The role of intergenerational educational mobility and household wealth in adult obesity: Evidence from Wave 2 of the World Health Organization’s Study on global AGEing and adult health

Background
Obesity has emerged as a major risk factor for non-communicable diseases in low and middle-income countries but may not follow typical socioeconomic status (SES)-related gradients seen in higher income countries. This study examines the associations between current and lifetime markers of SES and BMI categories (underweight, normal weight, overweight, obese) and central adiposity in Ghanaian adults.
Methods
Data from 4,464 adults (2,610 women) who participated in the World Health Organization’s Study on global AGEing and adult health (SAGE) Wave 2 were examined. Multilevel multinomial and binomial logistic regression models were used to examine associations. SES markers included parental education, individual education, intergenerational educational mobility and household wealth. Intergenerational educational mobility was classified: stable-low (low parental and low individual education), stable-high (high parental and high individual education), upwardly (low parental and high individual education), or downwardly mobile (high parental and low individual education).
Results
The prevalence of obesity (12.9%) exceeded the prevalence of underweight (7.2%) in the population. High parental and individual education were significantly associated with higher odds of obesity and central adiposity in women. Compared to the stable low pattern, stable high (obesity: OR = 3.15; 95% CI: 1.96, 5.05; central adiposity: OR = 1.75; 95% CI: 1.03, 2.98) and upwardly (obesity: OR = 1.71; 95% CI: 11.13, 2.60; central adiposity: OR = 1.60; 95% CI: 1.08, 2.37) mobile education patterns were associated with higher odds of obesity and central adiposity in women, while stable high pattern was associated with higher odds of overweight (OR = 1.88; 95% CI: 1.11, 3.19) in men. Additionally, high compared to the lowest household wealth was associated with high odds of obesity and central adiposity in both sexes.
Conclusion
Stable high and upwardly mobile education patterns are associated with higher odds of obesity and central adiposity in women while the stable high pattern was associated with higher odds of overweight in men.

研究背景
肥胖已成为中低收入国家非传染性疾病的主要危险因素，但该类国家中肥胖的分布规律可能并不遵循高收入国家中常见的与社会经济地位（Socioeconomic Status，缩写SES）相关的梯度特征。本研究旨在探讨加纳成年人群当前及终身SES指标与体质量指数（Body Mass Index，缩写BMI）分级（体重不足、体重正常、超重、肥胖）及中心性肥胖之间的关联。

研究方法
本研究分析了参与世界卫生组织（World Health Organization，缩写WHO）全球老龄化与成人健康研究（Study on global AGEing and adult health，缩写SAGE）第二波项目的4464名成年人（其中女性2610名）的数据。采用多层多项Logistic回归与二项Logistic回归模型分析变量间的关联。本研究的SES指标包括父母受教育程度、个体受教育程度、代际教育流动情况以及家庭财富水平。其中，代际教育流动情况被划分为四类：稳定低教育组（父母与个体均为低受教育程度）、稳定高教育组（父母与个体均为高受教育程度）、向上流动组（父母低受教育程度、个体高受教育程度）以及向下流动组（父母高受教育程度、个体低受教育程度）。

研究结果
本研究人群中肥胖患病率（12.9%）高于体重不足患病率（7.2%）。在女性群体中，父母受教育程度高与个体受教育程度高均与肥胖及中心性肥胖的患病风险升高显著相关。与稳定低教育组相比，稳定高教育组（肥胖：比值比OR=3.15；95%置信区间CI：1.96, 5.05；中心性肥胖：OR=1.75；95%CI：1.03, 2.98）与向上流动组（肥胖：OR=1.71；95%CI：11.13, 2.60）的肥胖及中心性肥胖患病风险更高；而在男性群体中，稳定高教育组与超重患病风险升高相关（OR=1.88；95%CI：1.11, 3.19）。此外，与最低家庭财富水平组相比，较高家庭财富水平组在两性中均与肥胖及中心性肥胖的患病风险升高相关。

研究结论
在女性群体中，稳定高教育组与向上流动教育组均与肥胖及中心性肥胖的患病风险升高相关；而在男性群体中，稳定高教育组与超重患病风险升高相关。