Abstract
Background: Many cohort studies have been carried out that have provided information on the relationship between diet and health-related outcomes. Omission of important covariates during multivariate analysis may give rise to error due to residual confounding. A possibly important covariate is socioeconomic status (SES) as this is related to both diet and health. Methodology: An analysis was carried out of 76 randomly selected papers from 66 cohort studies. The papers covered many dietary variables and a wide variety of diseases/health-related outcomes. The cohort studies were carried out in many different locations and the subjects varied widely in age. Results: Approximately two-thirds of the papers (65.8%) used at least one measure of SES as a covariate. Education was used most often (60.5% of papers), followed by income (14.4%) and social class (2.6%). More than one measure of SES was used in 11.8% of papers. Conclusions: Failure to include income (or another measure of present SES, such as occupation) may therefore be a common source of error in cohort studies. Failure to include education may be particularly important as it is likely to be a weaker measure of present SES than is income. There is a need for more research on this question. SES in childhood is almost never included in multivariate analysis in cohort studies carried out on adults. This could also play a significant role in disease risk in middle age or later. Very little is known regarding whether this is also a source of residual confounding.
Highlights
Socioeconomic status (SES) is related to diet and health
The findings reported here are based on 66 cohort studies of which 52 were carried out on adults and 14 on children
Cardiovascular disease was studied in 33 papers, of which 19 looked at all forms of CVD combined, 13 at coronary heart disease (CHD), one at both CVD and CHD, and two at stroke
Summary
Socioeconomic status (SES) is related to diet and health. It is well established that affluent people have superior health compared to poorer people. Many studies have reported that people with a higher SES consume a more nutritious diet2 This pattern has been consistently reported in the USA, Canada, and many European countries, and is seen with different indicators of SES – education, income, and occupation. This suggests that income, or other indicators of SES, may be a relevant factor in cohort studies. It follows, that failure to include SES in multivariate analysis of findings from cohort studies may be a source of error due to residual confounding. A possibly important covariate is socioeconomic status (SES) as this is related to both diet and health.
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