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Obesity and associated factors among adults in Estonia, 2000–2018
Elisa Kender
Summary
The thesis focused on obesity among Estonian adults in 2000−2018. The objectives of this study were 1) to describe the prevalence of obesity in Estonia over study period, 2) to describe trends in the prevlence of obesity according to age-group, nationality and education, 3) to analyze the associations between obesity and sociodemographic, -economic, health-related, and behavioural factors.
Data for this study were taken from the surveys of Health Behaviour among Estonian Adult Population, conducted in 2000–2018. The study sample consisted of a nationally representative sample of 25–64-year-old adults (n = 20,901), 40.6% men and 59.4% women.
Obese adults had BMI at least 30 kg/m2.Self-reported body weight and height were used to calculate Body Mass Index (BMI = body weight (kg) divided height (m) squared).The prevalence and standardized (European standard population) prevalence of obesity with 95%
confidence intervals (CI) was calculated for years 2000 and 2018. Chi-square test for trend was used to find statistically significant changes (p < 0.05) in the prevalence of obesity over the study period. Joinpoint regression analysis was used to calculate annual percentage changes (APC) to identify whether there was a significant change in the prevalences.
Logistic regression analysis was used to analyze associations between obesity and different factors. For logistic regression analysis BMI was used as dependent variable (obese vs. normal) and different factors as descriptive variables. The crude and fully adjusted odds ratios (OR) with 95% confidence intervals were calculated.
Standardized prevalence of obesity in 2018 was 22.2% among men and 17.9% among women. The prevalence of obesity changed significantly in 2000–2018 from 14.3% (95% CI 11.1–17.9) to 22.8% (95% CI 20.1–25,7) among men (p < 0.001) and from 17.7% (95% CI 14.8–20.8) to 18.9% (95% CI 16,8–21,1) among women (p = 0.023). Joinpoint regression analysis showed that the increase in obesity was statistically significant among men (APC = 4.4%, 95% CI 0.8 to 8.1) in 2000–2008 and among women (APC =1.8%, 95% CI 0.1 to 3.5%) in 2000–2014.
Over the study period, among men, the obesity increased significantly in all age groups (except in age-group 25–34), among Estonians and non-Estonians and in the group with secondary education. Among women, the obesity increased significantly among Estonians only and in the group of secondary education and fully adjusted logistic regression model showed,
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that obesity among Estonian adults was statistically significantly associated with age, education, income, alcohol use, smoking status and perceived health status. Obesity was associated with marital and employment status among men only and with ethnicity, leisure-time physical activity (LTPA) and perceived stress level among women only.
Compared to 25–34-year-old men and women, in age-groups 35–44, 45–54 and 55–64, odds for obesity were significantly higher. Compared to Estonians, non-Estonian women had higher odds for obesity (OR = 1.16, 95% CI 1.02–1.32). Compared to the adults with higher education, adults with basic and secondary education had higher odds for obesity. Compared to single men, odds for obesity were significantly higher among married men (OR = 1.39, 95%
CI 1.14–1.71). Compared to employed men, unemployed and retired men had lower odds for obesity. Compared to men with lower income, obesity was more prevalent among men with average (OR = 1.34, 95% CI 1.13–1.60) or higher income (OR = 1.26, 95% CI 1.03–1.56).
Compared to women with lower income obesity was less prevalent among women with higher income (OR = 0.81, 95% CI 0.68–0.97).
Regarding alcohol use, compared to the adults never drinking six alcohol units at one time, odds for obesity were higher among those, who used alcohol at least six alcohol units at one time. Compared with never-smokers, obesity was less prevalent among daily smokers (OR = 0.55, 95% CI 0.45–0.66 among men and OR = 0.68, 95% CI 0.58–0.80 among women) and more prevalent among ex-smokers, (OR = 1.59, 95% CI 1.32–1.91 among men and OR = 1.20, 95% CI 1.04–1.38 among women). According to LTPA, physically inactive women had higher odds for obesity than physically active women.
Compared to women with perceived low-stress level, women with high-stress level had lower odds (OR = 0.80, 95% CI 0.66–0.96) for obesity.Less-than-good self-perceived health was associated with higher obesity among men and women.
In conclusion, obesity increased significantly among 25–64-year-old men and women in Estonia in 2000−2018. Obesity was associated with sociodemographic, -economic, health-related, and behavioural factors. Based on the study results, it is possible to improve public health policies and health promotion activities to slow down and reduce the prevalence of obesity among adults in Estonia.
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Tänuavaldus
Südamlikud tänusõnad:
− juhendaja Kesti Pärnale väärtuslike nõuannete, pühendumuse ja hindamatu abi eest magistritöö juhendamisel;
− statistik Inge Ringmetsale kaasamõtlemise eest statistilise andmeanalüüsi osas ning eriti abi eest TKU andmete korrastamisel;
− tööandjale, Tartu Tervishoiu Kõrgkoolile, paindliku tööaja võimaldamise eest õpingute ajal;
− perekonnale mõistva suhtumise ning toetuse eest õpingute ajal.
Tänan Tervise Arengu Instituuti võimaluse eest kasutada TKU andmeid.
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Curriculum vitae
Üldandmed
Ees- ja perenimi: Elisa Kender Sünniaeg ja -koht: 29.09.1980, Tartu
E-post: elisa.kender@gmail.com
Hariduskäik:
2018–… Tartu Ülikool, magistriõpe (rahvatervishoid)
2014 – 2018 Tartu Tervishoiu Kõrgkool, rakenduskõrgharidus, cum laude (tervisekaitse spetsialist)
2002 – 2005 Tallinna Kergetööstustehnikum, rakenduskõrgharidus, cum laude (rõivaala korraldus)
1986 – 1998 Tartu Karlova Gümnaasium, keskharidus
Teenistuskäik:
06.2019–... Osalemine Sotsiaalministeeriumi ja WHO ühisprojektis „Tailoring Immunization Programmes”
02.2019–... Tartu Tervishoiu Kõrgkool, arendusspetsialist (0,25) 02.2018–... Tartu Tervishoiu Kõrgkool, töökeskkonnaspetsialist (0,25)
Keelteoskus:
eesti keel emakeel
inglise keel mõistmine C1, rääkimine B2; kirjutamine B2.
Preemiad ja tunnustused:
2018 Üliõpilaste teadustööde 2018. a riikliku konkursi 1. preemia terviseuuringute valdkonna rakenduskõrgharidusõppe ja bakalaureuseõppe üliõpilaste astmes: „Eesti lapsevanemate
vaktsineerimiskäitumine ning arusaamad ja uskumused seoses vaktsineerimisega”. Juhendajad Ülle Parm ja Nele Põldver.
2019 Riga Stradins University Student Conference. Health and Social Sciences, 1st prize oral presentation, public health session: "Parental beliefs and behaviour towards vaccination in Estonia".
Publikatsioonid:
Parm, Ü; Kender, E; Põldver, N (2019). Eesti lapsevanemate uskumused laste plaanilise
vaktsineerimise kohta ja vaktsineerimiskäitumist mõjutavad tegurid: internetiküsitluse tulemused.
Eesti Arst 2019; 96:323−33.
29.05.2020
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Lisa. Uuringus kasutatud küsimustik (TKU 2018)
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Lihtlitsents lõputöö reprodutseerimiseks ja lõputöö üldsusele kättesaadavaks tegemiseks
Mina, Elisa Kender,
1. annan Tartu Ülikoolile tasuta loa (lihtlitsentsi) enda loodud teose „Eesti täiskasvanute rasvumise levimus ja sellega seotud tegurid aastatel 2000–2018”, mille juhendaja on Kersti Pärna, reprodutseerimiseks eesmärgiga seda säilitada, sealhulgas lisada digitaalarhiivi DSpace kuni autoriõiguse kehtivuse lõppemiseni.
2. Annan Tartu Ülikoolile loa teha punktis 1 nimetatud teos üldsusele kättesaadavaks Tartu Ülikooli veebikeskkonna, sealhulgas digitaalarhiivi DSpace kaudu Creative Commonsi litsentsiga CC BY NC ND 3.0, mis lubab autorile viidates teost reprodutseerida, levitada ja üldsusele suunata ning keelab luua tuletatud teost ja kasutada teost ärieesmärgil, kuni autoriõiguse kehtivuse lõppemiseni.
3. Olen teadlik, et punktides 1 ja 2 nimetatud õigused jäävad alles ka autorile.
4. Kinnitan, et lihtlitsentsi andmisega ei riku ma teiste isikute intellektuaalomandi ega isikuandmete kaitse õigusaktidest tulenevaid õigusi.
Elisa Kender 01.06.2020