Socioeconomic - Related Inequalities in Overweight and Obesity: Findings from the PERSIAN Cohort Study

Background: Overweight and obesity are major health concerns worldwide, with adverse health consequences during the life span. This study measured socioeconomic inequality in overweight and obesity among Iranian adults.

Methods: Data were extracted from 129,257 Iranian adults (aged 35 years and older) participated in the Prospective Epidemiologic Research Studies in IrAN (PERSIAN) in 14 provinces of Iran in 2014. Socioeconomic-related inequality in overweight and obesity was estimated using the Concentration Index (C). The C further decomposed to find factors explaining the variability within the Socioeconomic related inequality in overweight and obesity.

Results: Of the total number of participants, 1.98, 26.82, 40.76 and 30.43% had underweight, normal weight, overweight and obesity respectively. The age-and sex standardized prevalence of obesity was higher in females than males (39.85% vs 18.79%). People with high socioeconomic status (SES) had a 39 and 15% higher chance of being overweight and obese than low SES people, respectively. The positive value of C suggested a higher concentration of overweight (0.081, 95% confidence interval [CI]; 0.074-0.087) and obesity (0.027, 95% CI; 0.021-0.034) among groups with high SES. There was a wide variation in socioeconomic-related inequality in overweight and obesity rate across 14 provinces. The decomposition results suggested that SES factor itself explained 66.77 and 89.07% of the observed socioeconomic inequalities in overweight and obesity among Iranian adults respectively. Following SES, province of residence, physical activity, using hookah and smoking were the major contributors to the concentration of overweight and obesity among the rich.

Conclusions: Overall, we found that overweight and obesity is concentrated among high SES people in the study population. . Accordingly, it seems that intersectional actions should be taken to control and prevent overweight and obesity among higher socioeconomic groups.

Citing Articles

Global prevalence of obesity in the older adults: A meta-analysis.

Khaleghi A, Salari N, Darvishi N, Bokaee S, Jafari S, Hemmati M Public Health Pract (Oxf). 2025; 9:100585.

PMID: 39902301 PMC: 11788860. DOI: 10.1016/j.puhip.2025.100585.

Socioeconomic inequality in exposure to second-hand smoke among middle-aged adults of the RaNCD cohort study: a decomposition analysis.

Khosravi O, Bazyar M, Soofi M, Nargesi S, Khorshidi A BMC Public Health. 2024; 24(1):3532.

PMID: 39696261 PMC: 11657884. DOI: 10.1186/s12889-024-20978-9.

Clustering the Economic Status via Partitioning around Medoid and Its Association with Common Non-communicable Diseases.

Sanjari E, Ahmadi A, Raeisi Shahraki H Iran J Med Sci. 2024; 49(11):699-706.

PMID: 39678524 PMC: 11645417. DOI: 10.30476/ijms.2023.100513.3275.

Did socioeconomic inequalities in overweight and obesity in South African women of childbearing age improve between 1998 and 2016? A decomposition analysis.

Nglazi M, Ataguba J PLOS Glob Public Health. 2024; 4(11):e0003719.

PMID: 39541287 PMC: 11563443. DOI: 10.1371/journal.pgph.0003719.

The mediating effect of sleep duration on metabolic syndrome severity in adults: a structural equation modeling approach.

Hemati N, Satari S, Khazaie H, Salimi Y, Najafi F, Pasdar Y BMC Endocr Disord. 2024; 24(1):75.

PMID: 38807076 PMC: 11134647. DOI: 10.1186/s12902-024-01611-7.

References

Singh G, Danaei G, Farzadfar F, Stevens G, Woodward M, Wormser D . The age-specific quantitative effects of metabolic risk factors on cardiovascular diseases and diabetes: a pooled analysis. PLoS One. 2013; 8(7):e65174. PMC: 3728292. DOI: 10.1371/journal.pone.0065174. View

Czernichow S, Kengne A, Stamatakis E, Hamer M, Batty G . Body mass index, waist circumference and waist-hip ratio: which is the better discriminator of cardiovascular disease mortality risk?: evidence from an individual-participant meta-analysis of 82 864 participants from nine cohort studies. Obes Rev. 2011; 12(9):680-7. PMC: 4170776. DOI: 10.1111/j.1467-789X.2011.00879.x. View

Lauby-Secretan B, Scoccianti C, Loomis D, Grosse Y, Bianchini F, Straif K . Body Fatness and Cancer--Viewpoint of the IARC Working Group. N Engl J Med. 2016; 375(8):794-8. PMC: 6754861. DOI: 10.1056/NEJMsr1606602. View

Anstey K, Cherbuin N, Budge M, Young J . Body mass index in midlife and late-life as a risk factor for dementia: a meta-analysis of prospective studies. Obes Rev. 2011; 12(5):e426-37. DOI: 10.1111/j.1467-789X.2010.00825.x. View

Kushner R, Foster G . Obesity and quality of life. Nutrition. 2000; 16(10):947-52. DOI: 10.1016/s0899-9007(00)00404-4. View

Lakerveld J, Mackenbach J . The Upstream Determinants of Adult Obesity. Obes Facts. 2017; 10(3):216-222. PMC: 5644962. DOI: 10.1159/000471489. View

Affenito S, Franko D, Striegel-Moore R, Thompson D . Behavioral determinants of obesity: research findings and policy implications. J Obes. 2012; 2012:150732. PMC: 3431098. DOI: 10.1155/2012/150732. View

Block J, He Y, Zaslavsky A, Ding L, Ayanian J . Psychosocial stress and change in weight among US adults. Am J Epidemiol. 2009; 170(2):181-92. PMC: 2727271. DOI: 10.1093/aje/kwp104. View

Kiecolt-Glaser J, Newton T . Marriage and health: his and hers. Psychol Bull. 2001; 127(4):472-503. DOI: 10.1037/0033-2909.127.4.472. View

10.

McLaren L . Socioeconomic status and obesity. Epidemiol Rev. 2007; 29:29-48. DOI: 10.1093/epirev/mxm001. View

11.

Kuntz B, Lampert T . Socioeconomic factors and obesity. Dtsch Arztebl Int. 2010; 107(30):517-22. PMC: 2925342. DOI: 10.3238/arztebl.2010.0517. View

12.

Azadbakht L, Mirmiran P, Shiva N, Azizi F . General obesity and central adiposity in a representative sample of Tehranian adults: prevalence and determinants. Int J Vitam Nutr Res. 2005; 75(4):297-304. DOI: 10.1024/0300-9831.75.4.297. View

13.

Hajian-Tilaki K, Heidari B . Prevalence of obesity, central obesity and the associated factors in urban population aged 20-70 years, in the north of Iran: a population-based study and regression approach. Obes Rev. 2007; 8(1):3-10. DOI: 10.1111/j.1467-789X.2006.00235.x. View

14.

Kolahi A, Moghisi A, Soleiman Ekhtiari Y . Socio-demographic determinants of obesity indexes in Iran: findings from a nationwide STEPS survey. Health Promot Perspect. 2018; 8(3):187-194. PMC: 6064748. DOI: 10.15171/hpp.2018.25. View

15.

Najafi F, Pasdar Y, Hamzeh B, Rezaei S, Nazar M, Soofi M . Measuring and Decomposing Socioeconomic Inequalities in Adult Obesity in Western Iran. J Prev Med Public Health. 2018; 51(6):289-297. PMC: 6283744. DOI: 10.3961/jpmph.18.062. View

16.

Raeisi A, Mehboudi M, Darabi H, Nabipour I, Larijani B, Mehrdad N . Socioeconomic inequality of overweight and obesity of the elderly in Iran: Bushehr Elderly Health (BEH) Program. BMC Public Health. 2017; 17(1):72. PMC: 5237161. DOI: 10.1186/s12889-016-3912-1. View

17.

Eghtesad S, Mohammadi Z, Shayanrad A, Faramarzi E, Joukar F, Hamzeh B . The PERSIAN Cohort: Providing the Evidence Needed for Healthcare Reform. Arch Iran Med. 2018; 20(11):691-695. View

18.

Poustchi H, Eghtesad S, Kamangar F, Etemadi A, Keshtkar A, Hekmatdoost A . Prospective Epidemiological Research Studies in Iran (the PERSIAN Cohort Study): Rationale, Objectives, and Design. Am J Epidemiol. 2017; 187(4):647-655. PMC: 6279089. DOI: 10.1093/aje/kwx314. View

19.

Jette M, Sidney K, Blumchen G . Metabolic equivalents (METS) in exercise testing, exercise prescription, and evaluation of functional capacity. Clin Cardiol. 1990; 13(8):555-65. DOI: 10.1002/clc.4960130809. View

20.

Ainsworth B, Haskell W, Herrmann S, Meckes N, Bassett Jr D, Tudor-Locke C . 2011 Compendium of Physical Activities: a second update of codes and MET values. Med Sci Sports Exerc. 2011; 43(8):1575-81. DOI: 10.1249/MSS.0b013e31821ece12. View