Socioeconomic inequalities in obesity among older adults in the Astana region of Kazakhstan: evidence of a reversed socioeconomic gradient

Anara Zhumadilova, Tolkyn Zhakupova, Alibek Kossumov, Almagul R. Kushugulova, Zhaxybay Sh. Zhumadilov, Zhaxybay Zhumadilov, Graciela Muniz Terrera, Zelalem Teka Haile, Adil Supiyev

Frontiers in Public Health, 2026

Full text Open access: Gold Metadata (CSL-JSON)
DOI 10.3389/fpubh.2026.1895120
Data confidence 85 high
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Abstract

Introduction There is limited information on cardiometabolic risk factors in Central Asia. This study examined the prevalence of overweight, obesity, and central obesity and assessed socioeconomic and demographic correlates among older adults in urban and rural areas of the Astana region of Kazakhstan. Methods This cross-sectional study included 977 adults aged 50 to 74 years recruited from urban (Astana) and rural (Akmol) sites in the Astana region of Kazakhstan. Multivariable binary logistic regression analyses with three sequential models were conducted to examine associations between obesity measures, socioeconomic characteristics, and cardiometabolic conditions. Robust standard errors were used throughout. Results Overall, 37% of participants were overweight, 44% were obese, and 72% had central obesity. Overweight and central obesity were more prevalent in men, while BMI-defined obesity was more common in women (52% vs. 34%). All three obesity measures were significantly and consistently associated with diabetes, hypertension, and hypercholesterolemia across all models. Rural residence was strongly protective against central obesity across all models (fully adjusted OR, 0.43; 95% CI, 0.30–0.64). Greater household asset ownership was positively associated with overweight and obesity in a dose–response fashion, with a significant linear trend confirmed for both outcomes (p for trend = 0.038 and p = 0.002, respectively), suggesting a reversed socioeconomic gradient consistent with an early-stage nutrition transition. Educational attainment showed a more complex pattern, with lower education associated with higher odds of obesity in the fully adjusted model. Older age was associated with greater odds of central obesity. Conclusion Obesity is highly prevalent among older adults in the Astana region of Kazakhstan. In contrast to the inverse socioeconomic gradient commonly observed in high-income settings, household asset ownership showed a reversed gradient: more affluent participants had significantly higher odds of obesity, whereas lower educational attainment was associated with higher obesity risk. The strong associations between all obesity measures and cardiometabolic conditions underscore the urgent need for integrated obesity and cardiometabolic disease prevention strategies. These findings highlight the need for context-specific public health approaches that account for the distinct socioeconomic patterning of obesity in Kazakhstan.