How Income Inequality, Policy, and Race Influence Obesity Ratio in US Counties: 2015-2019.

Hossein Zare, NS Meyerson, Paul Delgado, R McCleary, RT. Thorpe Jr, D Gaskin

Research output: Contribution to conferencePosterpeer-review


Research Objective: Obesity is one of the major public health problems in the US, with a prevalence ratio of 32.1% in 2019. It varies by income and income inequality. At the same time, state minimum wage policy may impact income and income inequality, but more evidence is needed on how income inequality may influence the prevalence of obesity. In this study, we examined the association between income inequality and obesity in adults ages 20 years and older in US counties. We tested how the state minimum wage policies change this relationship.

Study Design: We used the County Health Rankings Data (CHRD; 2015-2020) for the prevalence of obesity in US counties. We merged this data with the American Community Survey (ACS) for Gini Coefficient (GC) and county characteristics. The obesity commuted using Body Mass Index ≥ 30 kg/m2. We ran several regression analyses to estimate the Ordinary Least Score (OLS) between obesity and county characteristics. We controlled models for counties' racial composition of the population, age categories, percent of females, access to healthy foods, and county population. Additionally, we performed instrumental-variables regression using the state wage policies as endogenous regressors.

Population Studied: 3,129 counties reported obesity and GC between 2015 and 2020.

Principal Findings: On average, between 2015 and 2020, 31.7% of the population were obese, with wide variations across counties; the lowest prevalence was 19.3%, and the highest prevalence was 42.6%, with an average GC of 0.442 (Min: 0.367; Max: 0.541). The regression model results showed a positive association between GC and obesity (Coeff= 0.147 CI: [0.122-0.173]). Compared with counties with no state-level policy on minimum wages, counties with minimum wage between $7.26-$9.0, and $9+, had lower obesity ratios by -0.6 and -2.8 percentage points, respectively. We also found a positive association (Coeff= 0.022 CI: [0.019-0.025]) between obesity and lower access to healthy food (food environment index). Finally, counties' racial composition has a positive association with obesity rate; counties with 35-65 Whites and counties with 65 non-Whites have a higher rate of obesity.

Conclusions: Our findings extend those of prior studies of health and income disparities in counties with higher proportions of racial and ethnic minorities. Moreover, the state minimum wage policy and access to healthy food were associated with a lower obesity ratio across counties.

Implications for Policy or Practice: To better address obesity, we suggest shifting attention from individual-level focused interventions towards place-based interventions by considering counties' racial composition, wage policy, income inequality, and healthy food access to address obesity. As wages have increased over the years among the highest earners in the country, wages have remained stagnant among society's lowest earners. With increases in corporate profits, adjusting the minimum wage policy could reallocate some of those profits towards low-wage workers and consequently increase the potential to improve public health.
Original languageAmerican English
StatePublished - 25 Jun 2023
EventAcademy Health Annual Research Meeting -
Duration: 24 Jun 202327 Jun 2023


ConferenceAcademy Health Annual Research Meeting


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