Area-level socioeconomic disparity trends in nutritional status among 5-6-year-old children in Israel.

Objective: This study aimed to assess area-level socioeconomic position (SEP) disparities in nutritional status, to determine whether disparities differed by sex and to assess whether nutritional status and disparities changed over time.
Design: We used repeated cross-sectional data from a national programme that evaluates the quality of healthcare in Israel to assess children's nutritional status.
Setting: The study included all Israeli residents aged 7 years during 2014-2018 (n=699 255).
Methods: SEP was measured based on the Central Bureau of Statistics' statistical areas, and grouped into categories, ranging from 1 (lowest) to 10 (highest). We used multivariable multinomial regression to assess the association between SEP and nutritional status and between year and nutritional status. We included interactions between year and SEP to assess whether disparities changed over time.
Results: Children in SEP 1, comprised entirely of children from the Bedouin population from Southern Israel, had drastically higher odds of thinness compared with those in the highest SEP (Girls: OR 5.02, 99% CI 2.23 to 11.30; Boys: OR 2.03, 99% CI 1.19 to 3.48). Odds of obesity were highest in lower-middle SEPs (OR _{SEP 5 vs 10} 1.84, 99% CI 1.34 to 2.54). Prevalence of overweight and obesity decreased between 2014 and 2018, normal weight increased and thinness did not change. SEP disparities in thinness decreased over time in boys but showed a reverse trend for girls. No substantial improvement was seen in SEP disparities for other weight categories.
Conclusions: Our study demonstrates the need to consider initiatives to combat the considerable SEP disparities in both thinness and obesity.
Competing Interests: Competing interests: YLW reports grants from Azrieli Foundation, during the conduct of the study.
(© Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.)