The influence of socioeconomic status on the association between unhealthy lifestyle factors and adverse health outcomes: A systematic review

Foster, H. M.E. , Polz, P., Gill, J. M.R. , Celis-Morales, C. , Mair, F. S. and O'Donnell, C. A. (2023) The influence of socioeconomic status on the association between unhealthy lifestyle factors and adverse health outcomes: A systematic review. Wellcome Open Research, 8, 55. (doi: 10.12688/wellcomeopenres.18708.2)

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Abstract

Background Combinations of lifestyle factors (LFs) and socioeconomic status (SES) are independently associated with cardiovascular disease (CVD), cancer, and mortality. Less advantaged SES groups may be disproportionately vulnerable to unhealthy LFs but interactions between LFs and SES remain poorly understood. This review aimed to synthesise the available evidence for whether and how SES modifies associations between combinations of LFs and adverse health outcomes. Methods Systematic review of studies that examine associations between combinations of >3 LFs (eg.smoking/physical activity/diet) and health outcomes and report data on SES (eg.income/education/poverty-index) influences on associations. Databases (PubMed/EMBASE/CINAHL), references, forward citations, and grey-literature were searched from inception to December 2021. Eligibility criteria were analyses of prospective adult cohorts that examined all-cause mortality or CVD/cancer mortality/incidence. Results Six studies (n=42,467–399,537; 46.5–56.8 years old; 54.6–59.3% women) of five cohorts were included. All examined all-cause mortality; three assessed CVD/cancer outcomes. Four studies observed multiplicative interactions between LFs and SES, but in opposing directions. Two studies tested for additive interactions; interactions were observed in one cohort (UK Biobank) and not in another (National Health and Nutrition Examination Survey (NHANES)). All-cause mortality HRs (95% confidence intervals) for unhealthy LFs (versus healthy LFs) from the most advantaged SES groups ranged from 0.68 (0.32–1.45) to 4.17 (2.27–7.69). Equivalent estimates from the least advantaged ranged from 1.30 (1.13–1.50) to 4.00 (2.22–7.14). In 19 analyses (including sensitivity analyses) of joint associations between LFs, SES, and all-cause mortality, highest all-cause mortality was observed in the unhealthiest LF-least advantaged suggesting an additive effect. Conclusions Limited and heterogenous literature suggests that the influence of SES on associations between combinations of unhealthy LFs and adverse health could be additive but remains unclear. Additional prospective analyses would help clarify whether SES modifies associations between combinations of unhealthy LFs and health outcomes.

Item Type:Articles
Additional Information:Version 2; peer review: 2 approved, 1 approved with reservations. This work was supported by Wellcome [223499; to FM]; and a Medical Research Council Clinical Research Training Fellowship [MR/T001585/1; to HF] entitled 'Understanding interactions between lifestyle and deprivation to support policy and intervention development'.
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Foster, Dr Hamish and Celis, Dr Carlos and Gill, Professor Jason and Mair, Professor Frances and O'Donnell, Professor Kate
Creator Roles:
Foster, H. M.E.Conceptualization, Data curation, Formal analysis, Funding acquisition, Investigation, Methodology, Project administration, Resources, Software, Validation, Visualization, Writing – original draft, Writing – review and editing
Gill, J. M.R.Conceptualization, Formal analysis, Investigation, Methodology, Supervision, Validation, Writing – review and editing
Celis-Morales, C.Conceptualization, Formal analysis, Investigation, Methodology, Writing – review and editing
Mair, F. S.Conceptualization, Formal analysis, Investigation, Methodology, Project administration, Supervision, Writing – review and editing
O'Donnell, C. A.Conceptualization, Formal analysis, Investigation, Methodology, Project administration, Supervision, Validation, Writing – review and editing
Authors: Foster, H. M.E., Polz, P., Gill, J. M.R., Celis-Morales, C., Mair, F. S., 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:Wellcome Open Research
Publisher:F1000Research
ISSN:2398-502X
ISSN (Online):2398-502X
Copyright Holders:Copyright © 2023 Foster HME et al.
First Published:First published in Wellcome Open Research 8: 55
Publisher Policy:Reproduced under a Creative Commons License

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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
305234Using Big-data to Understand the Interactions between Lifestyle, Deprivation and health outcomes to support Intervention Development in deprived areas (BUILD): a mixed methods programmeCatherine O'DonnellMedical Research Council (MRC)MR/T001585?1HW - General Practice and Primary Care