Longitudinal associations between childhood socioeconomic position and adolescent eating disorder symptoms: findings from the ALSPAC cohort study

BackgroundThe 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 disorder 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. MethodWe 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 for National Statistics indicators linked to the participants 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. FindingsThe 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{middle dot}06, 95%CI 1{middle dot}04 to 1{middle dot}10) and greater weight and shape concerns (Mean difference[MD] = 0{middle dot}02, 95%CI 0{middle dot}01 to 0{middle dot}04) and body dissatisfaction (MD= 0{middle dot}22 95%CI 0{middle dot}06 to 0{middle dot}37). Lower parental education was associated with 1.80 higher odds of disordered eating (95% CI 1{middle dot}46 to 2{middle dot}23). InterpretationOur 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. Funding sourceMental Health Research UK, Wellcome Trust, UK Medical Research Council