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. 2022 Dec;99(6):1091-1103.
doi: 10.1007/s11524-022-00689-5. Epub 2022 Nov 10.

Are Women's Empowerment and Income Inequality Associated with Excess Weight in Latin American Cities?

Natalia Tumas  1   2   3 , Santiago Rodríguez López  4   5 , Mónica Mazariegos  6 , Ana Ortigoza  7 , Cecilia Anza Ramírez  8 , Carolina Pérez Ferrer  9 , Kari Moore  7 , Goro Yamada  7 , Mariana Carvalho Menezes  10 , Olga L Sarmiento  11 , Juan M Pericàs  12   13   14   15 , Francesc Belvis Costes  12   13 , Mariana Lazo  7 , Joan Benach  12   13   16
Affiliations

Are Women's Empowerment and Income Inequality Associated with Excess Weight in Latin American Cities?

Natalia Tumas et al. J Urban Health. 2022 Dec.

Abstract

While income gradients and gender inequalities in excess weight have been noted elsewhere, data from Latin American cities is lacking. We analyzed gender-specific associations between city-level women's empowerment and income inequality with individual-level overweight/obesity, assessing how these associations vary by individual education or living conditions within cities in Latin America. Data came from national surveys and censuses, and was compiled by the SALURBAL project (Urban Health in Latin America). The sample included 79,422 individuals (58.0% women), living in 538 sub-cities, 187 cities, and 8 countries. We used gender-stratified Poisson multilevel models to estimate the Prevalence Rate Ratios (PRR) for overweight/obesity (body mass index ≥ 25 kg/m2) per a unit change in city-level women's empowerment (proxied by a score that measures gender inequalities in employment and education) and income inequality (proxied by income-based Gini coefficient). We also tested whether individual education or sub-city living conditions modified such associations. Higher city labor women's empowerment (in women) and higher city Gini coefficient (in men) were associated with a lower prevalence of overweight/obesity (PRR = 0.97 (95%CI 0.94, 0.99) and PRR = 0.94 (95%CI 0.90, 0.97), respectively). The associations varied by individual education and sub-city living conditions. For labor women's empowerment, we observed weakened associations towards the null effect in women with lower education and in residents of sub-cities with worse living conditions (men and women). For the Gini coefficient, the association was stronger among men with primary education, and a negative association was observed in women with primary education. Our findings highlight the need for promoting equity-based policies and interventions to tackle the high prevalence of excess weight in Latin American cities.

Keywords: Cities; Income inequality; Latin America; Obesity; Overweight; Women’s empowerment.

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Figures

Fig. 1
Fig. 1
Age-adjusted percentage of overweight/obesity by quartiles of city. Gini coefficient and labor women’s empowerment and gender in 187 Latin American cities. SALURBAL study. 95% confidence intervals are shown in vertical lines
Fig. 2
Fig. 2
Adjusted associations between labor women’s empowerment and overweight/obesity, by a individual education and b sub-city living conditions in men and women in 187 Latin American cities. SALURBAL study. Significant global p-values for interactions: < 0.01 for individual education in women; < 0.05 for sub-city living conditions in men
Fig. 3
Fig. 3
Adjusted associations between Gini coefficient and overweight/obesity, by a individual education and b sub-city living conditions in men and women in 187 Latin American cities. SALURBAL study. Significant global p-values for interactions: < 0.05 for individual education in men and < 0.01 in women
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