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Socioeconomic inequalities in co-morbidity of overweight, obesity and mental ill-health from adolescence to mid-adulthood in two national birth cohort studies

By Amal R. Khanolkar, Praveetha Patalay

Posted 28 Oct 2020
medRxiv DOI: 10.1101/2020.10.21.20215764

AimTo examine socioeconomic inequalities in risk of comorbidity between overweight (including obesity) and mental ill-health in two national cohorts. We investigated independent effects of childhood and adulthood socioeconomic disadvantage on comorbidity from childhood to mid-adulthood, and differences by sex and cohort. MethodsData were from 1958 National Child Development Study (NCDS58) and 1970 British Cohort Study (BCS70) [total N=30,868, 51% males] assessed at ages 10, 16, 23, 34 and 42 years. Socioeconomic indicators included childhood and adulthood social class and educational level. Risk for i. having healthy BMI and mental ill-health, ii. overweight and good mental health, and iii. overweight and mental ill-health was analysed using multinomial logistic regression. ResultsSocioeconomic disadvantage was consistently associated with greater risk for overweight-mental ill-health comorbidity at all ages (RRR 1.43, 2.04, 2.38, 1.64 and 1.71 at ages 10, 16, 23, 34 and 42 respectively for unskilled/skilled vs. professional/managerial class). The observed inequalities in co-morbidity were greater than that observed for either condition alone (overweight; RRR 1.39 and 1.25, mental ill-health; 1.36 and 1.22 at ages 16 and 42 respectively, for unskilled/skilled vs. professional/managerial class). In adulthood, childhood and adulthood socioeconomic disadvantage were independently associated with comorbid overweight-mental ill-health, with a clear inverse gradient between educational level and risk for comorbidity; no education, RRR 6.11 (95% CI 4.31-8.65) at age 34 and 4.42 (3.28-5.96) at age 42 compared to university education. There were no differences observed in the extent of inequalities by sex and differences between cohorts were limited. ConclusionsSocioeconomic disadvantage in childhood and adulthood are consistently and independently associated with greater risk for mental ill-health and overweight separately, and even greater inequalities in the risk for comorbidity between both conditions through the lifecourse. These findings are significant given the increasing global prevalence of obesity and mental ill-health, and their implications for lifelong health and mortality.

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