The association between area-level socio-economic status and childhood overweight and the role of urbanicity

• Individual- and area-level SES are associated with overweight in children in more urbanised areas.
• None of the SES variables were related to overweight in the suburban group.
• Aspects of the physical environment seem to be of greater importance in suburban areas.
• Interventions in more urbanised areas should focus on social determinants.
• Interventions in suburban areas might be more effective when addressing the physical environment.

BackgroundThe relation between area-level socio-economic status (SES) and childhood overweight has primarily been investigated in urban areas. However, study areas have rarely been defined regarding their urbanicity. The aim of this study was to comparatively examine the relation between area-level SES and childhood overweight according to different types of areas within a German city.MethodsWe used the cross-sectional data of 2858 children (mean age 6 years, sd = 0.4, 49% female) who were taking the school entry examination. Individual data (weight status, parental SES) was subsequently linked to area-level SES. Multilevel logistic regression (MLRA) models were conducted to analyse associations between individual- and area-level SES and overweight in children from suburban, urban, and highly urban areas.ResultsUnadjusted analyses showed associations between parental and area-level SES and children's overweight in more urbanised areas but not in suburban areas. In multivariate MLRA models, only parental education remained statistically significant. None of the included SES predictors were associated with overweight in the suburban group.ConclusionsWhereas individual- and area-level SES are associated with childhood overweight in more urbanised areas, aspects of the physical environment might be more relevant in suburban areas. Levels of urbanicity should be considered when planning community-based obesity-prevention programmes.