Educational Inequalities in Obesity among Mexican Women: Time-Trends from 1988 to 2012

<div><p>Background</p><p>Obesity is one of the leading causes of global morbidity and mortality. Trends in educational inequalities in obesity prevalence among Mexican women have not been analysed systematically to date.</p><p>Methods</p><p>Data came from four nationally representative surveys (1988, 1999, 2006, and 2012) of a total of 51 220 non-pregnant women aged 20 to 49. Weight and height were measured during home visits. Education level (higher education, high school, secondary, primary or less) was self-reported. We analysed trends in relative and absolute educational inequalities in obesity prevalence separately for urban and rural areas.</p><p>Results</p><p>Nationally, age-standardised obesity prevalence increased from 9.3% to 33.7% over 25 years to 2012. Obesity prevalence was inversely associated with education level in urban areas at all survey waves. In rural areas, obesity prevalence increased markedly but there was no gradient with education level at any survey. The relative index of inequality in urban areas declined over the period (2.87 (95%CI: 1.94, 4.25) in 1988, 1.55 (95%CI: 1.33, 1.80) in 2012, trend p<0.001). Obesity increased 5.92 fold (95%CI: 4.03, 8.70) among urban women with higher education in the period 1988–2012 compared to 3.23 fold (95%CI: 2.88, 3.63) for urban women with primary or no education. The slope index of inequality increased in urban areas from 1988 to 2012. Over 0.5 M cases would be avoided if the obesity prevalence of women with primary or less education was the same as for women with higher education.</p><p>Conclusions</p><p>The expected inverse association between education and obesity was observed in urban areas of Mexico. The declining trend in relative educational inequalities in obesity was due to a greater increase in obesity prevalence among higher educated women. In rural areas there was no social gradient in the association between education level and obesity across the four surveys.</p></div

Relative index of inequality (RII) stratified by birth cohort in urban areas.

<p>*p<0.001.</p>∼<p>p<0.05.</p

Absolute and relative increases in obesity prevalence by education level from 1988 to 2012.

a<p>Age adjusted prevalence ratio.</p>b<p>Age adjusted prevalence difference.</p><p>Test for homogeneity across education levels *p<0.001 † p = 0.50.</p

Trend in absolute inequalities in obesity for urban and rural Mexican women 1988–2012.

<p>Each point represents the slope index of inequality (SII) for the particular year. Error bars represent the 95% confidence intervals of the SII. Plotted estimates are adjusted for age.</p

Age standardised distribution of women for selected characteristics 1988–2012.

<p>Standard errors in parenthesis.</p

Trend in relative inequalities in obesity for urban and rural Mexican women 1988–2012.

<p>Each point represents the relative index of inequality (RII) for the particular year. Error bars represent the 95% confidence intervals of the RII. Plotted estimates are adjusted for age.</p

Absolute and relative inequalities in obesity.

<p>RII: Relative index of inequality.</p><p>SII: Slope index of inequality.</p><p>*p<0.001 in each survey year.</p>a<p>estimated using survey weighted linear regression.</p>b<p>quadratic term p<0.001.</p