Separate and combined effects of individual and neighbourhood socio-economic disadvantage on health-related lifestyle risk factors: a multilevel analysis

Zhu, Yinjie; Duan, Ming-Jie; Riphagen, Ineke J.; Minovíc, Isidor; Mierau, Jochen O.; Carrero, Juan-Jesús; Bakker, Stephan J. L.; Navis, Gerjan; Dekker, Louise H.

doi:10.1093/ije/dyab079

Cited by 19 publications

(21 citation statements)

References 39 publications

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“…Several epidemiological studies have shown that differences in socio-economic and demographic characteristics carry a considerable impact on lifestyle risk factors [7]. For instance, individuals from low socio-economic status tend to have unhealthier lifestyle, such as unhealthy diets and decreased time spent on physical activity [8]. Moreover, differences within individual socio-economic status (SES) exist.…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…Poor health and diet quality are associated with individuals pertaining to a low socio-economic status (SES), as compared to those from middle or high SES [7,8]. Other socio-demographic characteristics can be associated with diet quality, such as the place of birth, education background, race/ethnicity and family aspects (such as the number of kids and their age) [8]. Evidence from LA countries has shown an increased intake of discretionary food items, such as those rich in saturated fats, added sugars and sodium and inadequate intakes, as compared with recommended levels of fruit and vegetables, milk and dairy products and whole grains [9].…”

Section: Introductionmentioning

confidence: 99%

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Socioeconomic Status Impact on Diet Quality and Body Mass Index in Eight Latin American Countries: ELANS Study Results

et al. 2021

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Poor health and diet quality are associated with living within a low socioeconomic status (SES). This study aimed to investigate the impact of SES on diet quality and body mass index in Latin America. Data from the “Latin American Health and Nutrition Study (ELANS)”, a multi-country, population-based study of 9218 participants, were used. Dietary intake was collected through two 24 h recalls from participants of Argentina, Brazil, Chile, Colombia, Costa Rica, Ecuador, Peru and Venezuela. Diet quality was assessed using the dietary quality score (DQS), the dietary diversity score (DDS) and the nutrients adequacy ratio (NAR). Chi-squared and multivariate-variance analyses were used to estimate possible associations. We found that participants from the low SES consumed less fruits, vegetables, whole grains, fiber and fish and seafood and more legumes than those in the high SES. Also, the diet quality level, assessed by DQS, DDS and NAR mean, increased with SES. Women in the low SES also showed a larger prevalence of abdominal obesity and excess weight than those in the middle and high SES. Health policies and behavioral-change strategies should be addressed to reduce the impact of socioeconomic factors on diet quality and body weight, with gender as an additional level of vulnerability.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Socioeconomic Status Impact on Diet Quality and Body Mass Index in Eight Latin American Countries: ELANS Study Results

et al. 2021

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“…It is noteworthy that we observed direct effects of education on obesity status, as well as of income, diet quality, and smoking on type 2 diabetes. A cautious interpretation is warranted, as it cannot be excluded that the observed direct effects are in fact due to other, but unobserved, existing mediators or confounders, such as neighborhood deprivation (distal environmental factors) and chronic inflammation (proximal clinical biomarkers) (Dekker et al, 2020;Kivimäki et al, 2018;Zhu et al, 2021).…”

Section: Table 1 Baseline Characteristics By Diabetes Statusmentioning

confidence: 99%

“…More specifically, obesity and abnormal blood lipids are largely attributed to unhealthy lifestyle behaviors, whereas all are strongly influenced by socioeconomic status. These factors, in turn, collectively form several hypothesized intersecting pathways that lead to the eventual development of type 2 diabetes (Duan et al, 2021;Foster et al, 2018;Maty et al, 2005;Vinke et al, 2020;Zhu et al, 2021). Socioeconomic status is thus considered the overarching upstream determinant of type 2 diabetes for its significant effects on proximal (or downstream) risk factors.…”

Section: Introductionmentioning

confidence: 99%

Using Structural Equation Modeling to Untangle Pathways of Risk Factors Associated with Incident Type 2 Diabetes: the Lifelines Cohort Study

et al. 2022

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Risk factors for type 2 diabetes are multifaceted and interrelated. Unraveling the complex pathways of modifiable risk factors related to incident type 2 diabetes will help prioritize prevention targets. The current analysis extended a previously proposed conceptual model by Bardenheier et al. (Diabetes Care, 36(9), 2655–2662, 2013) on prediabetes with a cross-sectional design. The model described the pathways of four aspects of modifiable risk factors in relation to incident type 2 diabetes, including socioeconomic status (income and education); lifestyle behaviors (diet quality, physical activity, TV watching, smoking, risk drinking, and unhealthy sleep duration); clinical markers (HDL-cholesterol, triglycerides, BMI, and waist circumference); and blood pressure. We performed structural equation modeling to test this conceptual model using a prospective population-based sample of 68,649 participants (35–80 years) from the Lifelines cohort study. During a median follow-up of 41 months, 1124 new cases of type 2 diabetes were identified (incidence 1.6%). The best-fitting model indicated that among all modifiable risk factors included, waist circumference had the biggest direct effect on type 2 diabetes (standardized β-coefficient 0.214), followed by HDL-cholesterol (standardized β-coefficient − 0.134). Less TV watching and more physical activity were found to play an important role in improving clinical markers that were directly associated with type 2 diabetes. Education had the biggest positive effects on all lifestyle behaviors except for unhealthy sleep duration. Our analysis provides evidence to support that structural equation modeling enables a holistic assessment of the interplay of type 2 diabetes risk factors, which not only allows the estimation of their total effects but also prioritization of prevention targets. Regarding the current guideline for diabetes prevention, waist management in addition to BMI control (clinical level), as well as less TV watching in addition to more physical activity (behavioral level), may provide additional public health benefits. Better education would be the main societal goal for the prevention of type 2 diabetes.

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Neighborhood Socioeconomic Disadvantage Across the Life Course and Premature Mortality

Lawrence,

Kucharska-Newton,

Magnani

et al. 2024

JAMA Netw Open

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ImportanceThere are consistent data demonstrating that socioeconomic disadvantage is associated with risk of premature mortality, but research on the relationship between neighborhood socioeconomic factors and premature mortality is limited. Most studies evaluating the association between neighborhood socioeconomic status (SES) and mortality have used a single assessment of SES during middle to older adulthood, thereby not considering the contribution of early life neighborhood SES.ObjectiveTo investigate the association of life course neighborhood SES and premature mortality.Design, Setting, and ParticipantsThis cohort study included Black and White participants of the multicenter Atherosclerosis Risk in Communities Study, a multicenter study conducted in 4 US communities: Washington County, Maryland; Forsyth County, North Carolina; Jackson, Mississippi; and the northwestern suburbs of Minneapolis, Minnesota. Participants were followed up for a mean (SD) of 18.8 (5.7) years (1996-2020). Statistical analysis was performed from March 2023 through May 2024.ExposureParticipants’ residential addresses during childhood, young adulthood, and middle adulthood were linked with US Census–based socioeconomic indicators to create summary neighborhood SES scores for each of these life epochs. Neighborhood SES scores were categorized into distribution-based tertiles.Main Outcomes and MeasuresPremature death was defined as all-cause mortality occurring before age 75 years. Multivariable-adjusted Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% CIs.ResultsAmong 12 610 study participants, the mean (SD) age at baseline was 62.6 (5.6) years; 3181 (25.2%) were Black and 9429 (74.8%) were White; and 7222 (57.3%) were women. The lowest, compared with the highest tertile, of neighborhood SES score in middle adulthood was associated with higher risk of premature mortality (HR, 1.28; 95% CI, 1.07-1.54). Similar associations were observed for neighborhood SES in young adulthood among women (HR, 1.25; 95% CI, 1.00-1.56) and neighborhood SES in childhood among White participants (HR, 1.25; 95% CI, 1.01-1.56). Participants whose neighborhood SES remained low from young to middle adulthood had an increased premature mortality risk compared with those whose neighborhood SES remained high (HR, 1.25; 95% CI, 1.05-1.49).Conclusions and RelevanceIn this study, low neighborhood SES was associated with premature mortality. The risk of premature mortality was greatest among individuals experiencing persistently low neighborhood SES from young to middle adulthood. Place-based interventions that target neighborhood social determinants of health should be designed from a life course perspective that accounts for early-life socioeconomic inequality.

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Separate and combined effects of individual and neighbourhood socio-economic disadvantage on health-related lifestyle risk factors: a multilevel analysis

Cited by 19 publications

References 39 publications

Socioeconomic Status Impact on Diet Quality and Body Mass Index in Eight Latin American Countries: ELANS Study Results

Socioeconomic Status Impact on Diet Quality and Body Mass Index in Eight Latin American Countries: ELANS Study Results

Using Structural Equation Modeling to Untangle Pathways of Risk Factors Associated with Incident Type 2 Diabetes: the Lifelines Cohort Study

Neighborhood Socioeconomic Disadvantage Across the Life Course and Premature Mortality

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