Area-level socioeconomic characteristics and incidence of metabolic syndrome: a prospective cohort study.

Anh D Ngo,Natasha J Howard,Mark Daniel,Anne Taylor,Catherine Paquet,Neil T Coffee,Robert Adams

doi:10.1186/1471-2458-13-681

Abstract

BackgroundThe evidence linking socioeconomic environments and metabolic syndrome (MetS) has primarily been based on cross-sectional studies. This study prospectively examined the relationships between area-level socioeconomic position (SEP) and the incidence of MetS.MethodsA prospective cohort study design was employed involving 1,877 men and women aged 18+ living in metropolitan Adelaide, Australia, all free of MetS at baseline. Area-level SEP measures, derived from Census data, included proportion of residents completing a university education, and median household weekly income. MetS, defined according to International Diabetes Federation, was ascertained after an average of 3.6 years follow up. Associations between each area-level SEP measure and incident MetS were examined by Poisson regression Generalised Estimating Equations models. Interaction between area- and individual-level SEP variables was also tested.ResultsA total of 156 men (18.7%) and 153 women (13.1%) developed MetS. Each percentage increase in the proportion of residents with a university education corresponded to a 2% lower risk of developing MetS (age and sex-adjusted incidence risk ratio (RR) = 0.98; 95% confidence interval (CI) =0.97-0.99). This association persisted after adjustment for individual-level income, education, and health behaviours. There was no significant association between area-level income and incident MetS overall. For the high income participants, however, a one standard deviation increase in median household weekly income was associated with a 29% higher risk of developing MetS (Adjusted RR = 1.29; 95%CI = 1.04-1.60).ConclusionsWhile area-level education was independently and inversely associated with the risk of developing MetS, the association between area-level income and the MetS incidence was modified by individual-level income.

Highlights

The evidence linking socioeconomic environments and metabolic syndrome (MetS) has primarily been based on cross-sectional studies
The underlying mechanisms involved in this relationship are not entirely elucidated [5,6,7], a growing body of evidence demonstrates that socioeconomic factors influence cardiometabolic health outcomes through shaping health related behaviours and psychological antecedents, and subsequently predicting biological risk factors [8,9,10]
Study population This study was conducted through the Place and Metabolic Syndrome (PAMS) project, a research initiative that aims to evaluate the relationships between localarea social and built environmental factors and cardiometabolic health

Summary

Introduction

The evidence linking socioeconomic environments and metabolic syndrome (MetS) has primarily been based on cross-sectional studies. This study prospectively examined the relationships between area-level socioeconomic position (SEP) and the incidence of MetS. A growing literature has documented the relationship between individual and residential area (often referred to as “neighbourhood”) socioeconomic position (SEP) with a wide range of health outcomes, including cardiometabolic diseases (i.e., cardiovascular diseases and type 2 diabetes). Associations between statelevel income inequality and cardiometabolic risk factors (e.g., body mass index (BMI), hypertension, and sedentarism) have been found to be stronger in low income individuals [43]. The role of area-level SEP in shaping the distribution and development of MetS - a stronger risk marker of cardiometabolic disease has been infrequently examined. A recent review reported that out of 56 studies evaluating the influence of the socioeconomic environment on cardiometabolic risk factors, only two considered MetS as the outcome in analysis [12]

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