Social determinants of disparities in weight among US children and adolescents |
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Affiliation: | 1. Centre for Sexual Health and HIV AIDS Research Zimbabwe, Harare, Zimbabwe;2. Research Department of Infection and Population Health, University College London, London WC1E 6AU, UK;1. Access Campaign, Médecins Sans Frontières, 78 Rue de Lausanne, Geneva, Switzerland;1. Department of Obstetrics and Gynecology, Medical Center, VU University, Amsterdam, The Netherlands;2. Medical Library, VU University, Amsterdam, The Netherlands;3. Department of Obstetrics and Gynecology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands;4. Department of Obstetrics and Gynecology, Amsterdam Medical Center, Amsterdam, The Netherlands;5. Department of Obstetrics and Gynecology, Medical Center Haaglanden, the Hague, The Netherlands;6. Department of Obstetrics and Gynecology, University Medical Center Utrecht, Utrecht, The Netherlands;7. Department of Obstetrics and Gynecology, Leiden University Medical Center, Leiden, The Netherlands |
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Abstract: | PurposeTo explore whether contextual variables attenuate disparities in weight among 18,639 US children and adolescents aged 2 to 18 years participating in the National Health and Nutrition Examination Survey, 2001 to 2010.MethodsDisparities were assessed using the Symmetrized Rényi Index, a new measure that summarizes disparities in the severity of a disease, as well as the prevalence, across multiple population groups. Propensity score subclassification was used to ensure covariate balance between racial and ethnic subgroups and account for individual-level and contextual covariates.ResultsBefore propensity score subclassification, significant disparities were evident in the prevalence of overweight and/or obesity and the degree of excess weight among overweight/obese children and adolescents. After propensity score subclassification, racial/ethnic disparities in the prevalence and severity of excess weight were completely attenuated within matched groups, indicating that racial and ethnic differences were explained by social determinants such as neighborhood socioeconomic and demographic factors.ConclusionsThe limited overlap in covariate distributions between various racial/ethnic subgroups warrants further attention in disparities research. The attenuation of disparities within matched groups suggests that social determinants such as neighborhood socioeconomic factors may engender disparities in weight among US children and adolescents. |
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Keywords: | Epidemiologic methods Health status disparities Multilevel analysis Propensity score Obesity Residence characteristics Social determinants of health |
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