Impact of education and place of residence on the risk of metabolic syndrome in Polish men and women

Abstract

⁎ Corresponding author. Department of Physiology, Medical University of Wroclaw, Poland. Tel.: +48 606742344. E-mail address: rskalik@fizjo.am.wroc.pl (R. Skalik). The metabolic syndrome (MS) is a constellation of cardiovascular risk factors including abdominal obesity, atherogenic dyslipidemia, elevated blood pressure, insulin resistance, a proinflammatory and prothrombotic state. This syndrome is associated with an approximately 2-fold increase in risk of cardiovascular diseases (CVD). The social gradient observed in MS could help explain socioeconomic inequalities in heart diseases. Hence, factors that causeMSmay also be important for the formation of social inequalities in stratification of CVD risk.MSmayalso offer a simple screening tool tofind subgroups at high risk of heart diseases. The economic transition period associated with political and social transformations in Poland since 1990 has contributed tomajor changes in lifestyle, dietary habits and knowledge of health promoting behaviours and influenced social stratification in this country. Some groups defined by their low educational and occupational status before the political and social transformation period experienced significant changes in income and lifestyle that might have influenced the body mass. Most of the evidences about inequalities in MS and impact of education and place of residence on development of MS have been gathered from Western industrialized societies so far. The latest results of SUNSET study by Agyemang C et al. demonstrate that low educationmay be associated with increased risk of MS among native white inhabitants but not among other ethnic groups in the Netherlands which is another evidence of inter-ethnic variations in the incidence of MS irrespective of the actual place of residence [1]. In our study we investigated the effect of the level of education and place of residence on the risk of development of MS among Polish population. A representative sample of 1648 adults (999 women and 649men), aged 25–85 years, from the local community of town of Jelcz-Laskowice (province of Lower Silesia, Poland) was examined (Table 1). The investigated individuals lived in a small town with a population of approximately 16 000 inhabitants or adjacent villages.Weused education as the sole criterion of adherence to a given social class because in Poland high correlation between three most often used predictors of social class, i.e. level of education, occupation and income is observed [2]. MS based on IDF criteria occurred significantly more often in men than in women whereas incidence of MS based on NCEP-ATP III-R criteria did not differ in both gender groups (Table 2). Generally in both sexes, MS was more frequent among town inhabitants as compared with inhabitants of villages. Percentage of men and women with MS increased with lowering the position of examined group on the social scale (Figs.1 and 2). The place of residence was a significant risk factor for developing MS in both genders. Men and women living in the urban area had a significantly higher risk of MS than individuals living in the countryside. Level of education significantly influenced the risk of MS only in women. Each step down in the level of education increased the risk of MS based on IDF criteria by 15% and by 26% when NCEP-ATP III-R criteria were used (Table 3). Among components of MS place of residence was significantly related to low HDL in men and low HDL and hyperglycemia inwomen (Table 3). Additionally, living in urban areas increased the risk of insulin resistance by 55% in men and 60% in women as compared with individuals living in the countryside. The low education significantly elevated the risk of abdominal obesity, arterial hypertension and hyperglycemia in women. None of the MS components was affected by level of education in men.