Trends in educational inequalities in obesity in 15 European countries between 1990 and 2010

Eero Lahelma,Jozsef Vitrai,Rianne De Gelder,Frank J. van Lenthe,Ola Ekholm,Johan P. Mackenbach,Matthias Bopp,Yannan Hu,Enrique Regidor,Gwenn Menvielle,Paula Santana,Kristina Hoffmann

doi:10.1186/s12966-017-0517-8

Abstract

BackgroundThe prevalence of obesity increased dramatically in many European countries in the past decades. Whether the increase occurred to the same extent in all socioeconomic groups is less known. We systematically assessed and compared the trends in educational inequalities in obesity in 15 different European countries between 1990 and 2010.MethodsNationally representative survey data from 15 European countries were harmonized and used in a meta-regression of trends in prevalence and educational inequalities in obesity between 1990 and 2010. Educational inequalities were estimated by means of absolute rate differences and relative rate ratios in men and women aged 30–64 years.ResultsA statistically significant increase in the prevalence of obesity was found for all countries, except for Ireland (among men) and for France, Hungary, Italy and Poland (among women). Meta-regressions showed a statistically significant overall increase in absolute inequalities of 0.11% points [95% CI 0.03, 0.20] per year among men and 0.12% points [95% CI 0.04, 0.20] per year among women. Relative inequalities did not significantly change over time in most countries. A significant reduction of relative inequalities was found among Austrian and Italian women.ConclusionThe increase in the overall prevalence aligned with a widening of absolute but not of relative inequalities in obesity in many European countries over the past two decades. Our findings urge for a further understanding of the drivers of the increase in obesity in lower education groups particularly, and an equity perspective in population-based obesity prevention strategies.

Highlights

The prevalence of obesity increased dramatically in many European countries in the past decades
At the same time countries witnessed a substantial increase in obesity, and current socioeconomic inequalities in obesity across Europe suggest that the increase was larger among lower socioeconomic groups [11]
The pooled estimates for all countries indicated an increase of 0.33% points in the prevalence of obesity per year [95% Confidence interval (CI) 0.26, 0.39]

Summary

Introduction

The prevalence of obesity increased dramatically in many European countries in the past decades. Socioeconomic inequalities in mortality and selfreported morbidity have been extensively documented in national and international studies [1,2,3,4,5,6,7]. For both of these outcomes, and either defined by educational or income level, rates are higher in the lower socioeconomic groups. Not static: a larger absolute decline in mortality rates in lower as compared to higher socioeconomic groups, has resulted. Elimination of socioeconomic inequalities in obesity might reduce inequalities in both mortality and morbidity substantially [12]; a widening of inequalities in obesity would buffer the impact of a decline of smoking attributable mortality on socioeconomic inequalities in mortality [13]

Methods

Results

Discussion

Conclusion