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Income and neighbourhood deprivation in relation to obesity in urban dwelling children 0–12 years of age: a cross-sectional study from 2013 to 2019
  1. Laura N Anderson1,2,
  2. Tooba Fatima1,
  3. Bindra Shah1,
  4. Brendan T. Smith3,4,
  5. Anne E. Fuller1,5,
  6. Cornelia M Borkhoff2,4,
  7. Charles D G Keown-Stoneman4,6,
  8. Jonathon L. Maguire4,5,6,7,
  9. Catherine S. Birken2,5,7,8
  1. 1Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
  2. 2Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
  3. 3Public Health Ontario, Toronto, Ontario, Canada
  4. 4Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
  5. 5Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
  6. 6Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
  7. 7Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada
  8. 8Paediatric Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
  1. Correspondence to Dr Laura N Anderson, Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada; LN.Anderson{at}


Background Childhood obesity is a major public health concern. This study evaluated the independent and joint associations of family-level income, neighbourhood-level income and neighbourhood deprivation, in relation to child obesity.

Methods A cross-sectional study was conducted in children ≤12 years of age from TARGet Kids! primary care network (Greater Toronto Area, 2013–2019). Parent-reported family income was compared with median neighbourhood income and neighbourhood deprivation measured using the Ontario Marginalization Index. Children’s height and weight were measured and body mass index (BMI) z-scores (zBMI) were calculated. ORs and 95% CIs were estimated for the three exposure variables separately using multilevel multinomial logistic regression models with zBMI categories as the outcome, adjusting in model 1 for age, sex, ethnicity and number of family members and in model 2 adding family income. A joint measure was derived combining income and deprivation measures.

Results A total of 5962 children were included. Low family income (Q1 vs Q5: OR=4.69, 95% CI 2.65 to 8.29), low neighbourhood income (Q1 vs Q5: OR=2.18, 95% CI 1.33 to 3.58) and high neighbourhood deprivation (Q1 vs Q5: OR=2.45, 95% CI 1.52 to 3.95) were each associated with increased OR of child obesity. However, after adjustment for family income, the association for both neighbourhood income (OR=1.39, 95% CI 0.82 to 2.34) and deprivation (OR=1.56, 95% CI 0.94 to 2.58) and obesity was attenuated. Children from low-income families living in low-income or high deprivation neighbourhoods had higher OR of obesity.

Conclusion Child obesity was independently associated with low family-level income and a joint measure suggests that neighbourhood also matters. Socioeconomic inequalities at both individual and neighbourhood levels should be addressed in childhood obesity interventions.

  • obesity
  • child health
  • epidemiology
  • poverty
  • social epidemiology

Data availability statement

Data are available upon reasonable request.

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Data availability statement

Data are available upon reasonable request.

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  • Twitter @AndersonLauraN

  • Collaborators The TARGet Kids! Collaboration.

  • Contributors LNA, TF, BShah and CDGK-S contributed to the statistical analysis. AF, CMB, BSmith, LNA, JM and CB contributed to the design and interpretation of study results. All authors read and revised the manuscript.

  • Funding Funding for this study was obtained from the Canadian Institutes of Health Research.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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