Rural-Urban Differences in Prevalence and Associated Factors of Underweight and Overweight/Obesity among Bangladeshi Adults: Evidence from Bangladesh Demographic and Health Survey 2017–2018
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design
2.2. Data Collection Tools
2.3. Data Collection
2.4. Outcome of Interest
2.5. Explanatory Variables
2.6. Statistical Analysis
- Log(Odds of Underweight) = β1*Age_30–49 + β2*Age_50–69 + β3*Age_70+ + β4*Education_Primary + β5*Education_Secondary + β6*Education_CollegeAndHigher + β7*WealthIndex_Poorer + β8*WealthIndex_Middle + β9*WealthIndex_Richer + β10*WealthIndex_Richest + β11*CurrentWorkingStatus_Yes + β12*DivisionOfResidence_Chattogram + β13*DivisionOfResidence_Dhaka + β14*DivisionOfResidence_Khulna + β15*DivisionOfResidence_Mymensingh + β16*DivisionOfResidence_Rajshahi + β17*DivisionOfResidence_Rangpur + β18*DivisionOfResidence_Sylhet + β19*MaritalStatus_CurrentlyMarried + β20*MaritalStatus_SeparatedDivorcedWidowed
- Log(Odds of Overweight/Obesity) = β1*Age_30–49 + β2*Age_50–69 + β3*Age_70+ + β4*Sex_Female + β5*Education_Primary + β6*Education_Secondary + β7*Education_CollegeAndHigher + β8*WealthIndex_Poorer + β9*WealthIndex_Middle + β10*WealthIndex_Richer + β11*WealthIndex_Richest + β12*CurrentWorkingStatus_Yes + β13*DivisionOfResidence_Chattogram + β14*DivisionOfResidence_Dhaka + β15*DivisionOfResidence_Khulna + β16*DivisionOfResidence_Mymensingh + β17*DivisionOfResidence_Rajshahi + β18*DivisionOfResidence_Rangpur + β19*DivisionOfResidence_Sylhet + β20*MaritalStatus_CurrentlyMarried + β21*MaritalStatus_SeparatedDivorcedWidowed
- Log(Odds of Underweight) = γ1*Age_30–49 + γ2*Age_50–69 + γ3*Age_70+ + γ4*Education_Primary + γ5*Education_Secondary + γ6*Education_CollegeAndHigher + γ7*WealthIndex_Poorer + γ8*WealthIndex_Middle + γ9*WealthIndex_Richer + γ10*WealthIndex_Richest + γ11*DivisionOfResidence_Chattogram + γ12*DivisionOfResidence_Dhaka + γ13*DivisionOfResidence_Khulna + γ14*DivisionOfResidence_Mymensingh + γ15*DivisionOfResidence_Rajshahi + γ16*DivisionOfResidence_Rangpur + γ17*DivisionOfResidence_Sylhet + γ18*MaritalStatus_CurrentlyMarried + γ19*MaritalStatus_SeparatedDivorcedWidowed
- Log(Odds of Overweight/Obesity) = γ1*Age_30–49 + γ2*Age_50–69 + γ3*Age_70+ + γ4*Sex_Female + γ5*Education_Primary + γ6*Education_Secondary + γ7*Education_CollegeAndHigher + γ8*WealthIndex_Poorer + γ9*WealthIndex_Middle + γ10*WealthIndex_Richer + γ11*WealthIndex_Richest + γ12*CurrentWorkingStatus_Yes + γ13*DivisionOfResidence_Chattogram + γ14*DivisionOfResidence_Dhaka + γ15*DivisionOfResidence_Khulna + γ16*DivisionOfResidence_Mymensingh + γ17*DivisionOfResidence_Rajshahi + γ18*DivisionOfResidence_Rangpur + γ19*DivisionOfResidence_Sylhet + γ20*MaritalStatus_CurrentlyMarried + γ21*MaritalStatus_SeparatedDivorcedWidowed
2.7. Ethical Consideration
3. Results
3.1. Characteristics of the Study Sample
3.2. Factors Associated with Underweight
3.3. Factors Associated with Overweight and Obesity
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
Appendix A
BMI Categories | WHO-Cut Off | Asia-Specific Cut Off |
---|---|---|
Underweight | <18.5 | <18.5 |
Normal BMI | 18.5 to <25.0 | 18.5 to <23.0 |
Overweight | 25.0 to 30.0 | 23.0 to <27.5 |
Obesity | ≥30.0 | ≥27.5 |
Variables | Prevalence (%) | Differences (%) | 95% CI, LL | 95% CI, UL | p Value | |
---|---|---|---|---|---|---|
Urban | Rural | |||||
Age (in Years) | ||||||
18–29 | 18.7 | 21.7 | −2.9 | −7.7 | 1.8 | 0.228 |
30–49 | 9.9 | 17.3 | −7.3 | −9.4 | −5.3 | <0.001 |
50–69 | 13.6 | 20.7 | −7.1 | −10.1 | −4.2 | <0.001 |
70+ | 12.5 | 21.4 | −8.9 | −15.0 | −2.8 | 0.004 |
Sex | ||||||
Male | 14.2 | 22 | −7.7 | −10.3 | −5.2 | <0.001 |
Female | 10.6 | 17.3 | −6.7 | −8.7 | −4.8 | <0.001 |
Education | ||||||
No Formal Schooling | 16.2 | 27.1 | −10.9 | −14.5 | −7.2 | <0.001 |
Primary | 15.4 | 19.5 | −4.1 | −7.2 | −1.0 | 0.009 |
Secondary | 9.5 | 14.1 | −4.6 | −7.1 | −2.2 | <0.001 |
College and Higher | 8.7 | 13.4 | −4.7 | −7.9 | −1.5 | 0.004 |
Wealth Index | ||||||
Poorest | 24.2 | 28.5 | −4.3 | −9.5 | 0.9 | 0.104 |
Poorer | 20 | 22.7 | −2.6 | −7.6 | 2.3 | 0.294 |
Middle | 16.6 | 16.9 | −0.3 | −4.3 | 3.7 | 0.884 |
Richer | 13.1 | 12.9 | 0.2 | −3.2 | 3.5 | 0.917 |
Richest | 7.8 | 7.8 | 0.0 | −2.7 | 2.7 | 0.996 |
Current Working Status | ||||||
No | 11.5 | 18.2 | −6.7 | −9.1 | −4.3 | <0.001 |
Yes | 12.7 | 20 | −7.3 | −9.4 | −5.1 | <0.001 |
Division of Residence | ||||||
Barisal | 11.2 | 18 | −6.8 | −11.7 | −1.9 | 0.007 |
Chittagong | 13.6 | 13.9 | −0.3 | −3.9 | 3.4 | 0.89 |
Dhaka | 10.7 | 20.8 | −10.1 | −15.1 | −5.0 | <0.001 |
Khulna | 11.3 | 16.2 | −4.9 | −8.5 | −1.3 | 0.008 |
Mymensingh | 14.9 | 27.4 | −12.5 | −17.9 | −7.1 | <0.001 |
Rajshahi | 12.8 | 19.5 | −6.7 | −11.8 | −1.6 | 0.01 |
Rangpur | 12.6 | 20.2 | −7.7 | −12.4 | −2.9 | 0.002 |
Sylhet | 19.8 | 23.1 | −3.3 | −9.2 | 2.6 | 0.268 |
Marital Status | ||||||
Never Married | 23.1 | 26.4 | −3.2 | −8.9 | 2.4 | 0.256 |
Currently Married | 10.1 | 17.9 | −7.8 | −9.5 | −6.1 | <0.001 |
Separated/Divorced/Widowed | 17.2 | 24.8 | −7.7 | −12.8 | −2.5 | 0.004 |
Variables | Prevalence (%) | Differences (%) | 95% CI, LL | 95% CI, UL | p Value | |
---|---|---|---|---|---|---|
Urban | Rural | |||||
Age (in Years) | ||||||
18–29 | 38 | 28.1 | 9.9 | 2.5 | 17.2 | 0.009 |
30–49 | 53.8 | 37.5 | 16.3 | 12.8 | 19.8 | <0.001 |
50–69 | 49.7 | 35.5 | 14.2 | 10.1 | 18.2 | <0.001 |
70+ | 45.4 | 38.1 | 7.3 | −1.6 | 16.3 | 0.108 |
Sex | ||||||
Male | 42.2 | 28.9 | 13.2 | 9.5 | 17.0 | <0.001 |
Female | 57.1 | 41.4 | 15.6 | 12.7 | 18.5 | <0.001 |
Education | 0.0 | 0.0 | 0.0 | <0.001 | ||
No Formal Schooling | 40.5 | 25.3 | 15.2 | 10.8 | 19.6 | <0.001 |
Primary | 41.8 | 34.7 | 7.2 | 3.0 | 11.3 | 0.001 |
Secondary | 54.6 | 44 | 10.6 | 6.2 | 15.0 | <0.001 |
College and Higher | 63.2 | 45 | 18.2 | 12.9 | 23.5 | <0.001 |
Wealth Index | ||||||
Poorest | 24.6 | 23 | 1.6 | −4.6 | 7.7 | 0.618 |
Poorer | 32.1 | 27.4 | 4.7 | −2.0 | 11.4 | 0.169 |
Middle | 39 | 37.2 | 1.8 | −2.9 | 6.5 | 0.445 |
Richer | 43.3 | 46.3 | −3.0 | −8.7 | 2.8 | 0.31 |
Richest | 63.4 | 62.9 | 0.5 | −4.5 | 5.4 | 0.858 |
Current Working Status | ||||||
No | 57.6 | 39.2 | 18.4 | 14.7 | 22.0 | <0.001 |
Yes | 45 | 34 | 10.9 | 7.8 | 14.1 | <0.001 |
Division of Residence | ||||||
Barisal | 53.6 | 36.4 | 17.2 | 8.1 | 26.4 | <0.001 |
Chittagong | 49.8 | 44.6 | 5.3 | −1.5 | 12.0 | 0.127 |
Dhaka | 52.8 | 38.3 | 14.5 | 7.8 | 21.2 | <0.001 |
Khulna | 53.7 | 41.5 | 12.1 | 6.3 | 18.0 | <0.001 |
Mymensingh | 41.4 | 26.3 | 15.1 | 5.8 | 24.5 | 0.002 |
Rajshahi | 46.1 | 33.3 | 12.9 | 5.3 | 20.4 | 0.001 |
Rangpur | 49.5 | 30.3 | 19.2 | 10.3 | 28.0 | <0.001 |
Sylhet | 37.5 | 29.7 | 7.8 | 1.1 | 14.5 | 0.024 |
Marital Status | ||||||
Never Married | 29.8 | 23.1 | 6.8 | 0.7 | 12.8 | 0.028 |
Currently Married | 53.8 | 38.5 | 15.4 | 12.5 | 18.3 | <0.001 |
Separated/Divorced/Widowed | 45.5 | 27.5 | 18.0 | 11.8 | 24.2 | <0.001 |
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Variables | Urban (n = 3412) | Rural (n = 9047) | ||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
Underweight | Normal Weight | Overweight/Obesity | Underweight | Normal Weight | Overweight/Obesity | |||||||
n | % | n | % | n | % | n | % | n | % | n | % | |
Age (in Years) | ||||||||||||
18–29 | 66 | 18.7 | 153 | 43.3 | 134 | 38.0 | 181 | 21.7 | 420 | 50.2 | 235 | 28.1 |
30–49 | 168 | 9.9 | 614 | 36.3 | 910 | 53.8 | 695 | 17.3 | 1820 | 45.3 | 1506 | 37.5 |
50–69 | 155 | 13.6 | 420 | 36.7 | 569 | 49.7 | 677 | 20.7 | 1431 | 43.8 | 1160 | 35.5 |
70+ | 28 | 12.5 | 93 | 42.1 | 100 | 45.4 | 197 | 21.4 | 373 | 40.5 | 351 | 38.1 |
Sex | ||||||||||||
Male | 222 | 14.2 | 682 | 43.6 | 659 | 42.2 | 871 | 22.0 | 1947 | 49.1 | 1147 | 28.9 |
Female | 195 | 10.6 | 599 | 32.4 | 1054 | 57.1 | 879 | 17.3 | 2097 | 41.3 | 2106 | 41.4 |
Education | ||||||||||||
No Formal Schooling | 110 | 16.2 | 294 | 43.3 | 275 | 40.5 | 690 | 27.1 | 1212 | 47.6 | 645 | 25.3 |
Primary | 142 | 15.4 | 393 | 42.8 | 385 | 41.8 | 548 | 19.5 | 1290 | 45.8 | 975 | 34.7 |
Secondary | 101 | 9.5 | 382 | 36.0 | 580 | 54.6 | 359 | 14.1 | 1069 | 41.9 | 1121 | 44.0 |
College and Higher | 65 | 8.7 | 211 | 28.1 | 475 | 63.2 | 153 | 13.4 | 473 | 41.6 | 512 | 45.0 |
Wealth Index | ||||||||||||
Poorest | 51 | 24.2 | 108 | 51.2 | 52 | 24.6 | 616 | 28.5 | 1046 | 48.5 | 497 | 23.0 |
Poorer | 46 | 20.0 | 111 | 47.9 | 74 | 32.1 | 498 | 22.7 | 1098 | 49.9 | 603 | 27.4 |
Middle | 75 | 16.6 | 200 | 44.4 | 176 | 39.0 | 355 | 16.9 | 965 | 45.9 | 781 | 37.2 |
Richer | 120 | 13.1 | 402 | 43.6 | 399 | 43.3 | 198 | 12.9 | 627 | 40.8 | 711 | 46.3 |
Richest | 125 | 7.8 | 460 | 28.8 | 1013 | 63.4 | 82 | 7.8 | 307 | 29.2 | 661 | 62.9 |
Current Working Status | ||||||||||||
No | 164 | 11.5 | 440 | 30.9 | 819 | 57.6 | 614 | 18.2 | 1436 | 42.6 | 1321 | 39.2 |
Yes | 253 | 12.7 | 841 | 42.3 | 894 | 45.0 | 1136 | 20.0 | 2608 | 46.0 | 1932 | 34.0 |
Division of Residence | ||||||||||||
Barisal | 14 | 11.2 | 44 | 35.2 | 67 | 53.6 | 102 | 18.0 | 258 | 45.6 | 206 | 36.4 |
Chattogram | 84 | 13.6 | 226 | 36.6 | 308 | 49.8 | 212 | 13.9 | 634 | 41.6 | 680 | 44.6 |
Dhaka | 153 | 10.7 | 522 | 36.5 | 754 | 52.8 | 322 | 20.8 | 635 | 41.0 | 593 | 38.3 |
Khulna | 39 | 11.3 | 122 | 35.0 | 187 | 53.7 | 192 | 16.2 | 500 | 42.3 | 491 | 41.5 |
Mymensingh | 25 | 14.9 | 74 | 43.8 | 70 | 41.4 | 232 | 27.4 | 394 | 46.4 | 223 | 26.3 |
Rajshahi | 45 | 12.8 | 146 | 41.2 | 163 | 46.1 | 276 | 19.5 | 671 | 47.3 | 472 | 33.3 |
Rangpur | 28 | 12.6 | 85 | 38.0 | 110 | 49.5 | 260 | 20.2 | 636 | 49.5 | 390 | 30.3 |
Sylhet | 28 | 19.8 | 62 | 42.8 | 54 | 37.5 | 154 | 23.1 | 315 | 47.3 | 198 | 29.7 |
Marital Status | ||||||||||||
Never Married | 96 | 23.1 | 195 | 47.1 | 123 | 29.8 | 223 | 26.4 | 427 | 50.6 | 195 | 23.1 |
Currently Married | 272 | 10.1 | 978 | 36.1 | 1459 | 53.8 | 1305 | 17.9 | 3191 | 43.7 | 2812 | 38.5 |
Separated/Divorced/Widowed | 50 | 17.2 | 108 | 37.3 | 131 | 45.5 | 222 | 24.8 | 426 | 47.7 | 246 | 27.5 |
Variables | Urban | Rural | ||
---|---|---|---|---|
AOR (95% CI) | p-Value | AOR (95% CI) | p-Value | |
Age (in Years) | ||||
18–29 | Ref | Ref | ||
30–49 | 0.6 (0.4–0.8) | 0.001 | 0.8 (0.7–1.0) | 0.094 |
50–69 | 0.8 (0.6–1.1) | 0.104 | 1.1 (0.9–1.3) | 0.521 |
70+ | 0.7 (0.4–1.0) | 0.08 | 1.2 (0.9–1.6) | 0.208 |
Education | ||||
No Formal Schooling | Ref | Ref | ||
Primary | 1.0 (0.8–1.3) | 0.887 | 0.8 (0.7–0.9) | 0.001 |
Secondary | 0.8 (0.6–1.0) | 0.094 | 0.7 (0.5–0.8) | <0.001 |
College and Higher | 0.6 (0.4–0.9) | 0.019 | 0.6 (0.5–0.8) | <0.001 |
Wealth Index | ||||
Poorest | Ref | Ref | ||
Poorer | 0.9 (0.6–1.4) | 0.768 | 0.8 (0.7–0.9) | 0.007 |
Middle | 0.8 (0.6–1.2) | 0.254 | 0.7 (0.6–0.8) | <0.001 |
Richer | 0.6 (0.4–0.8) | 0.001 | 0.6 (0.5–0.7) | <0.001 |
Richest | 0.5 (0.4–0.8) | 0.001 | 0.5 (0.3–0.6) | <0.001 |
Current Working Status | ||||
No | Ref | |||
Yes | 0.8 (0.7–1.0) | 0.045 | Not included in the final model | |
Division of Residence | ||||
Barisal | Ref | Ref | ||
Chattogram | 1.3 (0.9–2.1) | 0.178 | 0.9 (0.7–1.2) | 0.449 |
Dhaka | 1.2 (0.8–1.8) | 0.457 | 1.3 (1.0–1.8) | 0.084 |
Khulna | 1.2 (0.8–1.8) | 0.479 | 1.1 (0.8–1.4) | 0.666 |
Mymensingh | 1.2 (0.7–1.9) | 0.482 | 1.4 (1.1–1.8) | 0.018 |
Rajshahi | 1.0 (0.7–1.6) | 0.83 | 1.1 (0.8–1.5) | 0.479 |
Rangpur | 1.0 (0.6–1.6) | 0.958 | 1.0 (0.7–1.3) | 0.865 |
Sylhet | 1.4 (0.9–2.2) | 0.124 | 1.2 (0.9–1.6) | 0.163 |
Marital Status | ||||
Never Married | Ref | Ref | ||
Currently Married | 0.6 (0.4–0.7) | <0.001 | 0.7 (0.5–0.8) | <0.001 |
Separated/Divorced/Widowed | 0.8 (0.5–1.2) | 0.218 | 0.8 (0.6–1.1) | 0.153 |
Variables | Urban | Rural | ||
---|---|---|---|---|
AOR (95% CI) | p-Value | AOR (95% CI) | p-Value | |
Age (in Years) | ||||
18–29 | Ref | Ref | ||
30–49 | 1.4 (1.1–1.9) | 0.004 | 1.5 (1.2–1.8) | <0.001 |
50–69 | 1.3 (1.0–1.7) | 0.025 | 1.4 (1.2–1.8) | 0.001 |
70+ | 1.2 (0.8–1.7) | 0.344 | 1.4 (1.1–1.8) | 0.01 |
Sex | ||||
Male | Ref | Ref | ||
Female | 1.7 (1.4–2.0) | <0.001 | 2.0 (1.8–2.3) | <0.001 |
Education | ||||
No Formal Schooling | Ref | Ref | ||
Primary | 1.2 (1.0–1.5) | 0.071 | 1.3 (1.1–1.5) | <0.001 |
Secondary | 1.5 (1.2–1.9) | <0.001 | 1.6 (1.4–1.9) | <0.001 |
College and Higher | 2.1 (1.7–2.7) | <0.001 | 1.7 (1.4–2.1) | <0.001 |
Wealth Index | ||||
Poorest | Ref | Ref | ||
Poorer | 1.3 (0.9–1.8) | 0.22 | 1.1 (1.0–1.3) | 0.176 |
Middle | 1.7 (1.2–2.3) | 0.002 | 1.6 (1.4–1.9) | <0.001 |
Richer | 1.9 (1.4–2.5) | <0.001 | 2.1 (1.8–2.6) | <0.001 |
Richest | 3.9 (2.8–5.3) | <0.001 | 4.1 (3.3–5.2) | <0.001 |
Current Working Status | ||||
No | Ref | Ref | ||
Yes | 0.9 (0.8–1.1) | 0.183 | 1.2 (1.1–1.4) | 0.002 |
Division of Residence | ||||
Barisal | Ref | Ref | ||
Chattogram | 0.8 (0.6–1.1) | 0.212 | 1.0 (0.8–1.3) | 0.954 |
Dhaka | 0.8 (0.6–1.0) | 0.081 | 0.9 (0.7–1.2) | 0.591 |
Khulna | 0.9 (0.7–1.2) | 0.555 | 1.0 (0.8–1.3) | 0.904 |
Mymensingh | 0.6 (0.4–0.8) | 0.003 | 0.7 (0.5–0.8) | 0.001 |
Rajshahi | 0.7 (0.5–1.0) | 0.073 | 0.8 (0.6–1.0) | 0.068 |
Rangpur | 0.9 (0.7–1.3) | 0.676 | 0.8 (0.6–1.0) | 0.023 |
Sylhet | 0.6 (0.4–0.9) | 0.006 | 0.7 (0.5–0.9) | 0.002 |
Marital Status | ||||
Never Married | Ref | Ref | ||
Currently Married | 3.1 (2.5–3.9) | <0.001 | 2.2 (1.7–2.7) | <0.001 |
Separated/Divorced/Widowed | 2.4 (1.7–3.4) | <0.001 | 1.4 (1.1–1.9) | 0.013 |
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Share and Cite
Gupta, R.D.; Frank, H.A.; Akonde, M.; Mazumder, A.; Siddika, N.; Apu, E.H.; Chakraborty, P.A. Rural-Urban Differences in Prevalence and Associated Factors of Underweight and Overweight/Obesity among Bangladeshi Adults: Evidence from Bangladesh Demographic and Health Survey 2017–2018. Epidemiologia 2023, 4, 505-520. https://doi.org/10.3390/epidemiologia4040042
Gupta RD, Frank HA, Akonde M, Mazumder A, Siddika N, Apu EH, Chakraborty PA. Rural-Urban Differences in Prevalence and Associated Factors of Underweight and Overweight/Obesity among Bangladeshi Adults: Evidence from Bangladesh Demographic and Health Survey 2017–2018. Epidemiologia. 2023; 4(4):505-520. https://doi.org/10.3390/epidemiologia4040042
Chicago/Turabian StyleGupta, Rajat Das, Hanna A. Frank, Maxwell Akonde, Ananna Mazumder, Nazeeba Siddika, Ehsanul Hoque Apu, and Promit Ananyo Chakraborty. 2023. "Rural-Urban Differences in Prevalence and Associated Factors of Underweight and Overweight/Obesity among Bangladeshi Adults: Evidence from Bangladesh Demographic and Health Survey 2017–2018" Epidemiologia 4, no. 4: 505-520. https://doi.org/10.3390/epidemiologia4040042