Lifestyle factors as mediators of area-level socio-economic differentials in cardiovascular disease risk factors. The Troms? Study

• Introduction: Cardiovascular disease (CVD) is a leading cause of death and disability and living in areas with low socio-economic status (SES) is associated with increased risk of CVD. Lifestyle factors such as smoking, physical inactivity, an unhealthy diet and harmful alcohol use are main risk factors that contribute to other modifiable risk factors, such as hypertension, raised blood cholesterol, obesity, and diabetes. The potential impact of area -level socio-economic status (ASES) on metabolic CVD risk factors via lifestyle behaviors independent of indi-vidual SES has not been investigated previously.Aims: To estimate associations of ASES with CVD risk factors and the mediating role of lifestyle behaviors in-dependent of individual-level SES.Methods: In this cross-sectional study, we included 19,415 participants (52% women) from the seventh survey of the Tromso Study (2015-2016) (Tromso7). The exposure variable ASES was created by aggregating individual -level SES variables (education, income, housing ownership) at the geographical subdivision level. Individual -level SES data and geographical subdivision of Tromso municipality (36 areas) were obtained from Statistics Norway. Variables from questionnaires and clinical examinations obtained from Tromso7 were used as mediators (smoking, snuff, alcohol, and physical activity), while the outcome variables were body mass index (BMI), total/ high-density lipoprotein (HDL) cholesterol ratio, waist circumference, hypertension, diabetes. Mediation and mediated moderation analysis were performed with age as a moderator, stratified by sex.Results: ASES was significantly associated with all outcome variables. CVD risk factor level declined with an increase in ASES. These associations were mediated by differences in smoking habits, alcohol use and physical activity. The associations of ASES with total/HDL cholesterol ratio and waist circumference (women) were moderated by age, and the moderating effects were mediated by smoking and physical activity in both sexes. The largest mediated effects were seen in the associations of ASES with total/HDL cholesterol ratio, with the me-diators accounting for 43% of the observed effects.Conclusions: Living in lower SES areas is associated with increased CVD risk due to unhealthy lifestyle behaviors, such as smoking, alcohol use and physical inactivity. These associations were stronger in women and among older participants.

Ämnesord

MEDICIN OCH HÄLSOVETENSKAP  -- Hälsovetenskap -- Arbetsmedicin och miljömedicin (hsv//swe)

MEDICAL AND HEALTH SCIENCES  -- Health Sciences -- Occupational Health and Environmental Health (hsv//eng)

Nyckelord

Area level socio-economic status

Cardiovascular disease

Risk factors

Mediation

physical-activity level

social-class

neighborhood

health

deprivation

mortality

residence

population

countries

poverty

Public

Environmental & Occupational Health

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