Cumulative Social Risk Score Research Articles

A person-reported cumulative social risk measure does not show bias by income and education

BackgroundSocial risk such as housing instability, trouble affording medical care and food insecurity are a downstream effect of social determinants of health (SDOHs) and are frequently associated with worse health. SDOHs include experiences of racism, sexism and other discrimination as well as differences in income and education. The collective effects of each social risk a person reports are called cumulative social risk. Cumulative social risk has traditionally been measured through counts or sum scores that treat each social risk as equivalent. We have proposed to use item response theory (IRT) as an alternative measure of person-reported cumulative social risk as IRT accounts for the severity in each risk and allows for more efficient screening with computerized adaptive testing.MethodsWe conducted a differential item functioning (DIF) analysis comparing IRT-based person-reported cumulative social risk scores by income and education in a population-based sample (n = 2122). Six social risk items were analyzed using the two-parameter logistic model and graded response model.ResultsAnalyses showed no DIF on an IRT-based cumulative social risk score by education level for the six items examined. Statistically significant DIF was found on three items by income level but the ultimate effect on the scores was negligible.ConclusionsResults suggest an IRT-based cumulative social risk score is not biased by education and income level and can be used for comparisons between groups. An IRT-based cumulative social risk score will be useful for combining datasets to examine policy factors affecting social risk and for more efficient screening of patients for social risk using computerized adaptive testing.

Association of cumulative social risk and gestational diabetes mellitus in the US, 2007–2018

AimsLittle is known regarding the association of multiple social risk factors and gestational diabetes mellitus (GDM). MethodsWe analyzed the 2007–2018 National Health and Nutrition Examination Surveys including 10,439 women aged ≥20 years (8 % with history of GDM). We created a cumulative social risk score (CSR) by adding scores assigned to each of the following: race/ethnicity, citizenship status and country of birth, education, and family income (score of 0 used as reference group). Using logistic regression, we assessed the associations of individual social risk factors (education, income, race/ethnicity and citizenship status) and CSR score with GDM, adjusting for age, parity, insurance status, care access, smoking, diet, physical activity, and body mass index. ResultsAmong individual social risk factors, being a non-U.S. citizen (OR:1.51, 95% CI: 1.06–2.15) or belonging to a minority racial/ethnic group (OR:1.30, 95% CI: 1.04–1.59) was significantly associated with a greater odds of GDM. When examining the combined effects of social risk factors, a CSR score ≥3 was associated with an increased odds of GDM (OR:1.64, 95% CI: 1.22–2.1). ConclusionsWomen with a greater burden of social risk factors are more likely to have GDM, thus should be the focus of interventions to prevent and treat GDM.

Associations between cumulative social risk, psychosocial risk, and ideal cardiovascular health: Insights from the HeartSCORE study

BackgroundLimited studies have assessed the effects of psychosocial risk factors on achievement of ideal cardiovascular health (CVH). MethodsUsing the Heart Strategies Concentrating on Risk Evaluation (HeartSCORE) cohort, we examined the cross-sectional associations of cumulative social risk (CSR) and three psychosocial factors (depression, stress, perceived discrimination) with ideal CVH. CSR was calculated by assigning one point for each of: low family income, low education level, minority race (Black), and single-living status. Ideal CVH was calculated by assigning one point for ideal levels of each factor in American Heart Association's Life's Simple 7. Ideal CVH was dichotomized into fewer versus higher by combining participants achieving <3 versus ≥3 factors. Logistic regression models were used to calculate odds ratios (ORs) and 95% confidence intervals (CIs) of having fewer ideal CVH factors. Psychosocial factors were assessed as mediators of the association between CSR and ideal CVH. ResultsWe included 2000 participants (mean age 59.1 [7.5] years, 34.6% male, 42.7% Black, and 29.1% with low income), among whom 60.6% had <3 ideal CVH factors. The odds of having fewer ideal CVH factors increased significantly with increasing CSR scores from 1 to 2, to ≥3 compared to individuals with CSR score of zero, after adjusting for age and sex (OR [95% CIs]: 1.77 [1.41 - 2.22]; 2.09 [1.62 - 2.69] 2.67 [1.97 - 3.62], respectively). Taking the components of ideal CVH separately, higher CSR was directly associated with odds of being in ‘non-ideal’ category for six of the seven factors, but was inversely associated with probability of being in ‘non-ideal’ category for cholesterol. The association was modestly attenuated after adjusting for depression, stress, and perceived discrimination (corresponding OR [95% CI]: 1.69 [1.34 - 2.12], 1.96 [1.51 - 2.55], 2.34 [1.71 - 3.20]). The psychosocial factors appeared to mediate between 10% and 20% of relationship between CSR and ideal CVH. ConclusionsIncreased CSR was associated with lower probability of achieving ideal CVH factors. A modest amount of the effect of CSR on ideal CVH appeared to be mediated by depression, stress and perceived discrimination. Public health strategies aimed at improving ideal cardiovascular health may benefit from including interventions targeting social and psychosocial risk factors.

Abstract 9191: Association of Cumulative Social Risk Score With Cardiovascular Outcomes in the Multi-Ethnic Study of Atherosclerosis

Introduction: Although the importance of social determinants of health is well-established in atherosclerotic cardiovascular disease (ASCVD), there is a need for a validated polysocial risk construct in the current paradigm of ASCVD prevention and management. Methods: Data from the Multi-Ethnic Study of Atherosclerosis study were used to create an index of baseline Cumulative Social Risk (CSR) to explore its association with incident ASCVD (fatal/non-fatal myocardial infarction, stroke, definite angina, probable angina if followed by revascularization, or resuscitated cardiac arrest). CSR score was defined by assigning a point for the presence of each of 4 social factors: i) educational attainment less than a high school diploma, ii) household income less than the federal poverty level, iii) minority race/ethnicity (Black, Hispanic, or Asian), and iv) single-living status as a proxy for limited social support. Kaplan-Meier survival curves and log-rank tests were used to examine the univariate association between CSR score and ASCVD. Cox proportional hazards models were used to examine the association between CSR score and time-to-ASCVD with and without adjustment for traditional cardiovascular risk factors. Results: A total of 6,529 participants had available CSR scores (0, 24.3%; 1, 35.5%; 2, 25.5%; ≥3, 14.7%). In total, 947 ASCVD events over a median follow-up of 15.6 years were observed. There was a statistically significant difference between the survival curves according to CSR scores (overall log-rank p&lt;0.01). CSR score was crudely associated with increased risk of incident ASCVD in a graded manner (Table 1); however, this association was attenuated in the fully adjusted models. Conclusion: CSR score was associated with incident ASCVD even after adjusting for age and sex; however, this association was attenuated after also adjusting for traditional cardiovascular risk factors, whose role as potential mediators should be explored in future work.

The role of traditional risk factors in explaining the social disparities in cardiovascular death: The national health and Nutrition Examination Survey III (NHANES III)

Objective─ To assess the role of traditional risk factors in explaining the association between cumulative social risk exposure and disparities in CVD death among US adults. Methods─ The study included 15,906 participants from the Third National Health and Nutrition Examination Survey III who were CVD-free at enrollment. Baseline social risk factors (minority race, poverty-income ratio<1, education<12 grade, and living single) were used to create a cumulative social risk score (0 to ≥3). CVD death served as the primary outcome. We assessed the contribution of each major CVD risk factor to the link between cumulative social risk exposure and CVD death. Results─ During a median follow-up of 14 years, 1309 CVD deaths occurred. Participants with elevated cumulative social risk score were at increased risk of CVD death, with hazard ratio 1.19(95%CI 1.01–1.41), 1.52(95%CI 1.28–1.79), and 1.46 (95%CI 1.23–1.74) in individuals with score 1, 2 and ​≥ ​3 respectively, compared with individuals with score of 0. Traditional CVD risk factors explained about one third of the disparities in CVD death in individuals with the elevated social risk exposure. Among the one third effect by combined CVD risk factors, current smoking contributed the largest proportion, accounting for approximately one half of the combined risk factors effect, followed by obesity and diabetes. Conclusions─Among the traditional risk factors, control of smoking appears to be the greatest opportunity to attenuate the social disparities in CVD death. While these findings call for further studies to identify other pathways that explain the elevated CVD mortality in socially disadvantaged population.

Cumulative Social Risk and Cardiovascular Disease Among Adults in South Korea: A Cross-Sectional Analysis of a Nationally Representative Sample.

IntroductionThe Framingham risk score (FRS) is widely used to predict cardiovascular disease (CVD), but it neglects to account for social risk factors. Our study examined whether use of a cumulative social risk score in addition to the FRS improves prediction of CVD among South Korean adults.MethodsWe used nationally representative data on 19,147 adults aged 19 or older from the Korea National Health and Nutrition Examination Survey 2013–2016. We computed a cumulative social risk score (range, 0–3) based on 3 social risk factors: low household income, low level of education, and single-living status. CVD outcomes were stroke, myocardial infarction, and angina. Weighted logistic regression examined the associations between cumulative social risk, FRS, and CVD. McFadden pseudo-R 2 and area under receiver operating characteristic curve (AUC) assessed model performance. We conducted mediation analyses to quantify the association between cumulative social risk score and CVD outcomes that is not mediated by the FRS.ResultsA unit increase in social risk was associated with 89.4% higher risk of stroke diagnosis, controlling for the FRS (P < .001). The FRS explained 8.0% of stroke diagnosis (R 2) with fair discrimination (AUC = 0.728), and adding the cumulative social risk score enhanced R 2 and AUC by 2.4% and 0.039. In the association between cumulative social risk and stroke, the proportion not mediated by the FRS was 65% (P < .001). We observed similar trends in myocardial infarction and angina, such that an increase in social risk was associated with increased relative risk of disease and improved disease diagnosis, and a large proportion of the association was not mediated by the FRS.ConclusionControlling for the FRS, cumulative social risks predicted stroke, myocardial infarction, and angina among adults in South Korea. Future research is needed to examine non-FRS mediators between cumulative social risk and CVD.

Interrelations of Cumulative Social Risk, Silent Myocardial Infarction, and Mortality in the General Population

Cumulative social risk (CSR), defined as experiencing more than one social risk factor, is associated with a significant increase in cardiovascular mortality. However, it is unclear whether CSR is associated with prevalent silent myocardial infarction (SMI), and whether their joint presence is predictive of mortality more than the presence of CSR in isolation. This analysis included 6,708 participants from the third National Health and Nutrition Examination Survey who were free of clinical cardiovascular disease at the time of enrollment. Baseline social risk factors (poverty-income ratio <1, minority race, education <12 grade, and living single) were used to create the CSR score with values ranging from 0 to ≥3. SMI was defined as electrocardiographic evidence of MI in the absence of clinical MI. In a multivariable-adjusted logistic regression model, baseline CSR ≥ 3 (vs 0) was associated with a higher prevalence of SMI (odds ratio [95% confidence interval]: 2.21 [1.16 to 4.23]). Over a median follow-up of 14 years, there were 2,151 all-cause deaths. Compared with CSR of 0 and no SMI, the risk of mortality with CSR was higher in the presence of SMI than without SMI (multivariable adjusted Hazard Ratios [95% confidence intervals] with vs without SMI were 1.76 [1.13 to 2.75] vs 1.27 [1.10 to 1.46] for CSR≥ 3; 2.06 [1.31 to 3.24] vs 1.21 [1.06 to 1.39] for CSR = 2; and 2.02 [1.31 to 3.12] vs 1.33 [0.63 to 2.82] for CSR = 1, respectively). In conclusion, exposure to CSR is associated with increased risk of SMI, and concomitant presence of SMI with CSR is associated with a higher risk of mortality than presence of CSR alone.

Abstract P552: The Role of Traditional Risk Factors in Mediating the Influence of Cumulative Social Risk Exposure on Cardiovascular Death

Introduction: Cumulative social risk exposure, defined as experiencing more than one social risk factor and captured through an index of cumulative social risk, is associated with a significant increase in cardiovascular disease (CVD) mortality. However, the role of CVD risk factors in explaining this association is unclear. Methods: This analysis included 15,906 participants (45.6±19.5 years, 53.4% women, 57.7% minority race) from the Third National Health and Nutrition Examination Survey (NHANES-III) who were CVD-free at enrollment. Baseline social risk factors (minority race, poverty-income ratio&lt;1, education&lt;12 grade, and living single) were used to create a cumulative social risk score (0 to ≥3). The mediation by each CVD risk factor was assessed by estimating the magnitude of attenuation in the hazard ratio for the association between social risk score and CVD death adjusted by demographics and risk factors. Results: During a median follow up of 14 years, 1,309 CVD deaths occurred. Participants with more than one social risk factor were at increased risk of CVD death (Table) . The risk of CVD death in demographic adjusted models was attenuated by 31%, 21% and 36% in people with social risk score 1, 2, and ≥3 versus 0, respectively, after further adjustment for traditional CVD risk factors. Among all CVD risk factors included in the analysis, current smoking was the most powerful mediating effect, accounting for approximately one half of the combined risk factor effect, followed by obesity and diabetes ( Table ). Conclusions: Traditional CVD risk factors explain about one third of the association between cumulative social risk exposure and CVD death. While these findings underscore the importance of management of traditional CVD risk factors, particularly smoking, in socially disadvantaged population, they call for further studies to identify other pathways that explain the link between social risk exposure and CVD.

Association between cumulative social risk, particulate matter environmental pollutant exposure, and cardiovascular disease risk

BackgroundLong-term exposure to pollution has been shown to increase risk of cardiovascular disease (CVD) and mortality, and may contribute to the increased risk of CVD among individuals with higher social risk.MethodsData from the community-based Heart Strategies Concentrating on Risk Evaluation (HeartSCORE) study were used to quantify Cumulative Social Risk (CSR) by assigning a score of 1 for the presence of each of 4 social risk factors: racial minority, single living, low income, and low educational status. 1-year average air pollution exposure to PM2.5 was estimated using land-use regression models. Associations with clinical outcomes were assessed using Cox models, adjusting for traditional CVD risk factors. The primary clinical outcome was combined all-cause mortality and nonfatal CVD events.ResultsData were available on 1933 participants (mean age 59 years, 66% female, 44% Black). In a median follow up time of 8.3 years, 137 primary clinical outcome events occurred. PM2.5 exposure increased with higher CSR score. PM2.5 was independently associated with clinical outcome (adjusted hazard ratio [HR]: 1.19 [95% CI: 1.00, 1.41]). Participants with ≥2 CSR factors had an adjusted HR of 2.34 (1.48–3.68) compared to those with CSR = 0. The association was attenuated after accounting for PM2.5 (HR: 2.16; [1.34, 3.49]). Mediation analyses indicate that PM2.5 explained 13% of the risk of clinical outcome in individuals with CSR score ≥ 2.ConclusionIn a community-based cohort study, we found that the association of increasing CSR with higher CVD and mortality risks is partially accounted for by exposure to PM2.5 environmental pollutants.

Association of cumulative social risk with mortality and adverse cardiovascular disease outcomes

BackgroundQuantifying the cumulative effect of social risk factors on cardiovascular disease (CVD) risk can help to better understand the sources of disparities in health outcomes.Method and resultsData from the Heart Strategies Concentrating on Risk Evaluation (HeartSCORE) study were used to create an index of cumulative social risk (CSR) and quantify its association with incident CVD and all-cause mortality. CSR was defined by assigning a score of 1 for the presence of each of 4 social factors: i) racial minority status (Black race), ii) single living status, iii) low income, and iv) low educational level. Hazard ratios (HRs) were computed using Cox-regression models, adjusted for CVD risk factors. Over a median follow-up period of 8.3 years, 127 incident events were observed. The incidence of the primary outcome for subgroups of participants with 0, 1, and ≥2 CSR scores was 5.31 (95% CI, 3.40–7.22), 10.32 (7.16–13.49) and 17.80 (12.94–22.67) per 1000 person-years, respectively. Individuals with CSR score of 1 had an adjusted HR of 1.85 (1.15–2.97) for incident primary outcomes, compared to those with score of 0. The corresponding HR for individuals with CSR score of 2 or more was 2.58 (1.60–4.17).ConclusionAn accumulation of social risk factors independently increased the likelihood of CVD events and deaths in a cohort of White and Black individuals.

Cumulative social risk and type 2 diabetes in US adults: The National Health and Nutrition Examination Survey (NHANES) 1999-2006.

The cumulative effects of adverse social factors on the diabetes risk remains to be clarified. Cross-sectional analysis of the US National Health and Nutrition Examination Survey (NHANES) 1999-2006. We included 10,276 adults aged ≥20 years. Diabetes mellitus was defined by physician diagnosis or fasting plasma glucose (≥126 mg/dl) or glycated hemoglobin (≥6.5%). Social risk factors (low family income, low education level, minority racial/ethnic group status, and single-living status) and health-related behaviors (physical activity and dietary intake) were self-reported. Social risk factors were combined in a cumulative social risk index (range 0 to ≥3) and logistic regression used to assess the association of cumulative social risk and diabetes, taking into account complex survey design and sampling weights. Of 10,276 participants, 1515 (weighted proportion - 10%) had diabetes, 3295 (32.3%) and 1830 (9.0%) were exposed to ≥1 adverse social risk factor and ≥3 social risk factors, respectively. Diabetes was associated with increasing cumulative social risk in a graded manner (p for trend <0.001). Compared with a cumulative social risk score of 0, the age- and sex-adjusted diabetes odds for a cumulative social risk score of ≥3 was 2.84 (95% confidence interval: 2.23-3.62), and 2.72 (95% confidence interval: 2.05-3.60) after further adjustment for family history of diabetes, body mass index, smoking, dietary intake and leisure time physical activity. Health behaviors and adiposity only partially influenced the cumulative social risk and diabetes relationship. Simultaneous exposure to several adverse social risk factors significantly influences the odds of diabetes. Better prevention and control of diabetes needs accounting for all aspects of social disadvantage.

Cumulative social risk exposure and risk of cancer mortality in adulthood.

BackgroundAdults in the United States (U.S) can be simultaneously exposed to more than one social risk factor over their lifetime. However, cancer epidemiology tends to focus on single social risk factors at a time. We examined the prospective association between cumulative social risk exposure and deaths from cancer in a nationally representative sample of U.S. adults.MethodsThe study included 8745 adults (aged ≥ 40 years) in the NHANES Survey III Mortality Study over a median follow-up of 13.5 years (1988-1994 enrollment dates and 1988 through 2006 for mortality data). Social risk factors (low family income, low education level, minority race, and single-living status) were summed to create a cumulative social risk score (0 to ≥3). We used Cox proportional hazard models to estimate age- and sex-adjusted hazard ratios (HRs) and 95 % confidence intervals (95 % CI) for the association between cumulative social risk with deaths from all-cancers combined, tobacco-related cancers, and screening-detectable cancers.ResultsDeaths from all-cancers combined (P for trend = 0.001), tobacco-related cancers (P for trend = <0.001), and lung cancer (P for trend = 0.01) increased with an increasing number of social risk factors. As compared with adults with no social risk factors, those exposed to ≥3 social risk factors were at increased risk of deaths from all-cancers combined (HR = 1.8, 95 % CI = 1.3-2.4), tobacco-related cancers (HR = 2.6, 95 % CI: 1.6-4.0), and lung cancer (HR = 2.3, 95 % CI = 1.3-4.1).ConclusionsU.S. adults confronted by higher amounts of cumulative social risk appear to have increased mortality from all-cancers combined, tobacco-related cancers, and lung cancer. An enhanced understanding of the cumulative effect of social risk factors may be important for targeting interventions to address social disparities in cancer mortality.

Cumulative social risk and risk of death from cardiovascular diseases and all-causes

Mortality rates for cardiovascular diseases (CVD) have declinedsteadily over the past few decades in high-income countries. Thisdeclinehasbyfardisproportionatelyfavoredthosewithhigherincome,educational attainment, and social support or those who are membersof ethnic majority groups [1–7]. Few studies have examined the cumu-lative effects of multiple social risk factors on CVD mortality rates [8].Disparate exposure to multiple social risk factors may contribute tosocial inequalities in CVD mortality rates.We used data on 10,035 adults (age ≥ 30 years) with no history ofCVD, from the NHANES III Mortality Study (1988–1994 survey datalinked to2006mortalitydata), toassesstheprospectiveassociationbe-tween cumulative social risk and CVD deaths, b65-year-old mortality,and all-cause mortality. Linkage with the National Death Index alloweddefinition of CVD deaths as ICD-9 codes 390–459orICD-10codesI00-I99. Income was assessed using the poverty income ratio (ratio offamily income to the federal poverty level) dichotomized into below1.00 (below the official definition of poverty) vs. 1.00 or greater (incomeabove the poverty level). Education level was dichotomized into low(b12 years, representing b high school diploma) vs. high (≥12 years,representinghighschooldiploma,somecollege,orcollegedegree)levels.Self-reported race/ethnicity was classified into a minority group (non-Hispanic Black, Mexican-American and Other) vs. non-Hispanic White.Single-livingstatus (proxyfor social isolation/lowlevel of socialsupport)was classified into two groups, married/living as married vs. never mar-ried, widowed, divorced, or separated. Each of the four social risk factorswere assigned a score of 1 for their presence or 0 for absence and weresummed to create a cumulative social risk score (range 0 to 4). Cox pro-portional models were used to estimate hazard ratios (HR) and 95%confidence intervals (CI) for the association between cumulative socialrisk and mortality. We evaluated the contribution of biological risk fac-tors(bodymassindex[BMI], HbA1c,systolic blood pressure[SBP],cho-lesterol, triglycerides, C-reactive protein [CRP] and estimatedglomerular filtration rate [eGFR]) to the association between cumula-tive social risk and CVD deaths. We hypothesized that these biologicalfactorsareonthepathwayintheassociationbetweenexposuretosocialrisk factors and occurrence of CVD deaths, and thus are mediators of thisassociation.HbA1cwasmeasured usingaBio-RadDiamantionexchangehigh-performanceliquid chromatographysystem. Serumtotalcholester-ol and triglycerides were measured enzymatically by a Hitachi 704 Ana-lyzer. eGFR was based on the Modification of Diet in Renal Diseasestudy equation. Serum CRP was measured using the Behring latex-enhanced CRP assay.Atotalof 31.7%of adultsreportedatleastonesocialriskfactor;7.1%reported3 or more. Over a median14-yearfollow-up, there were 2604deaths (1386 in males and 1218 in females) including 924 deaths relatedto cardiovascular diseases. Table 1 shows the age-and sex-adjusted asso-ciationsofeachsocialriskfactorwithCVDdeaths, b65-year-oldmortality,and all-cause mortality. Ha zard ratios for CVD deaths, b65-year-old mor-tality and all-cause mortality signi ficantly increased with an increasingnumber of social risk factors and were greatest in those exposed to 3 ormore social risk factors compared with those with 0 (Table 1). Table 2shows the association between exposure to 3 or more social risk factorsand CVD deaths, as well as the contribution of biological risk factors tothis association. Biological risk factors accounted for 12% (95% CI: 4% to18%) of the association between exposure to 3 or more social risk factorsand CVD deaths.PreviousstudiesonsocialinequalitiesinCVDmortalityhavetypicallyoperationalized social disadvantage using single measures of socioeco-nomicstatus(e.g.manualoccupationalclass,loweducationlevel,lowin-come) or a composite of socioeconomic measures in several periodsthrough the life course [8]. However, summing the number of times anindividualhadbeeninalowersocioeconomiccategoryasaproxyforcu-mulative social disadvantage, may erroneously attribute CVD mortalityto risks associated with the accumulation of only socioeconomic

Social and behavioral risk factors for obesity in early childhood.

Although multiple social and behavioral risk factors associated with obesity co-occur among young children, most studies have examined them separately. The purpose of this study was to examine the relationship between social risk factors, behavioral problems, health behaviors, and obesity among preschoolers in the Fragile Families and Child Wellbeing Study (N = 1589). A cumulative social risk score was created by summing maternal reports of intimate partner violence, food insecurity, housing insecurity, maternal depressive symptoms, maternal substance use, and father's incarceration, obtained when the child was 3 years old. Mothers reported on the child's internalizing and externalizing behaviors with the Child Behavior Checklist at age 5 years. Mothers also reported on hours the child spent watching television and sleeping as well as servings of soda or juice drinks the child consumed per day. Child height and weight were measured at age 5 years. Obesity was defined as body mass index ≥ 95th percentile. In regression analyses adjusted for health behaviors, behavioral problems, and sociodemographic factors, cumulative social risk was associated with obesity among girls. Externalizing behavioral problems were associated with obesity among girls (prevalence ratios [PRs], 1.5; 95% confidence interval [CI], 1.2-1.7) and boys (PR, 1.3; 95% CI, 1.1-1.6). Short sleep duration was also associated with obesity among girls (PR, 1.2; 95% CI, 1.0-1.4) and boys (PR, 1.3; 95% CI, 1.1-1.5) even after adjusting for behavioral problems and social risk factors. Watching more than 2 hours of television per day was associated with obesity among boys (PR 1.5; 95% CI, 1.2 to 1.9) but not girls. Co-occurring social and behavioral risk factors are associated with obesity among 5-year-old children.

The Key Role of Psychosocial Risk on Therapeutic Outcome in Obese Children and Adolescents. Results from a Longitudinal Multicenter Study

Objective: Childhood obesity is high on the global public health agenda. Although risk factors are well known, the influence of social risk on the therapeutic outcome of lifestyle intervention is poorly examined. This study aims to investigate the influence of migration background, low education, and parental unemployment. Methods: 62,147 patients participated in multidimensional lifestyle intervention programs in 179 pediatric obesity centers. Data were collected using standardized software for longitudinal multicenter documentation. 12,305 (19.8%) attended care for 6-24 months, undergoing an intensive therapy period and subsequent follow-ups for up to 3 years. A cumulative social risk score was calculated based on different risk indicators. Results: Migration background, low education, and parental employment significantly influenced the outcome of lifestyle intervention. The observed BMI-SDS reduction was significantly higher in the subgroup with low social risks factors (Δ BMI-SDS -0.19) compared to those presenting moderate (Δ BMI-SDS -0.14) and high social risk (Δ BMI-SDS -0.11). Conclusion: Our data underline the effect of children's social setting on the outcome of multidimensional lifestyle intervention. The presence of a high social risk burden is a negative predictor for successful weight loss. Specific therapeutic programs need to be developed for disadvantaged children and adolescents.