Associations of Socioeconomic Status and Healthy Lifestyle With Incidence of Dyslipidemia: A Prospective Chinese Governmental Employee Cohort Study

Abstract

ObjectiveThe purpose of the study was to test whether primary lifestyles mediate associations of SES with incidence of dyslipidemia and to explore interaction relations of lifestyles and SES with incidence of dyslipidemia.MethodsWe included 9,901 individuals at baseline from January 2018 to November 2019, and incidence data were updated to 31 December 2020. Dyslipidemia was defined as total cholesterol (TC) 6.2 mmol/L TC ≥ or triglycerides (TG) ≥2.3 mmol/L or low-density lipoprotein cholesterol (LDL-C) ≥4.1 mmol/L or high-density lipoprotein cholesterol (HDL-C) <1.0 mmol/L; or physician diagnosed dyslipidemia or lipid-lowering drugs use. Lifestyles, socioeconomic factors, and personal characteristics were collected by a questionnaire. A latent class analysis based on education, family income, and occupational position was used to assess the SES. Lifestyle score was calculated using cigarette smoking, alcohol consumption, physical activity, and diet. Cox proportional hazard models and multivariate analyses were used to explore the associations. The mediation effect was evaluated using bootstrap method.ResultsParticipant mean age was 36.5 years (SD = 0.11). The cumulative incidence of dyslipidemia was 11.0% over a mean follow-up of 13.4 months. Compared with participants of high SES, those with low SES had higher risk of incidence of dyslipidemia [hazard ratio 1.32, 95% confidence interval (CI): 1.01–1.73], after adjusting for lifestyle scores and other covariates. The proportion mediated by lifestyles was 5.41% (95%CI: 4.17–7.11). A significant additive interaction was found between lifestyles and SES, whereas association between lifestyle and incidence of dyslipidemia was stronger among those of high SES. Additionally, individuals with low SES and no or one healthy lifestyle behavior had a higher risk of developing dyslipidemia than those with high SES and 3 or 4 healthy lifestyles.ConclusionUnhealthy lifestyles play a small moderating role in socioeconomic inequity in incidence of dyslipidemia among Chinese governmental employees, suggesting that promoting healthy lifestyles alone may not significantly reduce socioeconomic inequalities in health, and measures to address other social determinants of health should also be considered alongside.

Higher Socio-Economic Status (SES) is associated with the Traditional Risk Factors of Cardiovascular Diseases; Results of MASHAD Cohort Study

“…Lower SES group had slightly more participants with dyslipidemia, however, the differences between SES groups in terms of dyslipidemia prevalence was not remarkable. Li et al showed that low SES (based on income, education, and occupation) is associated with higher rates of dyslipidemia and stated that people with low SES adopt unhealthy lifestyles such as inactivity, smoking, and alcohol consumption and therefore they are at higher risk for dyslipidemia (47). On the other hand, Nam et al also reported that men who have higher levels of educational attainment and higher income are at more risk for dyslipidemia, however, educated women and women with higher income were at lower risk for dyslipidemia (48).…”

Prevalence and population attributable fractions of potentially modifiable risk factors for dementia in Canada: a cross-sectional analysis of the Canadian Longitudinal Study on Aging

“…The differences between the magnitude of the weighted multiplicative and additive combined PAFs are meaningful and ultimately rooted in strong assumptions of the form of interactivity of risk factors within individuals. Interactions between multiple risk factors for dementia is highly complex and the form of the interactions likely vary by each distinct set of risk factors present 26,30,31 . While we believe these combined PAF estimates are useful benchmarks, we have limited evidence on how multiple modifiable risk factors for dementia interact with each other and more research on dementia risk factor interaction could improve future estimation of their combined impact.…”

Barriers and shortcomings in access to cardiovascular management and prevention for familial hypercholesterolemia during the COVID‐19 pandemic

“…As a result, low‐socioeconomic status and issues with health literacy are major limiting factors in accessing nonpharmacological care, such as lifestyle modifications to control comorbidities and often are presented with fewer options. Low SES was linked with an increased incidence of dyslipidemia due to the established literature indicating a higher propensity of unhealthy dietary behaviors imposed by limited financial freedom 59,60 . Financial security is often an influential component for baseline testing, as prior screening is significantly disproportionate in these demographics 61 …”

“…Low SES was linked with an increased incidence of dyslipidemia due to the established literature indicating a higher propensity of unhealthy dietary behaviors imposed by limited financial freedom. 59,60 Financial security is often an influential component for baseline testing, as prior screening is significantly disproportionate in these demographics. 61 FH patients require specialist input for long-term management of CV risk which can impact financially disadvantaged individuals.…”