Persistent socioeconomic disparities in child health across intra-urban settings: evidence from a multidimensional socioeconomic index (The ASOMAD Study)

Abstract Aim Socioeconomic conditions are major determinants of child health, yet little is known about how disparities affect intra-urban environments. This study examined intra-urban socioeconomic disparities across multiple health domains in school-aged children. Subject and methods A cross-sectional study was conducted among 721 children aged 8–12 years. A multidimensional socioeconomic status (SES) index was developed using parental education, occupation, and census-tract income. Outcomes included Mediterranean diet adherence, BMI z-scores, body fat percentage, waist-to-height ratio, moderate-to-vigorous physical activity (MVPA), screen time, and emotional wellbeing. Parametric and nonparametric tests, complemented by multivariable regression models, were applied to ensure robustness. Results Clear SES gradients emerged across all domains. Children in the lowest SES group had poorer diet quality (67% vs. 51% in the highest group), greater adiposity, lower emotional wellbeing (48% vs. 28% below adequacy threshold), and less MVPA (84 vs. 111 min/day). They also accumulated ~90 additional weekday screen minutes. Regression analyses confirmed SES as an independent predictor of diet, adiposity, emotional wellbeing, physical activity, and screen time, beyond sex, age, and school ownership. The magnitude of intra-urban disparities often exceeded national and European reports. Conclusion Socioeconomic disparities in child health are persistent, multidimensional, and particularly pronounced within the urban context. By integrating a composite SES index and multiple health indicators, this study shows that disadvantage accumulates simultaneously across behaviours and outcomes. Addressing these disparities requires equity-oriented, place-based policies that go beyond single-domain interventions to effectively reduce persistent intra-urban health inequalities.