title: Interaction between education and household wealth on the risk of obesity in women in Egypt.
abstract: BACKGROUND
  Obesity is a growing problem in lower income countries particularly among women. There are few studies exploring individual socioeconomic status indicators in depth. This study examines the interaction of education and wealth in relation to obesity, hypothesising that education protects against the obesogenic effect of wealth.
  
  
  METHODS
  Four datasets of women of reproductive age from the Egyptian Demographic and Health Surveys spanning the period 1992-2008 are used to examine two distinct time periods: 1992/95 (N = 11097) and 2005/08 (N = 23178). The association in the two time periods between education level and household wealth in relation to the odds of being obese is examined, and the interaction between the two socioeconomic indicators investigated. Estimates are adjusted for age group and area of residence.
  
  
  RESULTS
  An interaction was found between the association of education and wealth with obesity in both time periods (P-value for interaction <0.001). For women with the lowest education level, moving up one wealth quintile was associated with a 78% increase in the odds of obesity in 1992/95 (OR; 95%CI: 1.78; 1.65,1.91) and a 33% increase in 2005/08 (OR; 95%CI: 1.33; 1.26,1.39). For women with the highest level of education, there was little evidence of an association between wealth and obesity (OR; 95%CI: 0.82; 0.57,1.16 in 1992/95 and 0.95; 0.84,1.08 in 2005/08). Obesity levels increased most in women who were in the no/primary education, poorest wealth quintile and rural groups (absolute difference in prevalence percentage points between the two time periods: 20.2, 20.1, and 21.3 respectively).
  
  
  CONCLUSIONS
  In the present study, wealth appears to be a risk factor for obesity in women with lower education levels, while women with higher education are protected. The findings also suggest that a reversal in the social distribution of obesity risk is occurring which can be explained by the large increase in obesity levels in lower socioeconomic groups between the two time periods.
authors: Department of Epidemiology and Public Health, University College London, London, United Kingdom. a.aitsi-selmi@ucl.ac.uk
authors: Amina
authors: A
authors: Aitsi-Selmi
authors: Tarani
authors: T
authors: Chandola
authors: Sharon
authors: S
authors: Friel
authors: Reza
authors: R
authors: Nouraei
authors: Martin J
authors: MJ
authors: Shipley
authors: Michael G
authors: MG
authors: Marmot
mesh_terms: D000328:Adult; D015992:Body Mass Index; D004522:Educational Status; D004534:Egypt / Q000453:epidemiology; D005191:Family Characteristics; D005260:Female; D006306:Health Surveys; D006801:Humans; D007182:Income / Q000706:statistics & numerical data; D009765:Obesity / Q000191:economics / Q000453:epidemiology / Q000209:etiology*; D011203:Poverty; D015995:Prevalence; D012307:Risk Factors; D012923:Social Class; D012959:Socioeconomic Factors; D016387:Women's Health