Abstract
BackgroundWe aimed to estimate the causal effect of health conditions and risk factors on social and socioeconomic outcomes in UK Biobank. Evidence on socioeconomic impacts is important to understand because it can help governments, policy makers and decision makers allocate resources efficiently and effectively.MethodsWe used Mendelian randomization to estimate the causal effects of eight health conditions (asthma, breast cancer, coronary heart disease, depression, eczema, migraine, osteoarthritis, type 2 diabetes) and five health risk factors [alcohol intake, body mass index (BMI), cholesterol, systolic blood pressure, smoking] on 19 social and socioeconomic outcomes in 336 997 men and women of White British ancestry in UK Biobank, aged between 39 and 72 years. Outcomes included annual household income, employment, deprivation [measured by the Townsend deprivation index (TDI)], degree-level education, happiness, loneliness and 13 other social and socioeconomic outcomes.ResultsResults suggested that BMI, smoking and alcohol intake affect many socioeconomic outcomes. For example, smoking was estimated to reduce household income [mean difference = -£22 838, 95% confidence interval (CI): -£31 354 to -£14 321] and the chance of owning accommodation [absolute percentage change (APC) = -20.8%, 95% CI: -28.2% to -13.4%], of being satisfied with health (APC = -35.4%, 95% CI: -51.2% to -19.5%) and of obtaining a university degree (APC = -65.9%, 95% CI: -81.4% to -50.4%), while also increasing deprivation (mean difference in TDI = 1.73, 95% CI: 1.02 to 2.44, approximately 216% of a decile of TDI). There was evidence that asthma decreased household income, the chance of obtaining a university degree and the chance of cohabiting, and migraine reduced the chance of having a weekly leisure or social activity, especially in men. For other associations, estimates were null.ConclusionsHigher BMI, alcohol intake and smoking were all estimated to adversely affect multiple social and socioeconomic outcomes. Effects were not detected between health conditions and socioeconomic outcomes using Mendelian randomization, with the exceptions of depression, asthma and migraines. This may reflect true null associations, selection bias given the relative health and age of participants in UK Biobank, and/or lack of power to detect effects.
Highlights
Poor health has the potential to affect an individual’s ability to engage with society.[1,2,3,4] For example, illnesses or adverse health behaviours could influence the ability to attend and concentrate at school or at work and affect educational attainment, employment and income
Coronary heart disease, osteoarthritis, cholesterol or systolic blood pressure unlikely to have plausible causal effects on the chance of obtaining a university degree, given that these health conditions usually occur later in life; the Mendelian randomization effect estimates for these associations were used as negative controls.[20,21]
All health conditions and risk factors in the main Mendelian randomization analysis had a low risk of weak instrument bias, and 75% of regressions had F statistics above 1000
Summary
Poor health has the potential to affect an individual’s ability to engage with society.[1,2,3,4] For example, illnesses or adverse health behaviours could influence the ability to attend and concentrate at school or at work and affect educational attainment, employment and income. Understanding the causal impacts of health on social and socioeconomic outcomes can help demonstrate the potential broader benefits of investing in effective health policy, thereby strengthening the case for crossgovernmental action to improve health and its wider determinants at the population level.[7] patients require accurate information about how their lives might be affected by their health, for example on returning to work after cancer.[8] studying the social and socioeconomic consequences of ill health (‘social drift’) is challenging because of social causation, i.e. the strong role of social and socioeconomic circumstances in disease causation. Methods: We used Mendelian randomization to estimate the causal effects of eight health conditions (asthma, breast cancer, coronary heart disease, depression, eczema, migraine, osteoarthritis, type 2 diabetes) and five health risk factors [alcohol intake, body mass index (BMI), cholesterol, systolic blood pressure, smoking] on 19 social and socioeconomic outcomes in 336 997 men and women of White British ancestry in UK Biobank, aged between 39 and 72 years.
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