IDEAS home Printed from https://ideas.repec.org/a/plo/pone00/0208624.html
   My bibliography  Save this article

Socioeconomic differences in body mass index in Spain: An intersectional multilevel analysis of individual heterogeneity and discriminatory accuracy

Author

Listed:
  • Aránzazu Hernández-Yumar
  • Maria Wemrell
  • Ignacio Abásolo Alessón
  • Beatriz González López-Valcárcel
  • George Leckie
  • Juan Merlo

Abstract

Many studies have demonstrated the existence of simple, unidimensional socioeconomic gradients in body mass index (BMI). However, in the present paper we move beyond such traditional analyses by simultaneously considering multiple demographic and socioeconomic dimensions. Using the Spanish National Health Survey 2011–2012, we apply intersectionality theory and multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA) to analyze 14,190 adults nested within 108 intersectional strata defined by combining categories of gender, age, income, educational achievement and living situation. We develop two multilevel models to obtain information on stratum-specific BMI averages and the degree of clustering of BMI within strata expressed by the intra-class correlation coefficient (ICC). The first model is a simple variance components analysis that provides a detailed mapping of the BMI disparities in the population and measures the accuracy of stratum membership to predict individual BMI. The second model includes the variables used to define the intersectional strata as a way to identify stratum-specific interactions. The first model suggests moderate but meaningful clustering of individual BMI within the intersectional strata (ICC = 12.4%). Compared with the population average (BMI = 26.07 Kg/m2), the stratum of cohabiting 18-35-year-old females with medium income and high education presents the lowest BMI (-3.7 Kg/m2), while cohabiting 36-64-year-old females with low income and low education show the highest BMI (+2.6 Kg/m2). In the second model, the ICC falls to 1.9%, suggesting the existence of only very small stratum specific interaction effects. We confirm the existence of a socioeconomic gradient in BMI. Compared with traditional analyses, the intersectional MAIHDA approach provides a better mapping of socioeconomic and demographic inequalities in BMI. Because of the moderate clustering, public health policies aiming to reduce BMI in Spain should not solely focus on the intersectional strata with the highest BMI, but should also consider whole population polices.

Suggested Citation

  • Aránzazu Hernández-Yumar & Maria Wemrell & Ignacio Abásolo Alessón & Beatriz González López-Valcárcel & George Leckie & Juan Merlo, 2018. "Socioeconomic differences in body mass index in Spain: An intersectional multilevel analysis of individual heterogeneity and discriminatory accuracy," PLOS ONE, Public Library of Science, vol. 13(12), pages 1-23, December.
    • Handle: RePEc:plo:pone00:0208624
    DOI: 10.1371/journal.pone.0208624
    as

    Download full text from publisher

    File URL: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0208624
    Download Restriction: no
    File URL: https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0208624&type=printable
    Download Restriction: no
    File URL: https://libkey.io/10.1371/journal.pone.0208624?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    References listed on IDEAS

    as
    1. Leckie, George & Charlton, Chris, 2013. "runmlwin: A Program to Run the MLwiN Multilevel Modeling Software from within Stata," Journal of Statistical Software, Foundation for Open Access Statistics, vol. 52(i11).
    2. Costa-Font, Joan & Gil, Joan, 2008. "What lies behind socio-economic inequalities in obesity in Spain A decomposition approach," Food Policy, Elsevier, vol. 33(1), pages 61-73, February.
    3. Raftopoulou, Athina, 2017. "Geographic determinants of individual obesity risk in Spain: A multilevel approach," Economics & Human Biology, Elsevier, vol. 24(C), pages 185-193.
    4. Kanchana Ruwanpura, 2008. "Multiple identities, multiple-discrimination: A critical review," Feminist Economics, Taylor & Francis Journals, vol. 14(3), pages 77-105.
    5. Bauer, Greta R., 2014. "Incorporating intersectionality theory into population health research methodology: Challenges and the potential to advance health equity," Social Science & Medicine, Elsevier, vol. 110(C), pages 10-17.
    6. Chiang-Ming Chen & Chen-Kang Chang & Chia-Yu Yeh, 2012. "A quantile regression approach to re-investigate the relationship between sleep duration and body mass index in Taiwan," International Journal of Public Health, Springer;Swiss School of Public Health (SSPH+), vol. 57(3), pages 485-493, June.
    7. Teodora Hurtado Saa, 2014. "Análisis de la relación entre género y sexualidad a partir del estudio de la nueva división internacional del trabajo femenino1," Revista Sociedad y Economía, Universidad del Valle, CIDSE, June.
    8. Sarlio-Lähteenkorva, S. & Silventoinen, K. & Lahelma, E., 2004. "Relative Weight and Income at Different Levels of Socioeconomic Status," American Journal of Public Health, American Public Health Association, vol. 94(3), pages 468-472.
    9. Antelo, Manel & Magdalena, Pilar & Reboredo, Juan C., 2017. "Obesity: A major problem for Spanish minors," Economics & Human Biology, Elsevier, vol. 24(C), pages 61-73.
    10. Juliet U. Elu & Linda Loubert, 2013. "Earnings Inequality and the Intersectionality of Gender and Ethnicity in Sub-Saharan Africa: The Case of Tanzanian Manufacturing," American Economic Review, American Economic Association, vol. 103(3), pages 289-292, May.
    11. Merino Ventosa, María & Urbanos-Garrido, Rosa M.maria.merino.ven@gmail.com, 2016. "Disentangling effects of socioeconomic status on obesity: A cross-sectional study of the Spanish adult population," Economics & Human Biology, Elsevier, vol. 22(C), pages 216-224.
    12. Costa-Font, Joan & Hernández-Quevedo, Cristina & Jiménez-Rubio, Dolores, 2014. "Income inequalities in unhealthy life styles in England and Spain," Economics & Human Biology, Elsevier, vol. 13(C), pages 66-75.
    13. Matheson, Flora I. & Moineddin, Rahim & Glazier, Richard H., 2008. "The weight of place: A multilevel analysis of gender, neighborhood material deprivation, and body mass index among Canadian adults," Social Science & Medicine, Elsevier, vol. 66(3), pages 675-690, February.
    14. Gil, Joan & Mora, Toni, 2011. "The determinants of misreporting weight and height: The role of social norms," Economics & Human Biology, Elsevier, vol. 9(1), pages 78-91, January.
    15. Marion Devaux & Franco Sassi & Jody Church & Michele Cecchini & Francesca Borgonovi, 2011. "Exploring the Relationship Between Education and Obesity," OECD Journal: Economic Studies, OECD Publishing, vol. 2011(1), pages 1-40.
    16. Gita Sen & Aditi Iyer & Chandan Mukherjee, 2009. "A Methodology to Analyse the Intersections of Social Inequalities in Health," Journal of Human Development and Capabilities, Taylor & Francis Journals, vol. 10(3), pages 397-415.
    17. Wardle, J. & Waller, J. & Jarvis, M.J., 2002. "Sex differences in the association of socioeconomic status with obesity," American Journal of Public Health, American Public Health Association, vol. 92(8), pages 1299-1304.
    18. Wemrell, Maria & Mulinari, Shai & Merlo, Juan, 2017. "Intersectionality and risk for ischemic heart disease in Sweden: Categorical and anti-categorical approaches," Social Science & Medicine, Elsevier, vol. 177(C), pages 213-222.
    19. Vallejo-Torres, Laura & Morris, Stephen, 2010. "The contribution of smoking and obesity to income-related inequalities in health in England," Social Science & Medicine, Elsevier, vol. 71(6), pages 1189-1198, September.
    20. Merkur, Sherry & Sassi, Franco & McDaid, David, 2013. "Promoting health, preventing disease: is there an economic case?," LSE Research Online Documents on Economics 55659, London School of Economics and Political Science, LSE Library.
    21. Evans, Clare R. & Williams, David R. & Onnela, Jukka-Pekka & Subramanian, S.V., 2018. "A multilevel approach to modeling health inequalities at the intersection of multiple social identities," Social Science & Medicine, Elsevier, vol. 203(C), pages 64-73.
    22. Seng, Julia S. & Lopez, William D. & Sperlich, Mickey & Hamama, Lydia & Reed Meldrum, Caroline D., 2012. "Marginalized identities, discrimination burden, and mental health: Empirical exploration of an interpersonal-level approach to modeling intersectionality," Social Science & Medicine, Elsevier, vol. 75(12), pages 2437-2445.
    Full references (including those not matched with items on IDEAS)

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    1. Daniel Holman & Alan Walker, 2021. "Understanding unequal ageing: towards a synthesis of intersectionality and life course analyses," European Journal of Ageing, Springer, vol. 18(2), pages 239-255, June.
    2. Aránzazu Hernández-Yumar & Maria Wemrell & Ignacio Abásolo-Alessón & Beatriz González López-Valcárcel & Juan Merlo, 2023. "Impact of the Economic Crisis on Body Mass Index in Spain: An Intersectional Multilevel Analysis Using a Socioeconomic and Regional Perspective," Population Research and Policy Review, Springer;Southern Demographic Association (SDA), vol. 42(4), pages 1-31, August.
    3. Evans, Clare & Leckie, George & Subramanian, SV & Bell, Andrew & Merlo, Juan, 2024. "A Tutorial for Conducting Intersectional Multilevel Analysis of Individual Heterogeneity and Discriminatory Accuracy (MAIHDA)," SocArXiv 635hx, Center for Open Science.
    4. Alvarez, Camila H. & Evans, Clare Rosenfeld, 2021. "Intersectional environmental justice and population health inequalities: A novel approach," Social Science & Medicine, Elsevier, vol. 269(C).
    5. Philipp Jaehn & Emily Mena & Sibille Merz & Robert Hoffmann & Antje Gößwald & Alexander Rommel & Christine Holmberg & on behalf of the ADVANCE GENDER study group, 2020. "Non-response in a national health survey in Germany: An intersectionality-informed multilevel analysis of individual heterogeneity and discriminatory accuracy," PLOS ONE, Public Library of Science, vol. 15(8), pages 1-17, August.
    6. Wilkes, Rima & Karimi, Aryan, 2024. "What does the MAIHDA method explain?," Social Science & Medicine, Elsevier, vol. 345(C).
    7. Evans, Clare R. & Nieves, Christina I. & Erickson, Natasha & Borrell, Luisa N., 2023. "Intersectional inequities in the birthweight gap between twin and singleton births: A random effects MAIHDA analysis of 2012–2018 New York City birth data," Social Science & Medicine, Elsevier, vol. 331(C).
    8. Anna Persmark & Maria Wemrell & Sofia Zettermark & George Leckie & S V Subramanian & Juan Merlo, 2019. "Precision public health: Mapping socioeconomic disparities in opioid dispensations at Swedish pharmacies by Multilevel Analysis of Individual Heterogeneity and Discriminatory Accuracy (MAIHDA)," PLOS ONE, Public Library of Science, vol. 14(8), pages 1-21, August.

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Aránzazu Hernández-Yumar & Maria Wemrell & Ignacio Abásolo-Alessón & Beatriz González López-Valcárcel & Juan Merlo, 2023. "Impact of the Economic Crisis on Body Mass Index in Spain: An Intersectional Multilevel Analysis Using a Socioeconomic and Regional Perspective," Population Research and Policy Review, Springer;Southern Demographic Association (SDA), vol. 42(4), pages 1-31, August.
    2. Anna Persmark & Maria Wemrell & Sofia Zettermark & George Leckie & S V Subramanian & Juan Merlo, 2019. "Precision public health: Mapping socioeconomic disparities in opioid dispensations at Swedish pharmacies by Multilevel Analysis of Individual Heterogeneity and Discriminatory Accuracy (MAIHDA)," PLOS ONE, Public Library of Science, vol. 14(8), pages 1-21, August.
    3. Evans, Clare R. & Erickson, Natasha, 2019. "Intersectionality and depression in adolescence and early adulthood: A MAIHDA analysis of the national longitudinal study of adolescent to adult health, 1995–2008," Social Science & Medicine, Elsevier, vol. 220(C), pages 1-11.
    4. Athina Raftopoulou & Joan Gil Trasfi, 2024. "Income-related inequality in obesity and its determinants in Spain: What happens beyond the obesity threshold?," International Journal of Health Economics and Management, Springer, vol. 24(1), pages 135-153, March.
    5. Alvarez, Camila H. & Evans, Clare Rosenfeld, 2021. "Intersectional environmental justice and population health inequalities: A novel approach," Social Science & Medicine, Elsevier, vol. 269(C).
    6. Evans, Clare R., 2019. "Adding interactions to models of intersectional health inequalities: Comparing multilevel and conventional methods," Social Science & Medicine, Elsevier, vol. 221(C), pages 95-105.
    7. Antelo, Manel & Magdalena, Pilar & Reboredo, Juan C., 2017. "Obesity: A major problem for Spanish minors," Economics & Human Biology, Elsevier, vol. 24(C), pages 61-73.
    8. Philipp Jaehn & Emily Mena & Sibille Merz & Robert Hoffmann & Antje Gößwald & Alexander Rommel & Christine Holmberg & on behalf of the ADVANCE GENDER study group, 2020. "Non-response in a national health survey in Germany: An intersectionality-informed multilevel analysis of individual heterogeneity and discriminatory accuracy," PLOS ONE, Public Library of Science, vol. 15(8), pages 1-17, August.
    9. Davillas, Apostolos & Jones, Andrew M., 2020. "Regional inequalities in adiposity in England: distributional analysis of the contribution of individual-level characteristics and the small area obesogenic environment," Economics & Human Biology, Elsevier, vol. 38(C).
    10. Evans, Clare & Leckie, George & Subramanian, SV & Bell, Andrew & Merlo, Juan, 2024. "A Tutorial for Conducting Intersectional Multilevel Analysis of Individual Heterogeneity and Discriminatory Accuracy (MAIHDA)," SocArXiv 635hx, Center for Open Science.
    11. Raftopoulou, Athina, 2017. "Geographic determinants of individual obesity risk in Spain: A multilevel approach," Economics & Human Biology, Elsevier, vol. 24(C), pages 185-193.
    12. Fagrell Trygg, Nadja & Månsdotter, Anna & Gustafsson, Per E., 2021. "Intersectional inequalities in mental health across multiple dimensions of inequality in the Swedish adult population," Social Science & Medicine, Elsevier, vol. 283(C).
    13. Merino Ventosa, María & Urbanos-Garrido, Rosa M.maria.merino.ven@gmail.com, 2016. "Disentangling effects of socioeconomic status on obesity: A cross-sectional study of the Spanish adult population," Economics & Human Biology, Elsevier, vol. 22(C), pages 216-224.
    14. Peng Nie & Andrew E. Clarck & Conchita D'Ambrosio & Lanlin Ding, 2020. "Income-related health inequality in urban China (1991-2015): The role of homeownership and housing conditions," Working Papers 524, ECINEQ, Society for the Study of Economic Inequality.
    15. Costa-Font, Joan & Fabbri, Daniele & Gil, Joan, 2009. "Decomposing body mass index gaps between Mediterranean countries: A counterfactual quantile regression analysis," Economics & Human Biology, Elsevier, vol. 7(3), pages 351-365, December.
    16. Evans, Clare R. & Williams, David R. & Onnela, Jukka-Pekka & Subramanian, S.V., 2018. "A multilevel approach to modeling health inequalities at the intersection of multiple social identities," Social Science & Medicine, Elsevier, vol. 203(C), pages 64-73.
    17. Solmi, Francesca & Von Wagner, Christian & Kobayashi, Lindsay C. & Raine, Rosalind & Wardle, Jane & Morris, Stephen, 2015. "Decomposing socio-economic inequality in colorectal cancer screening uptake in England," Social Science & Medicine, Elsevier, vol. 134(C), pages 76-86.
    18. Åsa Ljungvall & Ulf Gerdtham & Ulf Lindblad, 2015. "Misreporting and misclassification: implications for socioeconomic disparities in body-mass index and obesity," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 16(1), pages 5-20, January.
    19. Hsueh, Loretta & Layland, Eric K. & Kipke, Michele D. & Bray, Bethany C., 2021. "Linking racism and homonegativity to healthcare system distrust among young men of color who have sex with men: Evidence from the Healthy Young Men's (HYM) study," Social Science & Medicine, Elsevier, vol. 284(C).
    20. Costa-Font, Joan & Hernández-Quevedo, Cristina & Jiménez-Rubio, Dolores, 2014. "Income inequalities in unhealthy life styles in England and Spain," Economics & Human Biology, Elsevier, vol. 13(C), pages 66-75.

    More about this item

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:plo:pone00:0208624. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: plosone (email available below). General contact details of provider: https://journals.plos.org/plosone/ .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.