Abstract
Background. Social and behavioral risk markers (e.g., physical activity, diet, smoking, and socioeconomic position) cluster; however, little is known whether clustering is associated with coronary heart disease (CHD) risk. Objectives were to determine if sociobehavioral clustering is associated with biological CHD risk factors (total cholesterol, HDL cholesterol, systolic blood pressure, body mass index, waist circumference, and diabetes) and whether associations are independent of individual clustering components. Methods. Participants included 4,305 males and 4,673 females aged ≥20 years from NHANES 2001–2004. Sociobehavioral Risk Marker Index (SRI) included a summary score of physical activity, fruit/vegetable consumption, smoking, and educational attainment. Regression analyses evaluated associations of SRI with aforementioned biological CHD risk factors. Receiver operator curve analyses assessed independent predictive ability of SRI. Results. Healthful clustering (SRI = 0) was associated with improved biological CHD risk factor levels in 5 of 6 risk factors in females and 2 of 6 risk factors in males. Adding SRI to models containing age, race, and individual SRI components did not improve C-statistics. Conclusions. Findings suggest that healthful sociobehavioral risk marker clustering is associated with favorable CHD risk factor levels, particularly in females. These findings should inform social ecological interventions that consider health impacts of addressing social and behavioral risk factors.
Highlights
Coronary heart disease (CHD) is the leading cause of death in the United States, despite extensive gains in primary and secondary prevention [1, 2]
Healthful clustering of Sociobehavioral Risk Marker Index (SRI) components was strongly associated with more favorable biological coronary heart disease (CHD) risk factors in females (5 of 6 CHD risk factors were associated with SRI = 0 versus SRI = 1–3) and less so in males (2 of 6 risk factors were associated with SRI = 0 versus SRI = 1–3; Table 3)
In an effort to evaluate if the clustering itself was associated with the biological CHD risk factors over and above the individual contributions of SRI components, analyses adjusted for the individual SRI components, and generally showed substantial reductions in effect size, suggesting that the clustering itself was not overarchingly associated with CHD risk factors independently of the individual SRI components (Table 3)
Summary
Coronary heart disease (CHD) is the leading cause of death in the United States, despite extensive gains in primary and secondary prevention [1, 2]. In considering interventions to prevent CHD, it may be helpful to consider the potential mutually reinforcing characteristics of both social and behavioral risk markers This could facilitate the creation of more effective interventions, for example, if interventions on a single risk marker (e.g., physical activity) were substantially affected by other co-occurring risk factors such as diet, smoking and socioeconomic position. Social and behavioral risk markers (e.g., physical activity, diet, smoking, and socioeconomic position) cluster; little is known whether clustering is associated with coronary heart disease (CHD) risk. Findings suggest that healthful sociobehavioral risk marker clustering is associated with favorable CHD risk factor levels, in females These findings should inform social ecological interventions that consider health impacts of addressing social and behavioral risk factors
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