ARE GEOGRAPHIC REGIONS WITH HIGH-INCOME INEQUALITY ASSOCIATED WITH RISK OF ABDOMINAL WEIGHT-GAIN

Geographic regions characterized by income inequality are associated w ith adverse mortality statistics, but the pathophysiologic mechanisms that mediate this ecologic relationship have not been elucidated. This study used a United States mail survey of 34 158 male and 42 741 fema le healthy-adult volunteers to test the association between residence in geographic regions with relative income inequality and the likeliho od of weight gain at the waist. Respondents came from 21 states that w ere characterized by the household income inequality (HII) index, a me asure reflecting the proportion of total income received by the more w ell off 50% of households in the slate. The main outcome measure was s elf-reported weight gain mainly at the waist as opposed to weight gain at other anatomic sites. After controlling for age, other individual- level factors, and each slate's median household income, men's likelih ood of weight gain at the waist was positively associated (p = 0.0008) with the HII index. Men from states with a high HII (households above the median receive 81.6% to 82.6% of the income) described weight gai n at the waist more often than men from stales with a low HII (househo lds above the median receive 77.0% to 78.5% of the income) (odds ratio = 1.12, 95% confidence interval 1.03 to 1.22). Women's results showed a non-significant trend in the same direction. An association between ecologically defined socio-environmental stress and abdominal obesity may help to clarify the pathophysiologic pathways leading to several major chronic diseases. (C) 1998 Elsevier Science Ltd. All rights rese rved.