Abstract
BackgroundSocio-economic disadvantage at both individual and neighbourhood levels has been found to be associated with single lifestyle risk factors. However, it is unknown to what extent their combined effects contribute to a broad lifestyle profile. We aimed to (i) investigate the associations of individual socio-economic disadvantage (ISED) and neighbourhood socio-economic disadvantage (NSED) in relation to an extended score of health-related lifestyle risk factors (lifestyle risk index); and to (ii) investigate whether NSED modified the association between ISED and the lifestyle risk index.MethodsOf 77 244 participants [median age (IQR): 46 (40–53) years] from the Lifelines cohort study in the northern Netherlands, we calculated a lifestyle risk index by scoring the lifestyle risk factors including smoking status, alcohol consumption, diet quality, physical activity, TV-watching time and sleep time. A higher lifestyle risk index was indicative of an unhealthier lifestyle. Composite scores of ISED and NSED based on a variety of socio-economic indicators were calculated separately. Linear mixed-effect models were used to examine the association of ISED and NSED with the lifestyle risk index and to investigate whether NSED modified the association between ISED and the lifestyle risk index by including an interaction term between ISED and NSED.ResultsBoth ISED and NSED were associated with an unhealthier lifestyle, because ISED and NSED were both positively associated with the lifestyle risk index {highest quartile [Q4] ISED beta-coefficient [95% confidence interval (CI)]: 0.64 [0.62–0.66], P < 0.001; highest quintile [Q5] NSED beta-coefficient [95% CI]: 0.17 [0.14–0.21], P < 0.001} after adjustment for age, sex and body mass index. In addition, a positive interaction was found between NSED and ISED on the lifestyle risk index (beta-coefficient 0.016, 95% CI: 0.011–0.021, Pinteraction < 0.001), which indicated that NSED modified the association between ISED and the lifestyle risk index; i.e. the gradient of the associations across all ISED quartiles (Q4 vs Q1) was steeper among participants residing in the most disadvantaged neighbourhoods compared with those who resided in the less disadvantaged neighbourhoods.ConclusionsOur findings suggest that public health initiatives addressing lifestyle-related socio-economic health differences should not only target individuals, but also consider neighbourhood factors.
Highlights
Lifestyle risk factors are key to the prevention of non-communicable diseases
A positive interaction was found between neighbourhood socio-economic disadvantage (NSED) and individual socio-economic disadvantage (ISED) on the lifestyle risk index (Table 2); and the association between ISED and the lifestyle risk index was steeper for those who resided in a more disadvantaged neighbourhood (Figure 1)
The results showed that the strength of the adjusted associations between ISED and the lifestyle risk index were highest at the most disadvantaged neighbourhood quintile (Q5)
Summary
Abundant epidemiological studies have demonstrated that socio-economic differences bear a considerable impact on lifestyle risk factors;[1,2] i.e. individuals who are more socio-economically disadvantaged are more likely to have an unhealthy lifestyle (e.g. poor diet, smoking, less physical activity).[3,4,5,6,7] variations within individual socio-economic strata remain. The impact of NSED has been found to be greater for those who were more socio-economically disadvantaged.[20,21] It has been suggested that less-socio-economically disadvantaged individuals may be protected by their individual resources from NSED, whereas moresocio-economically disadvantaged individuals may be more dependent on neighbourhood resources.[22] those previous studies only examined single and traditional lifestyle risk factors, whereas a broader range of a combination of lifestyle factors, including emerging lifestyle factors, has rarely been studied in this context for their relationships with the combined effects of ISED and NSED.[23,24,25]. Results: Both ISED and NSED were associated with an unhealthier lifestyle, because ISED and NSED were both positively associated with the lifestyle risk index fhighest quartile [Q4] ISED beta-coefficient [95% confidence interval (CI)]: 0.64 [0.62–0.66], P < 0.001; highest quintile [Q5] NSED beta-coefficient [95% CI]: 0.17 [0.14–0.21], P < 0.001g after adjustment
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