Determinants of obesity in relation to socioeconomic status among middle-aged Swedish women

The differential effect of education and occupation on body mass and overweight in a sample of working people of the general population

PURPOSE

To assess whether two indicators of social class, education and occupation, have independent and/or synergistic effects in determining the body mass and overweight.

METHODS

Body mass index (BMI), education, and occupation were assessed in a survey of 1767 men and 1268 women from a representative sample of currently working people of the general population of Geneva, Switzerland. Education and occupation were categorized as low, medium, and high. Overweight was defined as BMI > or = 25 kg/m(2).

RESULTS

The prevalence of overweight was 52.1% in men and 28.7% in women. Men with overweight were more likely to have low education while women with overweight had lower education and lower occupation. Education and occupation were inversely related to BMI in both genders and, in women, had a synergistic effect (p-value for the interaction = 0.03).

CONCLUSIONS

Education and occupation have independent and, in women, synergistic effects on BMI. The two indicators may express different mechanisms through which low social class is related to high body mass.

Job strain and risk indicators for cardiovascular disease in young female nurses

This study examined the possible effects of job demands, decision latitude, and job-related social support on risk indicators for cardiovascular disease (CVD) in 165 female nurses. Job strain was measured with the Job Content Questionnaire; CVD risk was measured with insulin, total cholesterol, triglyceride (TG), high-density lipoprotein cholesterol (HDL-C), fibrinogen, tissue-type plasminogen activator (tPA) antigen, tPA activity, plasminogen activator inhibitor-1 antigen, and blood pressure. Multivariate analysis of covariance and regression analyses revealed no effects of either job strain or social support on these risk indicators. All risk indicators deteriorated with age and body mass index. Oral contraceptive use improved fibrinolytic potential and increased HDL-C but had adverse effects on TG levels. Results suggest that in healthy young women job strain is not associated with an unfavorable metabolic or fibrinolytic risk profile.

Psychosocial factors at work, smoking, sedentary behavior, and body mass index: a prevalence study among 6995 white collar workers

This cross-sectional study examined whether psychosocial factors at work were associated with smoking, sedentary behavior, and body mass index. The study population was composed of 3531 men and 3464 women employed as white collar workers in 21 organizations. Data were collected at worksites. Psychological demands and decision latitude at work were measured with the Karasek 18-item questionnaire. Smoking, sedentary behavior, and mean body mass index were compared by quartiles of decision latitude and psychological demands and by job strain categories. Prevalence of smoking, mean number of cigarettes smoked per day, prevalence of sedentary behavior, and mean body mass index were not consistently associated with decision latitude, psychological demands, or high job strain. However, prevalence of smoking was elevated in women belonging to the highest quartile of psychological demands (odds ratio [OR], 1.2; 95% confidence interval [CI], 1.0 to 1.6) and in the active job strain groups in both men (OR, 1.6; 95% CI, 1.2 to 2.1) and women (OR, 1.4; 95% CI, 1.0 to 2.0). Prevalence of sedentary behavior was elevated in men in the lowest quartile of decision latitude (OR, 1.3; 95% CI, 1.0 to 1.7), in the passive group (OR, 1.3; 95% CI, 1.0 to 1.5), and in the high strain group (OR, 1.2; 95% CI, 1.0 to 1.6). In women, this prevalence was elevated in the third quartile of psychological demand (OR, 1.3; 95% CI, 1.1 to 1.6). These results provide only partial support for an association between some psychosocial factors at work and the prevalence of smoking and sedentary behavior.

Potential explanations for the educational gradient in coronary heart disease: a population-based case-control study of Swedish women

OBJECTIVES

This study examined the association between educational attainment and coronary heart disease (CHD) and the factors that may explain this association.

METHODS

This population-based case-control study included 292 women with CHD who were 65 years or younger and 292 age-matched controls.

RESULTS

Compared with the adjusted odds ratio for CHD associated with college education, the age-adjusted odds ratio associated with mandatory education (< or = 9 years) was 1.87 (95% confidence interval [CI] = 1.23, 2.84) and the odds ratio for high school education was 1.35 (95% CI = 0.81, 2.25) (P for trend < .01). The odds ratio for mandatory education was reduced by 82%, to 1.16 (95% CI = 0.69, 2.09), after adjustment for psychosocial stress, unhealthy lifestyle patterns, hemostatic factors, hypertension, and lipids.

CONCLUSIONS

Much of the increased risk of CHD in women with low education appears to be linked to psychosocial stress and lifestyle factors. Hemostatic factors, lipids, and hypertension also contribute to a lesser extent. These factors may be considered in strategies geared to reducing socioeconomic inequalities in cardiovascular health.

Socioeconomic status and determinants of hemostatic function in healthy women

Hemostatic factors are reported to be associated with coronary heart disease (CHD). Socioeconomic status (SES) is 1 of the determinants of the hemostatic profile, but the factors underlying this association are not well known. Our aim was to examine determinants of the socioeconomic differences in hemostatic profile. Between 1991 and 1994, we studied 300 healthy women, aged 30 to 65 years, who were representative of women living in the greater Stockholm area. Fibrinogen, factor VII mass concentration (FVII:Ag), activated factor VII (FVIIa), von Willebrand factor (vWF), and plasminogen activator inhibitor-1 (PAI-1) were measured. Educational attainment was used as a measure of SES. Low educational level and an unfavorable hemostatic profile were both associated with older age, unhealthful life style, psychosocial stress, atherogenic biochemical factors, and hypertension. Levels of hemostatic factors increased with lower educational attainment. Independently of age, the differences between the lowest (mandatory) and highest (college/university) education in FVII:Ag levels were 41 microg/L (95% confidence interval [CI], 15 to 66 microg/L, P=0.001), 0.26 g/L (95% CI, 0.10 to 0.42 g/L, P=0.001) in fibrinogen levels, and 0.11 U/mL (95% CI, 0.09 to 0.12 U/mL, P=0.03) in levels of vWF. The corresponding differences in FVIIa and PAI-1 were not statistically significant. With further adjustment for menopausal status, family history of CHD, marital status, psychosocial stress, lifestyle patterns, biochemical factors, and hypertension, statistically significant differences between mandatory and college/university education were observed in FVII:Ag (difference=34 microg/L; 95% CI, 2 to 65 microg/L, P=0.05) but not in fibrinogen (difference=0.03 g/L; 95% CI, -0.13 to 0.19 g/L, P=0.92) or in vWF (difference=0.06 U/mL; 95% CI, -0.10 to 0.22 U/mL, P=0.45). An educational gradient was most consistent and statistically significant for FVII:Ag, fibrinogen, and vWF. Age, psychosocial stress, unhealthful life style, atherogenic biochemical factors, and hypertension mediated the association of low educational level with elevated levels of fibrinogen and vWF. Psychosocial stress and unhealthful life style were the most important contributing factors. There was an independent association between education and FVII:Ag, which could not be explained by any of these factors.

Variables independently associated with self-reported obesity in the European Union

OBJECTIVE

The rapid increase in obesity rates over recent years suggest that cultural and societal influences are affecting the adjustment in the energy balance equation in addition to other physiopathological or genetic determinants. Therefore, a pan-EU study was carried out to explore the influence of sociodemographic factors as well as some attitudes (smoking and exercise) on the prevalence of obesity in the adult population of all 15 member states of the EU.

DESIGN

Overall, a sample of 15,239 individuals aged 15 years and upwards in the EU completed the questionnaire. Subject selection was quota-controlled to make the sample nationally representative following a multistage stratified cluster sampling. Self-reported height and weight were used to calculate body mass index (BMI).

RESULTS

From the EU average results, it can be seen that only about half of the EU population (48%) is within the normal weight range, while the obesity (BMI > or = 30 kg m(-2)) prevalence was about 10% in the EU and the overweight prevalence was 36.6% and 25.6% among men and women, respectively. UK subjects had the highest prevalence of obesity (12%), while Italians, French and Swedes had the lowest levels of obesity (about 7%). Concerning age and social class interactions, logistic regression analysis showed that high social class and younger individuals in all groups had a lower odds ratio for obesity prevalence. People with a higher level of education are less likely to be obese, while the interaction between educational levels and obesity was different for men and women. A low participation in various leisure-time physical activities, the lack of interest (precontemplation) in being involved in exercise/physical activity and the increasing number of hours sitting down at work appear to be predictors of obesity. Single individuals were less prone to become obese than couples or widowed/divorced people. Finally, smoking status was statistically linked to the prevalence of obesity, since non-smokers or ex-smokers for more than 1 year presented a higher tendency for a BMI > 30.

CONCLUSIONS

This survey confirms that a priority area for health intervention aimed at preventing the development of obesity should be to increase levels of physical activity, although the approach will depend on the population, especially with respect to educational and socioeconomic aspects.

Cardiovascular risk factors and educational attainment in Southern Spain: a study of a random sample of 3091 adults

STUDY OBJECTIVE

To analyze the associations between educational attainment and major cardiovascular disease risk factors in the Murcia Region (Southern Spain).

DESIGN

During 1992 we conducted a survey by interview, with multi-stage random sampling, representative of the general adult population. We calculated odds ratios (OR) and trends by logistic regression as a measure of the association between educational levels and cardiovascular risk factors, taking the university level as the reference category.

PARTICIPANTS

A total of 1514 men and 1577 women aged between 18 and 65 years was included in the study. Rate of response to the questionnaire was 61%. Seventy-eight percent of the respondents provided a blood sample. A telephone survey on a representative sample of non-respondents (n = 347), showed no statistical differences in the level of studies.

MEASUREMENTS

We asked for educational level (highest schooling qualification completed), and according to the WHO MONICA protocol we measured: blood pressure, cigarette smoking, height, weight and total cholesterol, triglycerides and HDL-cholesterol. We also obtained the leisure-time physical activity by a validated questionnaire.

MAIN RESULTS

In a context of a low level of schooling, mainly among the older age groups, the prevalence of risk factors except smoking in women is higher in the lower educational levels. Systolic blood pressure tends slightly to increase as schooling level decreases (both genders, p<0.02). Conversely, serum total cholesterol and triglycerides decrease with higher level of schooling in men. The high levels of HDL-cholesterol observed in all educational groups show no trend in both genders. Arterial hypertension in men and women and overweight in women tend to decrease with higher educational attainment. Moreover, higher level of education is associated with vigorous physical exercise in both genders and cigarette smoking in women. We observed the strongest significant magnitude association in nonschooling with hypertension in men (OR: 1.82; 95% CI: 1.15, 2.89), in women (OR: 2.39; 95% CI: 1.05, 5.44), and with overweight in women (OR: 3.22; 95% CI: 1.97, 5.27), meaning that compared to people at the university level, people without schooling showed two to three times higher prevalence of hypertension and overweight (only women). Also non-schooling obtained the lowest significant association with protective physical exercise for coronary heart disease in men (OR: 0.32; 95% CI: 0.18, 0.56) and in women (OR: 0.31; 95% CI: 0.15, 0.62) pointing out that people at the university level of education had three times the prevalence of vigorous physical activity than their non schoolarized counterparts.

CONCLUSIONS

After adjusting for environmental factors, in our adult general population, educational attainment is inversely associated with arterial hypertension in both genders and with overweight in women, and directly associated with cigarette smoking in women and with leisure-time physical activity in both genders.