Area-Level Socioeconomic Characteristics, Prevalence and Trajectories of Cardiometabolic Risk

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

doi:10.3390/ijerph110100830

Abstract

This study examines the relationships between area-level socioeconomic position (SEP) and the prevalence and trajectories of metabolic syndrome (MetS) and the count of its constituents (i.e., disturbed glucose and insulin metabolism, abdominal obesity, dyslipidemia, and hypertension). A cohort of 4,056 men and women aged 18+ living in Adelaide, Australia was established in 2000–2003. MetS was ascertained at baseline, four and eight years via clinical examinations. Baseline area-level median household income, percentage of residents with a high school education, and unemployment rate were derived from the 2001 population Census. Three-level random-intercepts logistic and Poisson regression models were performed to estimate the standardized odds ratio (SOR), prevalence risk ratio (SRR), ratio of SORs/SRRs, and (95% confidence interval (CI)). Interaction between area- and individual-level SEP variables was also tested. The odds of having MetS and the count of its constituents increased over time. This increase did not vary according to baseline area-level SEP (ratios of SORs/SRRs ≈ 1; p ≥ 0.42). However, at baseline, after adjustment for individual SEP and health behaviours, median household income (inversely) and unemployment rate (positively) were significantly associated with MetS prevalence (SOR (95%CI) = 0.76 (0.63–0.90), and 1.48 (1.26–1.74), respectively), and the count of its constituents (SRR (95%CI) = 0.96 (0.93–0.99), and 1.06 (1.04–1.09), respectively). The inverse association with area-level education was statistically significant only in participants with less than post high school education (SOR (95%CI) = 0.58 (0.45–0.73), and SRR (95%CI) = 0.91 (0.88–0.94)). Area-level SEP does not predict an elevated trajectory to developing MetS or an elevated count of its constituents. However, at baseline, area-level SEP was inversely associated with prevalence of MetS and the count of its constituents, with the association of area-level education being modified by individual-level education. Population-level interventions for communities defined by area-level socioeconomic disadvantage are needed to reduce cardiometabolic risks.

Highlights

Cardiometabolic disease is a leading cause of mortality and morbidity, and accounts for a significant burden of disease worldwide [1]
The results indicated that the odds of having Metabolic syndrome (MetS) and its component count tended to increase over time, independent of individual- and area-level socioeconomic position (SEP) factors and health behaviours
This study is the first to examine the capacity of area-level SEP factors to predict actual trajectories of change in cardiometabolic risk expressed as MetS and the count of its components

Summary

Introduction

Cardiometabolic disease (i.e., cardiovascular disease and type 2 diabetes) is a leading cause of mortality and morbidity, and accounts for a significant burden of disease worldwide [1]. Studies have shown that cardiometabolic disorders tend to cluster [2] and people with multiple disorders who meet criteria for. MetS have an increased risk for cardiometabolic disease morbidity [3,4], cardiovascular mortality, and all-cause mortality [5]. In addition there is a continuum of elevated risk as the number of MetS components rises. Studies conducted in the United States (US) indicate that cardiovascular disease incidence, cardiovascular and all-cause mortality rise incrementally as the number of MetS components increases [4,6]

Methods

Results

Discussion

Conclusion