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Crossnational comparison of the association between race and mean waist circumference in older women

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There was evidence of socioeconomic inequality patterned by race in Sao Paulo and the US ... in waist circumference in Sao Paulo, Brazil but there was in ... – PowerPoint PPT presentation

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Title: Crossnational comparison of the association between race and mean waist circumference in older women


1
Cross-national comparison of the association
between race and mean waist circumference in
older women
  • Kiarri N. Kershaw, Ana V. Diez Roux, Sarah
    Burgard
  • University of Michigan, Ann Arbor
  • Department of Epidemiology
  • World Congress on Public Health
  • April 30, 2009

2
Study goal
  • To understand the interplay of race and
    socioeconomic inequality in Sao Paulo, Brazil and
    Havana, Cuba compared with the US and their
    associations with abdominal obesity

3
Obesity Trends Among U.S. AdultsBRFSS, 1990,
1998, 2007
(BMI ?30, or about 30 lbs. overweight for 54
person)
1998
1990
2007
Source CDC Behavioral Risk Factor Surveillance
System
4
Obesity in Developing Countries
Popkin 2006
5
Socioeconomic status and obesity
  • Understanding the social patterning of obesity is
    important for the development of effective
    intervention strategies
  • In high income countries there is typically a
    clear inverse association between SES and
    obesity1
  • In developing countries this relationship is less
    clear1,2

1McClaren 2007 2Monteiro 2001
6
Race and Obesity
Source Okosun 1999
7
Race, SES, and Obesity
  • In the US
  • Socioeconomic inequality is patterned by race1
  • Race and low SES are associated with obesity2
  • In Cuba and Brazil
  • Arguably less racial inequality than in the US3,4
  • Socioeconomic patterning of obesity may be
    different

1Williams 1995 2Wang 2007 3Telles 2004 4Fuente
2005
8
Specific research questions
  • Is there less socioeconomic inequality
    (education) by race in Sao Paulo, Brazil and
    Havana, Cuba compared with the US?
  • Is the association between race and mean waist
    circumference smaller in Sao Paulo and Havana
    than in the US?
  • Is the association between education and mean
    waist circumference different across the
    countries?

9
Sample
  • Women aged 60 years and older
  • 1999-2000 Survey on Health and Well-being in
    Latin America and the Caribbean (SABE)
  • 1999-2002 National Health and Nutrition
    Examination Surveys (NHANES)

10
Study measures
  • Waist circumference measured in cm
  • Self-identified race
  • Age modeled in 5-year age categories
  • Education country-specific tertiles

11
Methods
  • Descriptives
  • Multinomial logistic regression (for education
    outcome) and linear regression (for waist
    circumference outcome)
  • Interaction terms used to assess significant
    country variation in the associations between
    race and mean waist circumference and
    socioeconomic status and mean waist circumference

12
Specific research questions
  • Is there less socioeconomic inequality
    (education) by race in Sao Paulo, Brazil and
    Havana, Cuba compared with the US?
  • Is the association between race and mean waist
    circumference smaller in Sao Paulo and Havana
    than in the US?
  • Is the association between education and mean
    waist circumference different across the
    countries?

13
Logit(Educ) b0 b1Age b2Black b3Brazil
b4Cuba b5Black_Brazil b6Black_Cuba



plt0.05 plt0.01 plt0.10 for interaction term
plt0.05 for interaction term
14
Specific research questions
  • Is there less socioeconomic inequality
    (education) by race in Sao Paulo, Brazil and
    Havana, Cuba compared with the US?
  • Is the association between race and mean waist
    circumference smaller in Sao Paulo and Havana
    than in the US?
  • Is the association between education and mean
    waist circumference different across the
    countries?

15
WC b0 b1Age b2Black b3Brazil b4Cuba
b5Black_Brazil b6Black_Cuba


plt0.05 plt0.01 plt0.10 for interaction term
plt0.05 for interaction term
16
Specific research questions
  • Is there less socioeconomic inequality
    (education) by race in Sao Paulo, Brazil and
    Havana, Cuba compared with the US?
  • Is the association between race and mean waist
    circumference smaller in Sao Paulo and Havana
    than in the US?
  • Is the association between education and mean
    waist circumference different across the
    countries?

17
WC b0 b1Age b2Black b3Brazil b4Cuba
b5Low b6Med b7Brazil_Low b8Brazil_Med
b9Cuba_Low b10Cuba_Med





plt0.05 plt0.01 plt0.10 for interaction term
plt0.05 for interaction term Statistically
significant trends in Havana and the US
18
Conclusions
  • Findings
  • There was evidence of socioeconomic inequality
    patterned by race in Sao Paulo and the US
  • There was no Black-White disparity in waist
    circumference in Sao Paulo, Brazil but there was
    in the US
  • There was no Black-White disparity in waist
    circumference in Havana and the socioeconomic
    patterning was in the opposite direction compared
    with in the US
  • Potential implications
  • Reaffirms that socioeconomic inequality plays an
    important role in shaping racial health
    disparities in the US
  • The socioeconomic patterning of obesity in Havana
    suggests that the target groups for future
    prevention and intervention efforts may be
    different from those in the US

19
Thank you!
  • Co-authors
  • Ana Diez Roux
  • Sarah Burgard
  • Colleagues
  • Amar Hamoudi
  • Sandra Albrecht
  • Brady West
  • Funding
  • Rackham Merit Fellowship
  • Rackham Travel Award

20
Extra slides
21
Race in Brazil
  • Race refers to skin color or physical appearance
    more than ancestry
  • Approximately 53.7 White 38.5 Mulatto 6.2
    Black1
  • Race relations appear to be better than in the
    US2
  • Debate in the literature over the extent of
    racial inclusivity vs. exclusivity in Brazil2

1CIA World Factbook 2Telles 2004
22
Race in Cuba
  • Race refers to skin color and physical appearance
    more than ancestry
  • Approximately 65.1 White 24.8 Mulatto or
    Mestizo 10.1 Black1
  • Argued that there is less racial inequality than
    in the US2

1CIA World Factbook 2Fuente 2005
23
Exclusions from Brazil sample
  • 765 male and 1089 female black and white SABE
    Brazil participants
  • 631 men (82.5) and 920 women (84.5) were used
    in the waist circumference analyses
  • 631 men (82.5) and 916 women (84.1) were used
    in the obesity analyses
  • A different number of participants were excluded
    from each of the socioeconomic indicator-specific
    analyses based on whether or not they were
    missing that particular measure
  • 6 men and 5 women were excluded from the
    education analyses
  • 52 men and 43 women were excluded from the income
    analyses
  • 3 women were excluded from the occupation
    analyses.

24
Exclusions from Cuba sample
  • 702 men and 1190 black and white participants
  • 629 men (89.6) and 1046 women (87.9) were
    included in the waist circumference analyses
  • 625 men (89.0) and 1037 women (87.1) were
    included in the obesity analyses
  • A different number of participants were excluded
    from each of the socioeconomic indicator-specific
    analyses based on whether or not they were
    missing that particular measure
  • 3 women were excluded from the education analyses
  • 5 men and 7 women from the income analyses
  • 10 men and 11 women from the occupation analyses.

25
Exclusions from US sample
  • 1316 male and 1412 female black and white
    participants 60
  • 1087 men (82.6) and 1098 women (77.8) were
    included in the waist circumference analyses
  • 1084 men (82.4) and 1096 women (77.6) were
    included in the obesity analyses
  • A different number of participants were excluded
    from each of the socioeconomic indicator-specific
    analyses based on whether or not they were
    missing that particular measure
  • 4 men and 3 women were excluded from the
    education analyses
  • 111 men and 140 women were excluded from the
    income analyses
  • 63 men and 54 women were excluded from the
    occupation analyses.

26
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