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Pediatrics

Are there birth cohort effects in disparities in child obesity by maternal education?

International Journal of Obesity volume 45, pages 599–608 (2021)Cite this article

Subjects

Abstract

Background

Children belonging to the same birth cohort (i.e., born in the same year) experience shared exposure to a common obesity-related milieu during the critical early years of development—e.g., secular beliefs and feeding practices, adverse chemical exposures, food access and nutrition assistance policies—that set the stage for a shared trajectory of obesity as they mature. Fundamental cause theory suggests that inequitable distribution of recent efforts to stem the rise in child obesity may exacerbate cohort-based disparities over time.

Methods

Data were from electronic health records spanning 2007–2016 linked to birth records for children ages 2–19 years. We used hierarchical age-period-cohort models to investigate cohort effects on disparities in obesity related to maternal education. We hypothesized that maternal education-based disparities in prevalence of obesity would be larger among more recent birth cohorts.

Results

Sex-stratified models adjusted for race/ethnicity showed substantial obesity disparities by maternal education that were evident even at young ages: prevalence among children with maternal education < high school compared to maternal college degree was approximately three times as high among girls and twice as high among boys. For maternal education < high school, disparities compared to maternal college degree were higher in more recent birth cohorts. Among girls, this disparity cohort effect was evident at younger ages (at age 4, the disparity increased by 4 [0.1–8] percentage points per 5 birth years), while among boys it was larger at older ages (at age 16, the disparity increased by 7 [1–14] percentage points per 5 birth years).

Conclusions

There may be widening maternal education-based disparities in child obesity by birth cohort at some ages.

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Fig. 1: Unadjusted obesity prevalence among girls and boys, stratified by maternal education.
Fig. 2: Estimated obesity disparitiesa among girls and boys from hierarchical age-period-cohort modelsb, by age and maternal education level.
Fig. 3: Estimated obesity cohort effectsa among girls and boys from hierarchical age-period-cohort modelsb, by age and maternal education level.
Fig. 4: Estimated obesity disparity cohort effectsa among girls and boys from hierarchical age-period-cohort modelsb, by age and maternal education level.

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Acknowledgements

This study is part of the Pediatric Big Health Data initiative funded by the State of Pennsylvania and led by the Children’s Hospital of Philadelphia, University of Pennsylvania, and the Urban Health Collaborative at Drexel University. We would like to thank the investigators of the Pediatric Big Health Data initiative for their contributions. These individuals include: Christopher B. Forrest, MD, Ph.D.; L. Charles Bailey, MD, Ph.D.; Shweta P. Chavan, MSEE; Rahul A. Darwar, MPH; Jillian Benedetti, MPH; Daniel Forsyth; Chén C. Kenyon, MD, MSHP; Ritu Khare, Ph.D.; Mitchell G. Maltenfort, Ph.D.; Aaron J. Masino, Ph.D., ME; Xueqin Pang, Ph.D.; Ting Qian, Ph.D.; Hanieh Razzaghi, MPH; Justine Shults, Ph.D.; Levon H. Utidjian, MD, MBI from the Children’s Hospital of Philadelphia; Ana V. Diez Roux, MD, Ph.D., MPH; Amy H. Auchincloss, Ph.D., MPH; Elizabeth A. Campbell, MSPH; Kimberly Daniels, MS; Anneclaire J. De Roos, Ph.D., MPH; J. Felipe Garcia-Espana, MS, Ph.D.; Irene Headen, Ph.D., MS; Félice Lê-Scherban, Ph.D., MPH; Steven Melly, MS, MA; Yvonne L. Michael, ScD, SM; Jeffrey Moore, MS; Kari Moore, MS; Abigail E. Mudd, MPH; Leah Schinasi, Ph.D., MSPH; and Yuzhe Zhao, MS from Drexel University and, Yong Chen, Ph.D.; John H. Holmes, Ph.D.; Rebecca A. Hubbard, Ph.D.; A. Russell Localio, JD, MPH, Ph.D. from the University of Pennsylvania. This work was supported by a grant from the Commonwealth Universal Research Enhancement (CURE) program funded by the Pennsylvania Department of Health—2015 Formula award—SAP #4100072543.

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Authors and Affiliations

  1. Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, 3215 Market Street, 5th Floor, Philadelphia, PA, 19104, USA

    Félice Lê-Scherban & Jeffrey Moore

  2. Drexel Urban Health Collaborative, Drexel University, 3600 Market Street, 7th Floor, Philadelphia, PA, 19104, USA

    Félice Lê-Scherban, Irene Headen & Yuzhe Zhao

  3. Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University, 3215 Market Street, 4th Floor, Philadelphia, PA, 19104, USA

    Irene Headen

  4. Division of General Pediatrics, Children’s Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA, 19104, USA

    Levon Utidjian

  5. Applied Clinical Research Center, Department of Pediatrics, Children’s Hospital of Philadelphia, 2716 South Street, Suite 11-473, Philadelphia, PA, 19104, USA

    Levon Utidjian & Christopher B. Forrest

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Lê-Scherban, F., Moore, J., Headen, I. et al. Are there birth cohort effects in disparities in child obesity by maternal education?. Int J Obes 45, 599–608 (2021). https://doi.org/10.1038/s41366-020-00724-y

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