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. 2025 Mar;33(3):578-588.
doi: 10.1002/oby.24225. Epub 2025 Feb 18.

Trends in educational inequalities in obesity-attributable mortality in England and Wales, Finland, and Italy

Fanny Janssen  1   2 , Rolando Gonzales Martinez  1 , Nicolás Zengarini  3 , Pekka Martikainen  4   5   6 , Anton Kunst  7
Affiliations

Trends in educational inequalities in obesity-attributable mortality in England and Wales, Finland, and Italy

Fanny Janssen et al. Obesity (Silver Spring). 2025 Mar.

Abstract

Objective: We assessed trends in educational inequalities in obesity-attributable mortality (OAM) and their contribution to educational inequalities in all-cause mortality for people aged 30 years and older, in England and Wales (1991-2017), Finland (1978-2017), and Italy (1990-2018).

Methods: In our population-level study, we estimated the shares of all-cause mortality due to OAM by educational level (i.e., low, middle, and high) by applying the population-attributable fraction formula to harmonized obesity prevalence data by educational level, along with sex- and age-specific relative risks of dying from obesity. We obtained OAM rates by multiplying the shares with individually linked all-cause mortality data by educational level. We measured absolute inequalities in OAM and all-cause mortality by the slope index of inequality.

Results: OAM largely increased for the different sex- and education-specific populations and increased most strongly for those with low educational level up to 2010 to 2015. Educational inequalities in OAM initially increased but stabilized or declined from at least 2008 onward. Obesity contributed, on average, 15% to absolute educational inequalities in all-cause mortality in 1991 through 2017.

Conclusions: The mortality impact of the obesity epidemic by educational level changed over time. Although the observed change from increasing to declining or stable educational inequalities is encouraging, reducing OAM in all socioeconomic groups remains a challenge.

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Conflict of interest statement

The authors declared no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Trends in standardized obesity‐attributable mortality fractions (OAMFs) by educational level, for people aged 30 years and older in England (1991–2017), Finland (1978–2017), and Italy (1990–2018), by sex and country.
FIGURE 2
FIGURE 2
Trends in standardized obesity‐attributable mortality rates by educational level, for people aged 30 years and older in England and Wales (1991–2017), Finland (1978–2017), and Italy (Turin; 1990–2018), by sex and country.
FIGURE 3
FIGURE 3
Trends in absolute educational inequalities in obesity‐attributable mortality, measured by the slope index of inequality, by sex and country, for people aged 30 years and older in England and Wales (1991–2017), Finland (1978–2017), and Italy (Turin; 1990–2018).
FIGURE 4
FIGURE 4
The (changing) relative contribution of obesity‐attributable mortality to absolute educational inequalities in all‐cause mortality (measured by the slope index of inequality [SII]), for people aged 30 years and older in England and Wales (1991–2017), Finland (1978–2017), and Italy (Turin; 1990–2018), by sex and country.
See this image and copyright information in PMC

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