Sex-specific role of education on the associations of socioeconomic status indicators with obesity risk: A population-based study in South Korea
January
Sex-specific role of education on the associations of socioeconomic status indicators with obesity risk: A population- based study in South Korea
Woojin Chung 0 1
Jaeyeun Kim 0
Seung-ji Lim 0
Sunmi Lee 0
0 Editor: Meian He, Tongji Med College , HUST , CHINA
1 Department of Health Policy, Graduate School of Public Health, Yonsei University , Seoul , Republic of Korea, 2 Institute of Health Services Research, Yonsei University , Seoul , Republic of Korea, 3 Department of Public Health, Graduate School, Yonsei University , Seoul , Republic of Korea, 4 Health Insurance Policy Research Institute, National Health Insurance Service , Wonju-si , Republic of Korea
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OPEN ACCESS
Data Availability Statement: Data are from the
Fifth and Sixth Korea National Health and Nutrition
Examination Survey, which is available from the
Korea Centers for Disease Control and Prevention
database (https://knhanes.cdc.go.kr/knhanes/main.
do). These are third party data and free of charge to
anyone. Interested researchers can download the
data through a simple registration process.
Funding: The authors received no specific funding
for this work.
Background
Methods
Results
Competing interests: The authors have declared
that no competing interests exist.
Conclusions
The present study suggests the need to examine sex-specific studies regarding the role of
education on the association between other socioeconomic status indicators and obesity.
This should be considered in planning education policies to reduce the risk of obesity.
Introduction
Worldwide, obesity has become an important public health problem. Obesity can cause
various diseases and a diminished quality of life for individuals [
1
], and it can cause a heavy
economic burden by increasing a society's medical expenditures, decreasing manpower, and
thereby reducing labor productivity [
2,3
].
Regardless of whether they were for academic curiosity or policy development, numerous
studies have examined factors associated with obesity risk. Among these factors, the
association between socioeconomic status and obesity risk has attracted much attention across many
disciplines. Generally, the consensus has been that in developed countries, a higher
socioeconomic status is associated with a lower risk of obesity in both men and women [4±6].
Meanwhile, recent studies from developed countries point to a more complex association
between socioeconomic status indicators and obesity risk, thereby asking for more and better
research on the association. For example, studies from Canada [
7
], France [
8
], Luxembourg
[
9
], the United States [
10
], and South Korea [
11
] suggest that the association between a
particular socioeconomic status indicator and obesity risk may not only be positive in one sex, but
negative in the other sex.
Unfortunately, despite a lot of attention paid to the associations between socioeconomic
status indicators and obesity risk, a study of a multi-dimensional analysis on the associations
has not been performed for people in developed countries. This lack of studies may lead to the
unavailability of adequate information for developing theories and designing efficient public
health policies aimed at reducing obesity risk in specific groups of people.
Therefore, the aim of the present study was to employ a multi-dimensional analysis and
examine the role of education on the association between other socioeconomic status
indicators (such as marital status, residential area, occupation, and income) and obesity. In the
present study, we elected to focus on the role of education among the various socioeconomic status
indicators because education level is established during early adulthood and generally remains
unchanged unlike the other socioeconomic indicators that are more susceptible to change.
In this study, we sought to identify education as either a confounder or an effect modifier
or both a confounder and effect modifier in the association between another socioeconomic
status indicator and obesity. In addition, after considering the role of education in the
association between another socioeconomic status indicator and obesity, the study aimed to
investigate if a higher level of education was associated with a reduced risk of obesity in both men
and women. To fulfill the aims of the study, we analyzed a sample adult population aged 25
years from the nationally representative data in South Korea; this population was selected
because the country is one of the largest developed countries in the world [
12
], and people in
this age group were thought to have most likely completed their education.
Materials and methods
Data source and study sample
We used data from the Fifth and Sixth Korea National Health and Nutrition Examination
Survey (KNHANES V and VI, 2010±2014), performed by the Korea Centers for Disease Control
2 / 16
and Prevention. The sampling design for the KNHANES was a stratified, multistage
probability survey of the (...truncated)