Among low (SES) adults, the age-adjusted risk of all-cause mortality is 22.5 per 1000 person-years in the US and 7.4 in the UK.
Low SES is associated with significantly higher risks of all-cause mortality and (CVD) compared to high SES.
In the UK Biobank, the age-adjusted risk of CVD was 2.5 per 1000 person-years for low SES adults.
A small proportion of the socioeconomic inequity in health (12.3% for mortality and 4.0% for CVD mortality) may be mediated by unhealthy lifestyles.
No significant interaction between lifestyle and SES was found in the US NHANES, while stronger associations were observed in the UK Biobank.
Adults of low SES with fewer healthy lifestyle factors have higher risks of mortality and CVD compared to those of high SES with more healthy factors.
AI simplified
OBJECTIVE: To examine whether overall lifestyles mediate associations of (SES) with mortality and incident (CVD) and the extent of interaction or joint relations of lifestyles and SES with health outcomes.
DESIGN: Population based cohort study.
SETTING: US National Health and Nutrition Examination Survey (US NHANES, 1988-94 and 1999-2014) and UK Biobank.
PARTICIPANTS: 44 462 US adults aged 20 years or older and 399 537 UK adults aged 37-73 years.
EXPOSURES: SES was derived by latent class analysis using family income, occupation or employment status, education level, and health insurance (US NHANES only), and three levels (low, medium, and high) were defined according to item response probabilities. A healthy lifestyle score was constructed using information on never smoking, no heavy alcohol consumption (women ≤1 drink/day; men ≤2 drinks/day; one drink contains 14 g of ethanol in the US and 8 g in the UK), top third of physical activity, and higher dietary quality.
MAIN OUTCOME MEASURES: All cause mortality was the primary outcome in both studies, and CVD mortality and morbidity in UK Biobank, which were obtained through linkage to registries.
RESULTS: US NHANES documented 8906 deaths over a mean follow-up of 11.2 years, and UK Biobank documented 22 309 deaths and 6903 incident CVD cases over a mean follow-up of 8.8-11.0 years. Among adults of low SES, age adjusted risk of death was 22.5 (95% confidence interval 21.7 to 23.3) and 7.4 (7.3 to 7.6) per 1000 person years in US NHANES and UK Biobank, respectively, and age adjusted risk of CVD was 2.5 (2.4 to 2.6) per 1000 person years in UK Biobank. The corresponding risks among adults of high SES were 11.4 (10.6 to 12.1), 3.3 (3.1 to 3.5), and 1.4 (1.3 to 1.5) per 1000 person years. Compared with adults of high SES, those of low SES had higher risks of all cause mortality (hazard ratio 2.13, 95% confidence interval 1.90 to 2.38 in US NHANES; 1.96, 1.87 to 2.06 in UK Biobank), CVD mortality (2.25, 2.00 to 2.53), and incident CVD (1.65, 1.52 to 1.79) in UK Biobank, and the proportions mediated by lifestyle were 12.3% (10.7% to 13.9%), 4.0% (3.5% to 4.4%), 3.0% (2.5% to 3.6%), and 3.7% (3.1% to 4.5%), respectively. No significant interaction was observed between lifestyle and SES in US NHANES, whereas associations between lifestyle and outcomes were stronger among those of low SES in UK Biobank. Compared with adults of high SES and three or four healthy lifestyle factors, those with low SES and no or one healthy lifestyle factor had higher risks of all cause mortality (3.53, 3.01 to 4.14 in US NHANES; 2.65, 2.39 to 2.94 in UK Biobank), CVD mortality (2.65, 2.09 to 3.38), and incident CVD (2.09, 1.78 to 2.46) in UK Biobank.
CONCLUSIONS: Unhealthy lifestyles mediated a small proportion of the socioeconomic inequity in health in both US and UK adults; therefore, healthy lifestyle promotion alone might not substantially reduce the socioeconomic inequity in health, and other measures tackling social determinants of health are warranted. Nevertheless, healthy lifestyles were associated with lower mortality and CVD risk in different SES subgroups, supporting an important role of healthy lifestyles in reducing disease burden.
Key numbers
2.13
Increase in All-Cause Mortality Risk
Hazard ratio for all-cause mortality in US NHANES comparing low vs. high
12.3%
Mediation Proportion by Lifestyle
Proportion of all-cause mortality association mediated by lifestyle in US NHANES
2.25
Mortality Risk Increase
Hazard ratio for mortality in UK Biobank comparing low vs. high
Full Text
We can’t show the full text here under this license. Use the link below to read it at the source.
