Body Mass Index and Neighborhood Socioeconomic Status in Washington State

Thesis (Master's)--University of Washington, 2015-12

Introduction: Obesity and overweight are a critical public health problem in the United States1,2 and worldwide3. Obesity is affected by multiple factors including socioeconomic status (SES), built environments including opportunities for active transportation and access to supermarkets or fast food outlets, as well as disordered nutrition3–6. This study contributes to our knowledge by examining the relationship between Messer's neighborhood deprivation index7 and census-tract level body mass index (BMI) measures created using driver's license data8. Messer’s neighborhood deprivation index and census-tract BMI scores are new measures for Washington State. Methods: Messer's neighborhood deprivation index, based on census data, was combined with BMI outcomes calculated using Washington state driver’s license height and weight to explore neighborhood SES relationships to BMI. A second analysis explores which of Messer's neighborhood deprivation index variables are most closely related to BMI outcomes. Results: BMI is strongly associated (R2= 40.6%) with neighborhood deprivation in 1449 census tracts in Washington state. Among components of neighborhood deprivation index analyzed without Messer’s scale, unemployment rate among all adults over 16 years old and percent of female headed households were most associated with BMI outcomes. Together, unweighted components of Messer’s neighborhood deprivation index explained 54% of the variation in age-adjusted BMI outcomes. Conclusion: Study results support association of BMI with SES variables. Neighborhood deprivation indexes have been used as proxies for health status9 and allow targeting of interventions where they can have the most beneficial effect. Given the magnitude of the variance in BMI explained by the neighborhood deprivation, inclusion of SES measures in targeted multi-level built environment interventions for obesity could result in significant health savings10–14