Understanding the influence of socioeconomic status on the association between combinations of lifestyle factors and adverse health outcomes: a systematic review protocol

Foster, H. M.E. , Polz, P., Mair, F. S. , Gill, J. M.R. and O'Donnell, C. A. (2021) Understanding the influence of socioeconomic status on the association between combinations of lifestyle factors and adverse health outcomes: a systematic review protocol. BMJ Open, 11, e042212. (doi: 10.1136/bmjopen-2020-042212) (PMID:34045211) (PMCID:PMC8162079)

Abstract

Introduction Combinations of unhealthy lifestyle factors are strongly associated with mortality, cardiovascular disease (CVD) and cancer. It is unclear how socioeconomic status (SES) affects those associations. Lower SES groups may be disproportionately vulnerable to the effects of unhealthy lifestyle factors compared with higher SES groups via interactions with other factors associated with low SES (eg, stress) or via accelerated biological ageing. This systematic review aims to synthesise studies that examine how SES moderates the association between lifestyle factor combinations and adverse health outcomes. Greater understanding of how lifestyle risk varies across socioeconomic spectra could reduce adverse health by (1) identifying novel high-risk groups or targets for future interventions and (2) informing research, policy and interventions that aim to support healthy lifestyles in socioeconomically deprived communities. Methods and analysis Three databases will be searched (PubMed, EMBASE, CINAHL) from inception to March 2020. Reference lists, citations and grey literature will also be searched. Inclusion criteria are: (1) prospective cohort studies; (2) investigations of two key exposures: (a) lifestyle factor combinations of at least three lifestyle factors (eg, smoking, physical activity and diet) and (b) SES (eg, income, education or poverty index); (3) an assessment of the impact of SES on the association between combinations of unhealthy lifestyle factors and health outcomes; (4) at least one outcome from—mortality (all cause, CVD and cancer), CVD or cancer incidence. Two independent reviewers will screen titles, abstracts and full texts of included studies. Data extraction will focus on cohort characteristics, exposures, direction and magnitude of SES effects, methods and quality (via Newcastle-Ottawa Scale). If appropriate, a meta-analysis, pooling the effects of SES, will be performed. Alternatively, a synthesis without meta-analysis will be conducted. Ethics and dissemination Ethical approval is not required. Results will be disseminated via peer-reviewed publication, professional networks, social media and conference presentations. PROSPERO registration number CRD42020172588.

• Item Type: Articles
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Gill, Professor Jason and Foster, Dr Hamish and O'Donnell, Professor Kate and Mair, Professor Frances
• Authors: Foster, H. M.E., Polz, P., Mair, F. S., Gill, J. M.R., and O'Donnell, C. A.
• College/School: College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health; College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > General Practice and Primary Care
• Journal Name: BMJ Open
• Publisher: BMJ Publishing Group
• ISSN: 2044-6055
• ISSN (Online): 2044-6055
• Published Online: 27 May 2021
• Copyright Holders: Copyright © Author(s) (or their employer(s)) 2021
• First Published: First published in BMJ Open 11: e042212
• Publisher Policy: Reproduced under a Creative Commons licence

Project Code	Award No	Project Name	Principal Investigator	Funder's Name	Funder Ref	Lead Dept
305234		Using Big-data to Understand the Interactions between Lifestyle, Deprivation and health outcomes to support Intervention Development in deprived areas (BUILD): a mixed methods programme	Catherine O'Donnell	Medical Research Council (MRC)	MR/T001585?1	HW - General Practice and Primary Care