Socioeconomic differences in metabolic syndrome development: examining the mediating role of chronic stress using the Lifelines Cohort Study

Liza A Hoveling,Ute Bültmann,Nynke Smidt,Aart C Liefbroer

doi:10.1186/s12889-022-12684-1

Abstract

BackgroundMetabolic syndrome (MetS) development strongly varies based on individuals’ socioeconomic position (SEP), but to date, no studies have assessed the mediating role of perceived stress from long-term difficulties (chronic stress) in this association. The aim of this study is to examine the mediating role of chronic stress in the associations of the SEP measures education, occupational prestige and income, with MetS development, and whether associations between chronic stress and MetS are moderated by sex.MethodsWe used an adult subsample (n = 53,216) from the Lifelines Cohort Study without MetS at baseline. MetS development was measured 3.9 years after baseline (follow-up), and defined according to National Cholesterol Education Program’s Adult Treatment Panel III (NCEP-ATPIII) criteria. Direct associations between SEP, chronic stress and MetS development were estimated using multivariable logistic and linear regression analyses, and were adjusted for age, sex, the other SEP measures, and time between baseline and follow-up. The mediating percentages of chronic stress explaining the associations between SEP and MetS development were estimated using the Karlson-Holm-Breen method.ResultsUpon follow-up, 7.4% of the participants had developed MetS. Years of education and occupational prestige were inversely associated with MetS development. Chronic stress suppressed the association between education and MetS development (5.6%), as well as the association between occupational prestige and MetS development (6.2%). No effect modification of sex on the chronic stress-MetS pathway was observed.ConclusionsChronic stress does not explain educational and occupational differences in developing MetS. In fact, individuals with more years of education or higher occupational prestige perceive more chronic stress than their lower SEP counterparts. Further, no difference between males and females was observed regarding the relationship between chronic stress and MetS development.

Highlights

Socioeconomic health differences in chronic diseases are a significant public health issue, and are expected to increase [1]
Most participants had no chronic stress between T1 and T4 on the highlighted domains (46.580.2%)
SD Standard deviation, SIOPS08 Standard International Occupational Prestige Scale 2008, high-density lipoprotein (HDL) High-density lipoprotein a % Presented, unless otherwise indicated b Categories according to Dutch Standard Education Format [33] c According to definition of metabolic syndrome by NCEP-ATPIII d ≥ 102 cm in male, or ≥ 88 cm in female e ≥ 1.70 mmol/l, or use of medication for elevated triglycerides f < 1.0 mmol/L in male, < 1.3 mmol/L in female, or use of lipid-lowering medication g Systolic blood pressure ≥ 130 mmHg, diastolic blood pressure ≥ 85 mmHg, or use of blood pressure-lowering medication h Fasting blood glucose level ≥ 5.6 mmol/l, diagnosis of type 2 diabetes, or use of blood glucose-lowering medication

Summary

Introduction

Socioeconomic health differences in chronic diseases are a significant public health issue, and are expected to increase [1]. Direct effects of the chronic release of cortisol and catecholamines, and the activation of other endocrine systems, are: energy storage as fat, dysregulated carbohydrate metabolism, accumulation of blood lipids and increasing clotting factors, and the heart’s increased demand for oxygen while arteries are simultaneously narrowing [11, 12] These effects may contribute to the development of MetS, a precursor of CVD [13, 14]. Metabolic syndrome (MetS) development strongly varies based on individuals’ socioeconomic position (SEP), but to date, no studies have assessed the mediating role of perceived stress from long-term difficulties (chronic stress) in this association. The aim of this study is to examine the mediating role of chronic stress in the associations of the SEP measures education, occupational prestige and income, with MetS development, and whether associations between chronic stress and MetS are moderated by sex

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