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Socioeconomic differences in body mass index in Spain: An intersectional multilevel analysis of individual heterogeneity and discriminatory accuracy

Author:
  • Aranzazu Hernández Yumar
  • Maria Wemrell
  • Ignacio Abasolo Alesson
  • Beatrice Gonzales Lopez-Valcárcel
  • George Leckie
  • Juan Merlo
Publishing year: 2018-12-10
Language: English
Pages: 0208624-0208624
Publication/Series: PLoS ONE
Volume: 13
Issue: 12
Document type: Journal article
Publisher: Public Library of Science

Abstract english

Many studies have demonstrated the existence of simple, unidimensional socioeconomic gradients in body mass index (BMI). However, in the present paper we move beyond such traditional analyses by simultaneously considering multiple demographic and socioeconomic dimensions. Using the Spanish National Health Survey 2011–2012, we apply intersectionality theory and multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA) to analyze 14,190 adults nested within 108 intersectional strata defined by combining categories of gender, age, income, educational achievement and living situation. We develop two multilevel models to obtain information on stratum-specific BMI averages and the degree of clustering of BMI within strata expressed by the intra-class correlation coefficient (ICC). The first model is a simple variance components analysis that provides a detailed mapping of the BMI disparities in the population and measures the accuracy of stratum membership to predict individual BMI. The second model includes the variables used to define the intersectional strata as a way to identify stratum-specific interactions. The first model suggests moderate but meaningful clustering of individual BMI within the intersectional strata (ICC = 12.4%). Compared with the population average (BMI = 26.07 Kg/m2), the stratum of cohabiting 18-35-year-old females with medium income and high education presents the lowest BMI (-3.7 Kg/m2), while cohabiting 36-64-year-old females with low income and low education show the highest BMI (+2.6 Kg/m2). In the second model, the ICC falls to 1.9%, suggesting the existence of only very small stratum specific interaction effects. We confirm the existence of a socioeconomic gradient in BMI. Compared with traditional analyses, the intersectional MAIHDA approach provides a better mapping of socioeconomic and demographic inequalities in BMI. Because of the moderate clustering, public health policies aiming to reduce BMI in Spain should not solely focus on the intersectional strata with the highest BMI, but should also consider whole population polices.

Keywords

  • Public Health, Global Health, Social Medicine and Epidemiology

Other

Published
  • Social Epidemiology
  • ISSN: 1932-6203
maria wemrell
E-mail: maria [dot] wemrell [at] med [dot] lu [dot] se

Postdoctoral fellow

Social Epidemiology

33

Researcher

Department of Gender Studies

31

Department of Gender Studies
Visiting address: Allhelgona Kyrkogata 14, House M, Lund
Postal address: Box 117, 221 00 Lund, Sweden
Phone +46 46-222 00 00 (operator)
Fax: 046-222 40 04

Faculty of Social Sciences