Background This study investigated whether self-reported race/skin colour and perceived racial discrimination predict higher obesity incidence after approximately 4-year follow-up of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). We also investigated whether these associations are modified by educational level.
Methods Following exclusion of individuals defined as obese (body mass index ≥30 kg/m2) at baseline, associations between race/skin colour and obesity incidence between the first (2008–2010) and second (2012–2014) visits were investigated in 10 130 participants. Next, associations between perceived racial discrimination and obesity incidence among black (n=1532) and brown (n=2958) individuals were investigated separately. Racial discrimination (yes/no) was assessed using the Lifetime Major Event Scale. Logistic regression models adjusted for age, sex and research site were used. All analyses were stratified for educational level.
Results Obesity risk was higher in Blacks with high education compared with white individuals to the same education level (OR: 2.22; 95% CI 1.62 to 3.04) following adjustments. After adjustments, obesity incidence was higher among black individuals reporting racial discrimination compared with peers who did not report this experience, but only among the low education group (OR: 1.64; 95% CI 1.08 to 2.51). No statistical association with perceived discrimination was observed among brown individuals.
Conclusion Results are congruent with findings from other studies reporting associations between racial inequality and obesity incidence and also suggest racial discrimination may be one of the mechanisms leading to such inequalities. Also, it supports the paradox theory by which education modify the association in distinct directions.
- cohort studies
- health inequalities
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Contributors AVM, LVC and SMB wrote the analysis plan and had the primary responsibility for data analysis and drafting the manuscript. DC, RHG, JMNG and LG reviewed and commented on the data analysis, interpretation and drafts. Each author contributed important intellectual content during manuscript drafting or revision and accepts accountability for the overall work by ensuring that questions pertaining to the accuracy or integrity of any portion of the work are appropriately investigated and resolved.
Funding This study was funded by the Brazilian Ministry of Health (Department of Science and Technology) and the Brazilian Ministry of Science, Technology and Innovation (FINEP, Financiadora de Estudos e Projetos and CNPq, National Research Council), Grant No 01 06 0010.00, 01 06 0212.00, 01 06 0300.00, 01 06 0278.00, 01 06 0115.00 and 01 06 0071.00. This study was financed in part by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior, Brasil (CAPES) Finance Code 001. AVM received a scholarchip from the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES). LVC was supported by a research grant from Universidade Federal de Minas Gerais, Brazil (Programa Institucional de Auxílio a Pesquisa de Docentes Recém-Contratados). SMB, DC, LG and RHG are research fellows of the National Research Council (CNPq). SMB is supported by a research grant (Pesquisador Mineiro) from the Fundação de Amparo à Pesquisa do Estado de Minas Gerais (FAPEMIG), Brazil.
Disclaimer The funders had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript.
Competing interests None declared.
Patient consent for publication Not required.
Ethics approval ELSA-Brasil research protocol was approved by the Research Ethics Committee of Universidade de São Paulo (USP), Research Ethics Committee of Universidade Federal de Minas Gerais (UFMG), Research Ethics Committee of Fundação Oswaldo Cruz (FIOCRUZ), Research Ethics Committee of Universidade Federal do Espírito Santo (UFES), Research Ethics Committee of Universidade Federal da Bahia (UFBA), Research Ethics Committee of Universidade Federal do Rio Grande do Sul (UFRGS) and also by the National Research Ethics Committee (CONEP).
Data availability statement Data are available on reasonable request. The data used in this study are available for research proposal on request to the ELSA’s Datacenter and to the ELSA’s Publications Committee (publiELSA). Additional information can be obtained from the ELSA’s Datacenter (firstname.lastname@example.org) and from the ELSA Coordinator from the Research Center of Minas Gerais (email@example.com).
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