Income and neighbourhood deprivation in relation to obesity in urban dwelling children 0-12 years of age: a cross-sectional study from 2013 to 2019

Laura N Anderson; Tooba Fatima; Bindra Shah; Brendan T Smith; Anne E Fuller; Cornelia M Borkhoff; Charles D G Keown-Stoneman; Jonathon L Maguire; Catherine S Birken

doi:10.1136/jech-2021-216455

Income and neighbourhood deprivation in relation to obesity in urban dwelling children 0-12 years of age: a cross-sectional study from 2013 to 2019

J Epidemiol Community Health. 2022 Mar;76(3):274-280. doi: 10.1136/jech-2021-216455. Epub 2021 Sep 6.

Authors

Laura N Anderson^{1

2}, Tooba Fatima³, Bindra Shah³, Brendan T Smith^{4

5}, Anne E Fuller^{3

6}, Cornelia M Borkhoff^{2

5}, Charles D G Keown-Stoneman^{5

7}, Jonathon L Maguire^{5

6

7

8}, Catherine S Birken^{2

6

8

9}

Affiliations

¹ Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada LN.Anderson@mcmaster.ca.
² Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada.
³ Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada.
⁴ Public Health Ontario, Toronto, Ontario, Canada.
⁵ Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
⁶ Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.
⁷ Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada.
⁸ Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada.
⁹ Paediatric Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada.

Abstract

Background: Childhood obesity is a major public health concern. This study evaluated the independent and joint associations of family-level income, neighbourhood-level income and neighbourhood deprivation, in relation to child obesity.

Methods: A cross-sectional study was conducted in children ≤12 years of age from TARGet Kids! primary care network (Greater Toronto Area, 2013-2019). Parent-reported family income was compared with median neighbourhood income and neighbourhood deprivation measured using the Ontario Marginalization Index. Children's height and weight were measured and body mass index (BMI) z-scores (zBMI) were calculated. ORs and 95% CIs were estimated for the three exposure variables separately using multilevel multinomial logistic regression models with zBMI categories as the outcome, adjusting in model 1 for age, sex, ethnicity and number of family members and in model 2 adding family income. A joint measure was derived combining income and deprivation measures.

Results: A total of 5962 children were included. Low family income (Q1 vs Q5: OR=4.69, 95% CI 2.65 to 8.29), low neighbourhood income (Q1 vs Q5: OR=2.18, 95% CI 1.33 to 3.58) and high neighbourhood deprivation (Q1 vs Q5: OR=2.45, 95% CI 1.52 to 3.95) were each associated with increased OR of child obesity. However, after adjustment for family income, the association for both neighbourhood income (OR=1.39, 95% CI 0.82 to 2.34) and deprivation (OR=1.56, 95% CI 0.94 to 2.58) and obesity was attenuated. Children from low-income families living in low-income or high deprivation neighbourhoods had higher OR of obesity.

Conclusion: Child obesity was independently associated with low family-level income and a joint measure suggests that neighbourhood also matters. Socioeconomic inequalities at both individual and neighbourhood levels should be addressed in childhood obesity interventions.

Keywords: child health; epidemiology; obesity; poverty; social epidemiology.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Child
Cross-Sectional Studies
Humans
Income
Pediatric Obesity* / epidemiology
Residence Characteristics
Socioeconomic Factors
Urban Population

Grants and funding

CIHR/Canada