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Socioeconomic Patterning of Childhood Overweight Status in Europe

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      There is growing evidence of social disparities in overweight among European children. This paper examines whether there is an association between socioeconomic inequality and prevalence of child overweight in European countries, and if socioeconomic disparities in child overweight are increasing. We analyse cross-country comparisons of household inequality and child overweight prevalence in Europe and review within-country variations over time of childhood overweight by social grouping, drawn from a review of the literature. Data from 22 European countries suggest that greater inequality in household income is positively associated with both self-reported and measured child overweight prevalence. Moreover, seven studies from four countries reported on the influence of socioeconomic factors on the distribution of child overweight over time. Four out of seven reported widening social disparities in childhood overweight, a fifth found statistically significant disparities only in a small sub-group, one found non-statistically significant disparities, and a lack of social gradient was reported in the last study. Where there is evidence of a widening social gradient in child overweight, it is likely that the changes in lifestyles and dietary habits involved in the increase in the prevalence of overweight have had a less favourable impact in low socio-economic status groups than in the rest of the population. More profound structural changes, based on population-wide social and environmental interventions are needed to halt the increasing social gradient in child overweight in current and future generations.

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        Comparisons among countries can help to identify opportunities for the reduction of inequalities in health. We compared the magnitude of inequalities in mortality and self-assessed health among 22 countries in all parts of Europe. We obtained data on mortality according to education level and occupational class from census-based mortality studies. Deaths were classified according to cause, including common causes, such as cardiovascular disease and cancer; causes related to smoking; causes related to alcohol use; and causes amenable to medical intervention, such as tuberculosis and hypertension. Data on self-assessed health, smoking, and obesity according to education and income were obtained from health or multipurpose surveys. For each country, the association between socioeconomic status and health outcomes was measured with the use of regression-based inequality indexes. In almost all countries, the rates of death and poorer self-assessments of health were substantially higher in groups of lower socioeconomic status, but the magnitude of the inequalities between groups of higher and lower socioeconomic status was much larger in some countries than in others. Inequalities in mortality were small in some southern European countries and very large in most countries in the eastern and Baltic regions. These variations among countries appeared to be attributable in part to causes of death related to smoking or alcohol use or amenable to medical intervention. The magnitude of inequalities in self-assessed health also varied substantially among countries, but in a different pattern. We observed variation across Europe in the magnitude of inequalities in health associated with socioeconomic status. These inequalities might be reduced by improving educational opportunities, income distribution, health-related behavior, or access to health care. Copyright 2008 Massachusetts Medical Society.
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            Author and article information

            [1 ]London School of Hygiene & Tropical Medicine, 15–17 Tavistock Place, London WC1H 9SH, UK; Email: harry.rutter@ (H.R.); martin.mckee@ (M.M.)
            [2 ]International Association for the Study of Obesity, Charles Darwin House, 12 Roger Street, London WCIN 2JU, UK; Email: tlobstein@
            [3 ]INRA, UMR1260, INSERM, UMR1062, Nutrition, Obesity and Risk of Thrombosis, Faculté de Médecine, Aix-Marseille University, F-13385, Marseille, France; Email: nicole.darmon@
            Author notes
            [* ] Author to whom correspondence should be addressed; Email: cecile.knai@ ; Tel.: +44-207-958-8155; Fax: +44-207-927-2701.
            Int J Environ Res Public Health
            Int J Environ Res Public Health
            International Journal of Environmental Research and Public Health
            16 April 2012
            April 2012
            : 9
            : 4
            : 1472-1489
            © 2012 by the authors; licensee MDPI, Basel, Switzerland.

            This article is an open-access article distributed under the terms and conditions of the Creative Commons Attribution license (


            Public health

            social gradient, overweight, child, europe


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