Gender and the double burden of economic and social disadvantages on healthy eating: cross-sectional study of older adults in the EPIC-Norfolk cohort.

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Conklin, Annalijn I 
Forouhi, Nita G 
Surtees, Paul 
Wareham, Nicholas J 

BACKGROUND: Multiple economic factors and social relationships determine dietary behaviours, but the inter-relations between determinants is unknown. Whether women and men differ in the vulnerability to, and impact of, combined disadvantages is also unclear. We examined associations between diverse combinations of economic resources and social relationships, and healthy eating in British older women and men. METHODS: Our sample comprised 9,580 over-50s (47 % of over-50 respondents) in the EPIC-Norfolk cohort study. We examined six economic factors (education, social class, home-ownership, money for needs, frequency of insufficient money for food/clothing, paying bills) and three social relationships (marital status, living arrangement and friend contact), independently and in combination, in relation to fruit variety and vegetable variety. We analysed gender-specific associations using multivariable linear regression with interaction terms. RESULTS: Lower social class, lower education, and difficulty paying bills were associated with lower fruit and vegetable variety in both genders, independent of social relationships. All social relationships were independently associated with fruit variety in men and with vegetable variety in both genders. Substantially lower variety was found for all combinations of low economic resources and lack of social relationship than for either measure alone, with men faring worse in the majority of combined disadvantages. For example, the difference in vegetable variety for men reporting low social class and non-married was much greater (β -4.1, [-4.8, -3.4]), than the independent association of low social class (β -1.5, [-1.8,-1.2]), or non-married (β -1.8, [-2.3,-1.3]). Variety was also lower among men with high economic resources but non-married or lone-living. CONCLUSION: A double burden of low economic resources and lack of social relationships suggested they are unique joint determinants, particularly in older men, and that public health efforts to improve healthy eating would offer most benefit to older adults with intersecting economic and social disadvantages.

Aged, Cohort Studies, Cross-Sectional Studies, Diet, Diet Surveys, Female, Fruit, Gender Identity, Health Behavior, Humans, Male, Middle Aged, Residence Characteristics, Socioeconomic Factors, Vegetables
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BMC Public Health
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Springer Science and Business Media LLC
Medical Research Council (MR/K023187/1)
Medical Research Council (MC_UU_12015/5)
Medical Research Council (MC_UU_12015/1)
Economic and Social Research Council (ES/G007462/1)
Wellcome Trust (087636/Z/08/Z)
Medical Research Council (MC_U106179471)
The work was undertaken by the Centre for Diet and Activity Research (CEDAR), a UKCRC Public Health Research of Excellence, funded by: the British Heart Foundation, Economic and Social Research Council, Medical Research Council, National Institute for Health Research and the Wellcome Trust, under the auspices of the UK Clinical Research Collaboration. EPIC-Norfolk is supported by programme grants from the Medical Research Council and Cancer Research UK. We further acknowledge core MRC Epidemiology Unit support through Programmes MC_UU_12015/1 and MC_UU_12015/5.