The effect of socioeconomic deprivation on the association between an extended measurement of unhealthy lifestyle factors and health outcomes: a prospective analysis of the UK Biobank cohort

Abstract

Background Combinations of lifestyle factors interact to increase mortality. Combinations of traditional factors such as smoking and alcohol are well described, but the additional effects of emerging factors such as television viewing time are not. The effect of socioeconomic deprivation on these extended lifestyle risks also remains unclear. We aimed to examine whether deprivation modifies the association between an extended score of lifestyle-related risk factors and health outcomes. Methods Data for this prospective analysis were sourced from the UK Biobank, a prospective population-based cohort study. We assigned all participants an extended lifestyle score, with 1 point for each unhealthy lifestyle factor (incorporating sleep duration and high television viewing time, in addition to smoking, excessive alcohol, poor diet [low intake of oily fish or fruits and vegetables, and high intake of red meat or processed meats], and low physical activity), categorised as most healthy (score 0-2), moderately healthy (score 3-5), or least healthy (score 6-9). Cox proportional hazards models were used to examine the association between lifestyle score and health outcomes (all-cause mortality and cardiovascular disease mortality and incidence), and whether this association was modified by deprivation. All analyses were landmark analyses, in which participants were excluded if they had an event (death or cardiovascular disease event) within 2 years of recruitment. Participants with non-communicable diseases (except hypertension) and missing covariate data were excluded from analyses. Participants were also excluded if they reported implausible values for physical activity, sleep duration, and total screen time. All analyses were adjusted for age, sex, ethnicity, month of assessment, history of hypertension, systolic blood pressure, medication for hypercholesterolaemia or hypertension, and body-mass index categories. Findings 328 594 participants aged 40-69 years were included in the study, with a mean follow-up period of 4•9 years (SD 0•83) after the landmark period for all-cause and cardiovascular disease mortality, and 4•1 years (0•81) for cardiovascular disease incidence. In the least deprived quintile, the adjusted hazard ratio (HR) in the least healthy lifestyle category, compared with the most healthy category, was 1•65 (95% CI 1•25-2•19) for all-cause mortality, 1•93 (1•16-3•20) for cardiovascular disease mortality, and 1•29 (1•10-1•52) for cardiovascular disease incidence. Equivalent HRs in the most deprived quintile were 2•47 (95% CI 2•04-3•00), 3•36 (2•36-4•76), and 1•41 (1•25-1•60), respectively. The HR for trend for one increment change towards least healthy in the least deprived quintile compared with that in the most deprived quintile was 1•25 (95% CI 1•12-1•39) versus 1•55 (1•40-1•70) for all-cause mortality, 1•30 (1•05-1•61) versus 1•83 (1•54-2•18) for cardiovascular disease mortality, and 1•10 (1•04-1•17) versus 1•16 (1•09-1•23) for cardiovascular disease incidence. A significant interaction was found betwe...

Socio-economic disparities in the association of diet quality and type 2 diabetes incidence in the Dutch Lifelines cohort

“…This is expected to happen more often in low SES, where more concurrent risk factors exist. The results of the previously discussed UK Biobank study [26] are in line with this reasoning, as this study, investigating a combined lifestyle score instead of a single risk factor, did not find an elevated risk of cardiovascular disease and mortality for the most healthy lifestyle category in low SES compared to high SES individuals. This indicates that when multiple risk factors are targeted, low SES individuals with a healthy lifestyle are at similar health risk as their high SES peers with a comparable lifestyle.…”

“…A few previous studies investigated the possibility of socio-economic disparities in associations of lifestyle factors with other health outcomes, although not for diet and diabetes. In the UK Biobank, an extended score of unhealthy lifestyle factors had a much stronger association with cardiovascular and all-cause mortality in lower SES groups [26]. In the Scottish Health Surveys, the risk of morbidity or mortality from high alcohol intake was greater for drinkers in deprived areas [27].…”

Socioeconomic deprivation and mortality after emergency laparotomy: an observational epidemiological study

“…9,10 Socioeconomic deprivation can also exacerbate the effect that lifestyle-related risk factors have on poor health and mortality. 11 Insecurity or lack of control over finances, work, or housing, coupled with barriers to maintaining a cohesive social support network, can all have negative effects on health. 12e14 All of these mechanisms could result in differences in the types of pathology with which patients in different socioeconomic groups present, or the age at which certain conditions develop.…”

Empirical Evidences for Urban Influences on Public Health in Hamburg

“…Additionally, confounders such as gender, age or income, and behavioral variables such as smoking status, alcohol consumption, or physical activity have to be taken into account as effect-modifying variables [34,35,47,73]. Access to healthcare and social support play a role in specific health outcomes and should be considered in studies as well [8,[74][75][76].…”