Longitudinal associations between childhood socioeconomic position and adolescent eating disorder symptoms: findings from the ALSPAC cohort study
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Background
The recorded incidence of eating disorders is elevated in people from higher socioeconomic positions, but self-reported eating disorder symptoms are more common in those from lower socioeconomic positions in cross-sectional studies. Longitudinal studies investigating the role of different socioeconomic indicators in the aetiology of a range of eating disorders symptoms might avoid biases associated with the use of clinical samples but have multiple limitations. We aimed to investigate the association between early childhood socioeconomic indicators and eating disorder symptoms across adolescence.
Method
We used data from the Avon Longitudinal Study of Parents and Children. Parental income, education, occupation, and financial hardship were reported by mothers between 32 weeks of gestation and 47 months postpartum. Area-level deprivation was derived from the Office of National Statistics indicators linked to the participant’s residential post code at 32 weeks gestation. Outcomes were disordered eating (restrictive eating, binge eating, and purging), weight and shape concerns, and body dissatisfaction at age 14, 16, and 18 years. To model these associations, we used univariable and multivariable multilevel logistic and linear regression, and linear regression models.
Findings
The sample included 7,824 participants (48.9% females; 3.8% minoritised ethnic background). Greater financial hardship was associated with increased odds of disordered eating (Odds Ratio= 1·06, 95%CI 1·04 to 1·10) and greater weight and shape concerns (Mean difference[MD] = 0·02, 95%CI 0·01 to 0·04) and body dissatisfaction (MD= 0·22 95%CI 0·06 to 0·37). Lower parental education was associated with 1.80 higher odds of disordered eating (95% CI 1·46 to 2·23).
Interpretation
Our findings point to potential socioeconomic inequalities in eating disorder identification in clinical settings, which need to be understood and addressed. Reducing population-level socioeconomic inequalities could also aid eating disorder prevention.
Research in context
We conducted a search in PubMED and Google Scholar on 12 June 2024 using the terms (“deprivation” OR “education” OR “income” OR “poverty” OR “socioeconomic position” OR “socioeconomic status” OR “SEP” OR “SES”) AND (“eating disorder*” OR “disordered eating*” OR “body dissatisfaction”). We found 19 longitudinal studies investigating the association between socioeconomic position and eating disorders. Of these, nine studies used recorded diagnoses as the outcome. Seven of these studies were based in Sweden, Denmark, and the UK and found that higher socioeconomic position was associated with increased incidence of eating disorders diagnoses. A further two Spain-based studies showed that there was no evidence of a difference in socioeconomic variation in eating disorder incidence. On the other hand, eight studies used self-reported eating disorder symptoms as outcome; seven found that risk of these symptoms was higher in people from deprived backgrounds and one found no evidence of an association between socioeconomic background and eating disorder symptoms. These studies were from the UK, USA, Sweden, and Finland. These studies measured socioeconomic position in late childhood/adolescence or adulthood using individual or composite indicators and focused on specific eating disorder symptoms rather than the full range of eating disorder symptoms.
Added value of this study
This study is the first to investigate the association between multiple indicators of socioeconomic position in childhood and disordered eating from early to late adolescence, a high-risk period for eating disorder onset. We found that adolescents from more deprived backgrounds were at highest risk of eating disorder symptoms, especially those whose parents reported difficulties in affording cost of essential material goods. Children of parents who had only compulsory education were also at highest risk of developing disordered eating.
Implications of all available evidence
From a public health perspective, our study emphasises that reducing socioeconomic inequalities could also help prevent eating disorders in the general population. Further, the results of our study stand in stark contrast with register-based studies, which found that diagnosed eating disorders are more common in people from more affluent backgrounds. This suggest that there might be steep barriers in accessing eating disorder services for people from more deprived backgrounds, which need to be better understood.
