adulthood socioeconomic disadvantage were independently associated with comorbid overweight-mental ill-health, with a clear inverse gradient between educational level and risk for comorbidity. For instance, for the no education group (compared to university education) the RRR is 6.11 (95% CI 4.31-8.65) at age 34 and 4.42 (3.28-5.96) at age 42. There were no differences observed in the extent of inequalities by sex and differences between cohorts were limited.InterpretationWhile socioeconomic disadvantage in childhood and adulthood are consistently and independently associated with greater risk for mental ill-health and being overweight separately, these associations are even larger for their comorbidity across the lifecourse. These findings are significant given the increasing global prevalence of obesity and mental ill-health, and their implications for lifelong health and mortality.FundingThis research was supported by grants from the Wellcome Trust (ISSF3/ H17RCO/NG1) and Medical Research Council (MRC) [MC_UU_00019/3].

Highlights

Obesity and mental ill-health are often childhood-onset, are chronic with a strong propensity to track across the lifecourse, and are associated with increased risk for a wide range of health outcomes and mortality [1,2]
This study found that socioeconomic disadvantage was consistently associated with increased risk of comorbidity between obesity and mental ill-health in childhood and adolescence, and the risk progressively increased with age
Greater levels of socioeconomic disadvantage were associated with increasing risks of comorbidity, with inverse gradients observed with childhood and adulthood social class and educational level

Summary

Introduction

Obesity and mental ill-health are often childhood-onset, are chronic with a strong propensity to track across the lifecourse, and are associated with increased risk for a wide range of health outcomes and mortality [1,2]. Both conditions have increased in Socioeconomic inequalities in obesity and mental ill-health. There is substantial evidence for comorbidity (i.e. co-occurrence) of obesity and mental illhealth in adolescence and across adulthood. It is known whether the prevalence of comorbidity differs between socioeconomic groups and across the lifecourse

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