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Underpinnings of entangled ethnical and gender inequalities in obesity in Cochabamba-Bolivia: an intersectional approach
Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health. Biomedical and Social Research Institute, Faculty of Medicine, San Simon University, Cochabamba, Bolivia.ORCID iD: 0000-0003-0400-0414
Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.ORCID iD: 0000-0001-7234-3510
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2019 (English)In: International Journal for Equity in Health, ISSN 1475-9276, E-ISSN 1475-9276, Vol. 18, no 1, article id 153Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Social inequalities in obesity have been observed not only by gender but also between ethnic groups. Evidence on combined dimensions of inequality in health, and specifically including indigenous populations, is however scarce, and presents a particularly daunting challenge for successful prevention and control of obesity in Bolivia, as well as worldwide.

OBJECTIVE: The aims of this study were i) to examine intersectional inequalities in obesity and ii) to identify the factors underlying the observed intersectional inequalities.

METHODS: An intersectional approach study was employed, using the information collected in a cross-sectional community-based survey. The sample consisted of youth and adults with permanent residence in Cochabamba department (N = 5758), selected through a multistage sampling technique. An adapted version of the WHO-STEPS survey was used to collect information about Abdominal obesity and risk factors associated. Four intersectional positions were constructed from gender (woman vs. men) and ethnic group (indigenous vs. mestizo). Joint and excess intersectional disparities in obesity were estimated as absolute prevalence differences between binary groups, using binomial regression models. The Oaxaca-Blinder decomposition was applied to estimate the contributions of explanatory factors underlying the observed intersectional disparities, using Oaxaca command in Stata software v15.1.

RESULTS: The prevalence of abdominal obesity had a higher prevalence in mestizos (men 35.01% and women 30.71%) as compared to indigenous (men 25.38% and women 27.75%). The joint disparity was estimated at 7.26 percentage points higher prevalence in the doubly advantaged mestizo men than in the doubly disadvantaged indigenous women. The gender referent disparity showed that mestizo-women had a higher prevalence than indigenous-women. The ethnic referent disparity showed that mestizo-men had a higher prevalence than indigenous men. The behavioural risk factors were the most important to explain the observed inequalities, while differences in socioeconomic and demographic factors played a less important role.

CONCLUSION: Our study illustrates that abdominal obesity is not distributed according to expected patterns of structural disadvantage in the intersectional space of ethnicity and gender in Bolivia. In the Cochabamba case, a high social advantage was related to higher rates of abdominal obesity, as well as the behavioural risk factors associated with them.

Place, publisher, year, edition, pages
BioMed Central, 2019. Vol. 18, no 1, article id 153
Keywords [en]
Obesity, Gender, Ethnic, Intersectionality, Health inequality, Decomposition analysis, Bolivia
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
URN: urn:nbn:se:umu:diva-164917DOI: 10.1186/s12939-019-1062-7ISI: 000490424100002PubMedID: 31615512Scopus ID: 2-s2.0-85073295885OAI: oai:DiVA.org:umu-164917DiVA, id: diva2:1367807
Available from: 2019-11-05 Created: 2019-11-05 Last updated: 2019-11-13Bibliographically approved
In thesis
1. Cardiovascular risk factors in Cochabamba, Bolivia: estimating its distribution and assessing social inequalities
Open this publication in new window or tab >>Cardiovascular risk factors in Cochabamba, Bolivia: estimating its distribution and assessing social inequalities
2019 (English)Licentiate thesis, comprehensive summary (Other academic)
Alternative title[sv]
Kardiovaskulär sjukdom i Cochabamba, Bolivia : påverkbara riskfaktorer och sociala ojämlikheter
Abstract [en]

Background: The increase in the prevalence of cardiovascular risk factors (CVRFs) is considered one of the most important public health problems worldwide and especially in Latin American (LA) countries. Although the systematic surveillance of chronic diseases and their risk factors has been recommended, Bolivia has not yet implemented a national strategy to collect and monitor CVRF information. Evidence from previous studies in Bolivia and other Latin American countries has suggested that CVRFs affect women more than men and mestizos more than indigenous people. However, a more accurate and comprehensive picture of the CVRF situation and how ethnicity and gender intersect to affect CVRFs is dearly needed to support the development of health policies to improve population health and reduce inequalities.

Objective: to estimate the distribution of CVRFs and to examine intersectional in equalities in Cochabamba – Bolivia in order to provide useful information for public health practice and decision making. The specific objectives are: i) to estimate the prevalence of preventable risk factors associated with CVDs and ii) to assess and explain obesity inequalities in the intersectional spaces of ethnicity and gender.

Methods: The data collection procedure was based on the Pan-American version (V2.0) of the WHO STEPS approach adapted to the Bolivian context. Between 2015 and 2016, 10,754 individuals aged over 18 years old were surveyed. The two first stages of the STEPS approach were conducted: a) Step 1 consisted of the application of a questionnaire to collect demographic and lifestyle data; b) Step 2 involved taking measurements of height, weight, blood pressure, and waist circumference of the participants.

To achieve objective 1, the prevalence of relevant behavioural risk factors and anthropometric measures were calculated, and then odds ratios/prevalence ratios were estimated for each CVRF, both with crude and adjusted regression models. Regarding objective 2, an intersectionality approach based on the method suggested by Jackson et al. (67) was used to analyse the ethnic and gender inequalities in obesity. Gender and ethnicity information were combined to form four mutually exclusive intersectional positions: i) the dually disadvantaged group of indigenous women; ii) the dually advantaged group of mestizo men; and the singly disadvantaged groups of iii) indigenous men and iv) mestizo women. Joint and excess intersectional disparities in abdominal obesity were estimated as absolute prevalence differences between binary groups, using binomial regression models. The Oaxaca-Blinder decomposition was applied to estimate the contributions of explanatory factors underlying the observed intersectional disparities.

Main findings: Our findings revealed that Cochabamba had a high prevalence of CVRFs, with significant variations among the different socio-demographic groups. Indigenous populations and those living in the Andean region showed, in general, a lower prevalence for most of the risk factors evaluated. The prevalence of behavioural risk factors were: current smoking (11.6%); current alcohol consumption (42.76%); low consumption of fruits and vegetables (76.73%); and low level of physical activity (64.77%). The prevalence of metabolic risk factors evaluated were: being overweight (35.84%); obesity (20.49%); abdominal obesity (54.13%); and raised blood pressure (17.5%). It is important to highlight that 40.7% of participants had four or more CVRFs simultaneously.

Dually and singly disadvantaged groups (indigenous women, indigenous men, and mestizo women) were less obese than the dually advantaged group (mestizomen). The joint disparity showed that the obesity prevalence was 7.26 percentage points higher in the doubly advantaged mestizo men (MM) than in the doubly disadvantaged indigenous women (IW). Mestizo men (MM) had an obesity prevalence of 4.30 percentage points higher than mestizo women (MW) and 9.18 percentage points higher than indigenous men (IM). The resulting excess intersectional disparity was 6.22 percentage points, representing -86 percentage points of the joint disparity. The lower prevalence of obesity in the doubly disadvantaged group of indigenous women (7.26 percentage points) was mainly due to ethnic differences alone. However, they had higher obesity than expected when considering both genders alone and ethnicity alone. Health behaviours were important factors in explaining the intersectional inequalities, while differences in socioeconomic and demographic factors played less important roles.

Conclusion: The prevalence of all CVRFs in Cochabamba was high, and nearly two-thirds of the population reported two or more risk factors simultaneously. The intersectional disparities illustrate that abdominal obesity is not distributed according to expected patterns of structural disadvantages in the intersectional spaces of ethnicity and gender in Bolivia. A high social advantage was related to higher rates of abdominal obesity, with health behaviours as the most important factors explaining the observed inequalities. The information generated by this study provides evidence for health policymakers at the regional level and a baseline data for department-wide action plans to carry out specific interventionsin the population and on individual levels.

Place, publisher, year, edition, pages
Umeå: Umeå universitet, 2019. p. 85
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-164923 (URN)9789178550999 (ISBN)
Presentation
2019-11-22, Triple Helix, universitetsledningshuset, Umeå universitet, Umeå, 09:00 (English)
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Available from: 2019-11-12 Created: 2019-11-05 Last updated: 2019-11-12Bibliographically approved

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Mamani-Ortiz, YercinGustafsson, Per ESan Sebastián Chasco, MiguelMosquera Méndez, Paola A.

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