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Unhealthy Lifestyle Only Explains Part of Health Disparities of Poor

WEDNESDAY, April 28, 2021 -- Adults with low socioeconomic status (SES) and the least healthy lifestyle have a twofold higher risk for mortality and more than a 3.5-fold increased risk for incident cardiovascular disease (CVD) compared with adults with high SES and the healthiest lifestyles, according to a study published online April 14 in The BMJ.

Yan-Bo Zhang, from the Huazhong University of Science and Technology in Wuhan, China, and colleagues used data from the U.S. National Health and Nutrition Examination Survey (NHANES; 1988 to 1994 and 1999 to 2014; including 44,462 adults aged ≥20 years) and the U.K. Biobank (including 399,537 adults aged 37 to 73 years) to examine whether overall lifestyles mediate associations of SES with mortality and incident CVD.

The researchers found that among adults of low SES, the age-adjusted risk for death was 22.5 per 1,000 person-years in NHANES and 7.4 per 1,000 person-years in the U.K. Biobank, while the age-adjusted risk for CVD was 2.5 per 1,000 person-years in the U.K. Biobank. For adults of high SES, the corresponding risks were 11.4, 3.3, and 1.4 per 1,000 person years. Adults with low SES had higher risks for all-cause mortality (hazard ratio [HR], 2.13 in NHANES and 1.96 in U.K. Biobank), CVD mortality (HR, 2.25), and incident CVD (HR, 1.65) in the U.K. Biobank compared with adults of high SES. The proportions mediated by lifestyle were 12.3, 4.0, 3.0, and 3.7 percent, respectively. Adults with low SES and no or one healthy lifestyle factor had higher risks for all-cause mortality (HR, 3.53 in NHANES; HR, 2.65 in U.K. Biobank), CVD mortality (HR, 2.65), and incident CVD (HR, 2.09) in the U.K. Biobank compared with adults with high SES and three or four healthy lifestyle factors.

"Healthy lifestyle promotion alone might not substantially reduce the socioeconomic inequity in health, and other measures tackling social determinants of health are warranted," the authors write.

Abstract/Full Text

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