Socioeconomic differences in body mass index in Spain: An intersectional multilevel analysis of individual heterogeneity and discriminatory accuracy
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...
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| Veröffentlicht in: | PloS one 2018-12, Vol.13 (12), p.e0208624-e0208624 |
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| creator | Hernández-Yumar, Aránzazu Wemrell, Maria Abásolo Alessón, Ignacio González López-Valcárcel, Beatriz Leckie, George Merlo, Juan |
| description | 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. |
| doi_str_mv | 10.1371/journal.pone.0208624 |
| format | Article |
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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. 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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.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0208624</identifier><identifier>PMID: 30532244</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Academic achievement ; Adolescent ; Adult ; Adults ; Aged ; Analysis ; Biology and Life Sciences ; Body mass ; Body Mass Index ; Body size ; Caring Science ; Cluster Analysis ; Clustering ; Correlation coefficient ; Correlation coefficients ; Cross-Sectional Studies ; Demographics ; Education ; Educational Status ; Epidemiology ; Family Characteristics ; Female ; Females ; Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi ; Health aspects ; Health policy ; Health Sciences ; Health Surveys ; Heterogeneity ; Humans ; Hälsovetenskap ; Income ; Interviews as Topic ; Male ; Mapping ; Medical and Health Sciences ; Medicin och hälsovetenskap ; Medicine and Health Sciences ; Middle Aged ; Multilevel ; Obesity ; People and places ; Public health ; Public Health, Global Health, Social Medicine and Epidemiology ; Social Sciences ; Socio-economic aspects ; Socioeconomics ; Spain ; Strata ; Studies ; Surveys ; Variance analysis ; Vårdvetenskap ; Young Adult</subject><ispartof>PloS one, 2018-12, Vol.13 (12), p.e0208624-e0208624</ispartof><rights>COPYRIGHT 2018 Public Library of Science</rights><rights>2018 Hernández-Yumar et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2018 Hernández-Yumar et al 2018 Hernández-Yumar et al</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c799t-62fd2a112011e38ed296f9253b50f434e4539b7addc2103440e99b3d4ad22ca3</citedby><cites>FETCH-LOGICAL-c799t-62fd2a112011e38ed296f9253b50f434e4539b7addc2103440e99b3d4ad22ca3</cites><orcidid>0000-0001-8379-9708 ; 0000-0002-3299-4180</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC6287827/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC6287827/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,551,724,777,781,861,882,2097,2916,23848,27906,27907,53773,53775,79350,79351</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30532244$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink><backlink>$$Uhttps://urn.kb.se/resolve?urn=urn:nbn:se:lnu:diva-117373$$DView record from Swedish Publication Index$$Hfree_for_read</backlink><backlink>$$Uhttps://lup.lub.lu.se/record/7d44b6d1-2987-4a9c-a2d2-f78c52a243d4$$DView record from Swedish Publication Index$$Hfree_for_read</backlink></links><search><contributor>Meyre, David</contributor><creatorcontrib>Hernández-Yumar, Aránzazu</creatorcontrib><creatorcontrib>Wemrell, Maria</creatorcontrib><creatorcontrib>Abásolo Alessón, Ignacio</creatorcontrib><creatorcontrib>González López-Valcárcel, Beatriz</creatorcontrib><creatorcontrib>Leckie, George</creatorcontrib><creatorcontrib>Merlo, Juan</creatorcontrib><title>Socioeconomic differences in body mass index in Spain: An intersectional multilevel analysis of individual heterogeneity and discriminatory accuracy</title><title>PloS one</title><addtitle>PLoS One</addtitle><description>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. 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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.</description><subject>Academic achievement</subject><subject>Adolescent</subject><subject>Adult</subject><subject>Adults</subject><subject>Aged</subject><subject>Analysis</subject><subject>Biology and Life Sciences</subject><subject>Body mass</subject><subject>Body Mass Index</subject><subject>Body size</subject><subject>Caring Science</subject><subject>Cluster Analysis</subject><subject>Clustering</subject><subject>Correlation coefficient</subject><subject>Correlation coefficients</subject><subject>Cross-Sectional Studies</subject><subject>Demographics</subject><subject>Education</subject><subject>Educational Status</subject><subject>Epidemiology</subject><subject>Family Characteristics</subject><subject>Female</subject><subject>Females</subject><subject>Folkhälsovetenskap, 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Beatriz</au><au>Leckie, George</au><au>Merlo, Juan</au><au>Meyre, David</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Socioeconomic differences in body mass index in Spain: An intersectional multilevel analysis of individual heterogeneity and discriminatory accuracy</atitle><jtitle>PloS one</jtitle><addtitle>PLoS One</addtitle><date>2018-12-10</date><risdate>2018</risdate><volume>13</volume><issue>12</issue><spage>e0208624</spage><epage>e0208624</epage><pages>e0208624-e0208624</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>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.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>30532244</pmid><doi>10.1371/journal.pone.0208624</doi><tpages>e0208624</tpages><orcidid>https://orcid.org/0000-0001-8379-9708</orcidid><orcidid>https://orcid.org/0000-0002-3299-4180</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1932-6203 |
| ispartof | PloS one, 2018-12, Vol.13 (12), p.e0208624-e0208624 |
| issn | 1932-6203 1932-6203 |
| language | eng |
| recordid | cdi_plos_journals_2154247235 |
| source | MEDLINE; DOAJ Directory of Open Access Journals; SWEPUB Freely available online; Public Library of Science (PLoS); EZB-FREE-00999 freely available EZB journals; PubMed Central; Free Full-Text Journals in Chemistry |
| subjects | Academic achievement Adolescent Adult Adults Aged Analysis Biology and Life Sciences Body mass Body Mass Index Body size Caring Science Cluster Analysis Clustering Correlation coefficient Correlation coefficients Cross-Sectional Studies Demographics Education Educational Status Epidemiology Family Characteristics Female Females Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi Health aspects Health policy Health Sciences Health Surveys Heterogeneity Humans Hälsovetenskap Income Interviews as Topic Male Mapping Medical and Health Sciences Medicin och hälsovetenskap Medicine and Health Sciences Middle Aged Multilevel Obesity People and places Public health Public Health, Global Health, Social Medicine and Epidemiology Social Sciences Socio-economic aspects Socioeconomics Spain Strata Studies Surveys Variance analysis Vårdvetenskap Young Adult |
| title | Socioeconomic differences in body mass index in Spain: An intersectional multilevel analysis of individual heterogeneity and discriminatory accuracy |
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