Understanding socioeconomic differences in incident metabolic syndrome among adults: What is the mediating role of health behaviours?

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

doi:10.1016/j.ypmed.2021.106537

Abstract

BackgroundThe incidence of metabolic syndrome (MetS) strongly varies by socioeconomic position (SEP), but little is known about the mediating role of health behaviours in this association. This study examines the associations between the SEP measures, education, income and occupational prestige, and incident MetS and whether the associations are mediated by health behaviours, including physical activity, smoking, alcohol intake and diet quality. MethodsA subsample (n = 85,910) of the adult Lifelines Cohort Study without MetS at baseline was used. MetS was measured at the second assessment (median follow-up time 3.8 years) defined according to the NCEP-ATPIII criteria. Direct associations between SEP, health behaviours and incident MetS were estimated using multivariable logistic regression analyses. The mediating percentages of health behaviours explaining the associations between SEP and incident MetS were estimated using the Karlson-Holm-Breen method. Analyses were independent of age, sex, the other SEP measures and follow-up time. ResultsEducation and occupational prestige were inversely associated with MetS. Income was not associated with MetS. Health behaviours explained only partly (13.8%) the association between education and MetS, with smoking as the strongest mediating factor (8.8%). Health behaviours played also a minor role (2.7%) in explaining occupational MetS differences, with physical activity as the strongest suppressing factor (−9.4%). ConclusionIndividuals with more years of education or a higher occupational prestige had a lower risk to develop MetS. This was mainly because of non-smoking, less excessive alcohol intake and a higher diet quality. However, individuals with a higher SEP were more often physically inactive.

Highlights

Metabolic syndrome (MetS) is a global health problem and can cause high healthcare expenditures
A participant who had followed 6 years of education has 11.9% risk of developing metabolic syndrome (MetS), while if all parameters in the model were kept the same and only the years of education changed to 16 years, the risk of developing MetS decreased to 5.6% (Fig. 2)
A participant who had an occupational prestige of 20 has 8.7% risk of developing MetS, while if all parameters in the model were kept the same and only the occupational prestige changed to 70, the risk of developing MetS decreased to 6.6% (Fig. 2)

Summary

Introduction

Metabolic syndrome (MetS) is a global health problem and can cause high healthcare expenditures. Socioeconomic position (SEP) is highly associated with developing MetS, a clear distinction between different SEP measures, including education, income and occupational prestige is lacking (Blanquet et al, 2019). This study examines the as sociations between the SEP measures, education, income and occupational prestige, and incident MetS and whether the associations are mediated by health behaviours, including physical activity, smoking, alcohol intake and diet quality. Conclusion: Individuals with more years of education or a higher occupational prestige had a lower risk to develop MetS. This was mainly because of non-smoking, less excessive alcohol intake and a higher diet quality. Individuals with a higher SEP were more often physically inactive

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