Association Between Neighborhood Socioeconomic Status and Obesity in 89,160 Lifelines Participants

Background: We examined to what extent the association between neighborhood socioeconomic status (NSES) and obesity among the Dutch adult general population is moderated by exposure to pay-for-use physical activity (PA) facilities and fast-food (FF) outlets. Methods: Data from the baseline adult Lifelines cohort, Statistics Netherlands and LISA were used. Individuals’ residential addresses were linked to neighborhood data and pay-for-use PA facility (0, 1, or >1 within 1 km) and FF outlet locations (0, 1, or >1 within 1 km) using geocoding. Multivariable logistic regression was used to investigate the association between NSES (categorised as low, middle and high) and obesity (Body Mass Index ≥ 30.0), adjusting for neighborhood address density, age, sex, education, partner status, occupational prestige, and income. If the interaction term with NSES was significant, analysis was stratified for having 0, 1, >1 pay-for-use PA facility and 0, 1, or >1 FF outlet within 1 km around the residential address. Results: Obesity was present among 14.7% of the 89,160 participants. People living in low NSES or middle NSES more often had obesity than people living in high NSES (OR (95%CI): 1.56 (1.48 to 1.64), OR (95%CI):1.22 (1.16 to 1.28), respectively). The association between low NSES and obesity was weaker in neighborhoods without any FF outlet within 1 km (OR (95%CI)=1.32 (1.10 to 1.59)) compared to neighborhoods with one FF outlet (OR (95%CI)=1.58 (1.37 to 1.82)) or more than one FF outlet (OR (95%CI): 1.52 (1.43 to 1.62)). Exposure to pay-for-use PA facilities did not moderate the association between NSES and obesity. Conclusions: People living in low NSES more often had obesity than people living in high NSES. This association became weaker if no FF outlets are available within 1km around the residential address. These results indicate that health disparities may be reduced if fewer FF outlets are available

Neighborhood socioeconomic differences in BMI: The role of fast-food outlets and physical activity facilities

Objective: The goal of this study was to investigate the association between neighborhood socioeconomic status (NSES) and BMI and to what extent this association is moderated by availability of fast-food (FF) outlets and pay-for-use physical activity (PA) facilities. Methods: Baseline data of adults in Lifelines (N = 146,629) were linked to Statistics Netherlands and a register using geocoding to compute, respectively, NSES (i.e., low, middle, high) and the number of FF outlets and PA facilities within 1 km of the residential address. Multivariable multilevel linear regression analyses were performed to examine the association between NSES and BMI. Two-way and three-way interaction terms were tested to examine moderation by FF outlets and PA facilities. Results: Participants living in low NSES areas had a higher BMI than participants living in high (B [95% CI]: 0.76 [0.65 to 0.87]) or middle NSES areas (B [95% CI]: 0.40 [0.28 to 0.51]), independent of individual socioeconomic status. Although two- and three-way interactions between NSES, FF outlets, and PA facilities were significant, stratified analyses did not show consistent moderation patterns. Conclusions: People living in lower NSES areas had a higher BMI, independent of their individual socioeconomic status. The study found no clear moderation of FF outlets and PA facilities. Environmental factors that may mitigate NSES differences in BMI should be the subject of future research