Abstract
ObjectiveTo describe the evidence on global and regional economic inequality in malnutrition, and the associations between economic inequality and malnutrition.MethodsWe conducted a systematic review and meta-analysis. Between 1 November 2020 and 22 January 2021, we searched Medline, Embase, Global Health, Eldis, Web of Science and EBSCO Discovery Service. We contacted 39 experts and tracked citations. We included any study reporting a concentration index (CIX) relating economic status and nutritional status and any multilevel study reporting an association between economic inequality and nutritional status. Nutritional status was measured as stunting, wasting, anaemia, or overweight in children (<5 years), or underweight, overweight or obesity, or anaemia in adults (15–49 years). We had no study date or language restriction. Quality was assessed using the Appraisal Tool for Cross-Sectional Studies (AXIS tool). We mapped estimates and pooled them using multilevel random-effects meta-analyses.ResultsFrom 6185 results, 91 studies provided 426 CIX (>2.9 million people) and 47 associations (~3.9 million people). Stunting (CIX −0.15 (95% CI −0.19 to −0.11)) and wasting (−0.03 (95% CI −0.05 to −0.02)) are concentrated among poor households. Adult overweight and obesity is concentrated in wealthier households (0.08 (95% CI −0.00 to 0.17)), particularly in South Asia (0.26 (95% CI 0.19 to 0.34)), but not in Europe and Central Asia (−0.02 (95% CI −0.08 to 0.05)) or North America (−0.04 (95% CI −0.10 to 0.03)). We found no association between 0.1 increase in Gini coefficient and adult underweight (OR 1.03 (95% CI 0.94 to 1.12)) or overweight and obesity (0.92 (95% CI 0.80 to 1.05)).ConclusionsThere is good evidence that the prevalence of malnutrition varies by levels of absolute economic status. Undernutrition is concentrated in poor households, whereas concentration of overweight and obesity by economic status depends on region, and we lack information on economic inequalities in anaemia and child overweight. In contrast, links between malnutrition and relative economic status are less clear and should not be assumed; robust evidence on causal pathways is needed.PROSPERO registration numberCRD42020201572.
Funder
Foreign, Commonwealth and Development Office
Bill and Melinda Gates Foundation
Wellcome
Subject
Public Health, Environmental and Occupational Health,Health Policy
Reference147 articles.
1. Development Initiatives . 2020 global nutrition report: action on equity to end malnutrition. Bristol, UK, 2020.
2. Revisiting maternal and child undernutrition in low-income and middle-income countries: variable progress towards an unfinished agenda
3. Hosseinpoor A , Bergen N . Health inequality monitoring. Luxembourg: WHO Press, 2013.
4. Socioeconomic inequalities in health: Measurement, computation, and statistical inference
5. Alao R . Measures of socioeconomic inequality and their associations with maternal and child health outcomes in sub-Saharan Africa: a systematic review, 2020. Available: https://drive.google.com/file/d/1q_tdOfbFX0aVzvzGuklKcepBfBkqyaw5/view?usp=sharing [Accessed 9 Nov 2021].