The association of current and sustained area-based adverse socioeconomic environment with physical inactivity

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Abstract

This paper evaluates the association between socioeconomic environment in the province of residence and physical inactivity, using measures of current and sustained area-based adverse socioeconomic environment. The analysis included 19,324 individuals representative of the Spanish non-institutionalised population aged 16–74 years. The measure of association estimated was the prevalence odds ratio for physical inactivity by current gross domestic product per capita (GDPpc) and current Gini coefficient, and by number of times each province has had a low GDPpc and number of times each province has had a high Gini coefficient in the last two decades. After adjusting for age, individual socioeconomic characteristics, and number of sports facilities per 1000 population, the odds ratio for physical inactivity in residents of provinces with the lowest current GDPpc versus those with the highest was 1.64 in men and 2.01 in women. The odds ratio in residents of provinces that had always been among those with the lowest GDPpc versus residents in provinces that had never been among those with lowest GDPpc was 1.54 in men and 1.91 in women. Neither the current Gini coefficient nor the indicator that reflects sustained high Gini coefficient were associated with physical inactivity. These findings show that physical inactivity is associated with current socioeconomic context and with the duration of exposure of the area of residence to adverse socioeconomic circumstances when the indicators of socioeconomic environment are based on GDPpc, but not on income inequality. Also, this association is not explained by individual socioeconomic characteristics or the number of sports facilities.

Introduction

The relation between physical inactivity and health is well established. Numerous studies have shown that physical inactivity increases the risk of mortality and the risk of the emergence or exacerbation of a large number of non-communicable diseases (Erikssen et al., 1998; Mayer-Davis et al., 1998; Pate et al., 1995; US Department of Health and Human Services, 1996). Consequently, one of the health objectives in developed societies is to reduce physical inactivity in the population by acting on those factors or circumstances associated with this risk behaviour.

The prevalence of physical inactivity is higher in women than in men, increases at older ages and shows an inverse gradient with individual socioeconomic position (Dishman, Sallis, & Orenstein, 1985; Varo et al., 2003). Various studies have shown that, in addition to individual characteristics, different characteristics of the area of residence are also related with physical inactivity (Ball, Bauman, Leslie, & Owen, 2001; Browson, Baker, Houseman, Brennan, & Bacak, 2001; Centers for Disease Control and Prevention, 1999; Diez-Roux, Link, & Northridge, 2000; Ecob & Macintyre, 2000; Giles-Corti & Donovan, 2002; Macintyre & Ellaway, 1998; Parks, Houseman, & Browson, 2003; Takano, Nakamura, & Watanabe, 2002; Van Lenthe, Brug, & Mackenbach, 2005). The demonstration of an independent effect of area-based characteristics on physical inactivity suggests the need for intervention not only at the individual level, but also in the areas where people live.

One characteristic of the area of residence that has been studied is the socioeconomic environment. For example, it has been observed that areas with lower levels of material wellbeing and areas with greater income inequality have higher prevalences of physical inactivity (Diez-Roux et al., 2000; Ecob & Macintyre,2000; Giles-Corti & Donovan, 2002; Macintyre & Ellaway, 1998; Van Lenthe et al., 2005). The authors of most of these studies attribute the results to the fact that these areas have fewer services, such as green spaces or infrastructure for sports and recreational activities. It is assumed that areas with lower material wellbeing and those that are less egalitarian invest fewer resources in the creation of spaces and infrastructure that lead to the development and maintenance of healthy behaviours. However, the few studies that have investigated the relation between socioeconomic context in the area of residence and the availability of services that facilitate physical activity have yielded inconsistent results (Giles-Corti & Donovan, 2002; Sooman & Macintyre, 1995; Van Lenthe et al., 2005). Several studies have examined the association between the availability of facilities and physical activity (Eyler, Brownson, Bacak, & Housemann, 2003; Giles-Corti & Donovan, 2003; Humpel, Owen, Iverson, Leslie, & Bauman 2004; Li, Fisher, Brownson, & Bosworth, 2005; Wendel-Vos, Schuit, Boshuizen, Saris, & Kromhout, 2004), but the only study to explore whether the availability of services is responsible for the association between socioeconomic context and physical activity yielded inconclusive results (Van Lenthe et al., 2005).

It should also be noted that most studies reflect the socioeconomic environment at a given point in time. Although the level of physical activity at a particular time may depend on the availability of green spaces and sports and recreational installations, the provision of these services is influenced by investments made at a previous period of time. In this regard, the availability of services probably reflects the socioeconomic environment of an area over time more than the socioeconomic environment at the current moment.

In this study, we evaluate the association between socioeconomic environment in the province of residence and physical inactivity at the beginning of the 21st century in Spain, using two indicators of socioeconomic environment of the province around that time—per capita income and income inequality—as well as two indicators that reflect the cumulative exposure of each province to an adverse socioeconomic environment in the last two decades of the 20th century. Based on previous investigations, we suggest four hypotheses: (1) The socioeconomic context of the province is associated with the availability of green spaces and sports and recreational installations; (2) The prevalence of physical inactivity will show an inverse relation with per capita income in the province of residence and a direct relation with income inequality; moreover, the magnitude of this relation will increase when provinces are classified in accordance with cumulative exposure to adverse economic environment in the last two decades of the 20th century; (3) The relation between the indicators of socioeconomic context and physical inactivity will decrease after controlling for different variables of individual socioeconomic position; (4) Finally, the relation between indicators of socioeconomic context and physical inactivity will decrease even more when we take into account the availability of green spaces and of sports and recreational facilities in each province.

Section snippets

Measure of physical inactivity

The estimation of physical inactivity was based on the 2001 National Health Survey. Individuals were selected using a multistage procedure in each province: first, the towns were chosen by random selection proportional to the size of the population and then the census areas were chosen by simple random selection. Finally, households were chosen within each census area by means of random routes, and one individual was chosen in each home based on age- and sex-quotas. The non-response rate was

Results

Table 1 shows the distribution of the sample by age, socioeconomic characteristics and the indicators of socioeconomic environment. The Pearson correlation coefficients for the association of GDPpc and the Gini coefficient with the number of sports facilities per 1000 population were 0.49 (p<0.001) and 0.10 (p=0.100), respectively. The Spearman correlation coefficient for the association of the indicators that reflect exposure to adverse socioeconomic environment in the preceding two decades

Discussion

Other studies have explored the effect of exposure to economic conditions in the place of residence on mortality (Curtis, Southall, Congdon, & Dodgeon, 2004) and on self-rated health (Blakely, Kennedy, Glass, & Kawachi, 2000). This is the first study to evaluate the effect of cumulative exposure of areas to adverse socioeconomic circumstances over time on physical inactivity. The results obtained with regard to current GDPpc are similar to the indicator that reflects the number of times each

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