Foster Hamish M E, Polz Peter, Gill Jason M R, Celis-Morales Carlos, Mair Frances S, O'Donnell Catherine A
General Practice and Primary Care, School of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, Scotland, G12 9LX, UK.
School of Cardiovascular and Metabolic Health, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, Scoland, G12 8TA, UK.
Wellcome Open Res. 2023 Dec 8;8:55. doi: 10.12688/wellcomeopenres.18708.2. eCollection 2023.
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.
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.
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.
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.
Protocol is registered with PROSPERO (CRD42020172588;25 June 2020).
生活方式因素（LFs）与社会经济地位（SES）的组合分别与心血管疾病（CVD）、癌症和死亡率相关。社会经济地位较低的群体可能更容易受到不健康生活方式因素的影响，但生活方式因素与社会经济地位之间的相互作用仍知之甚少。本综述旨在综合现有证据，探讨社会经济地位是否以及如何改变生活方式因素组合与不良健康结局之间的关联。
系统回顾研究生活方式因素组合（如吸烟/体育活动/饮食）与健康结局之间的关联，并报告社会经济地位（如收入/教育/贫困指数）对这些关联影响的数据。检索数据库（PubMed/EMBASE/CINAHL）、参考文献、向前引用文献和灰色文献，检索时间从开始至2021年12月。纳入标准为对前瞻性成年队列进行分析，研究全因死亡率或心血管疾病/癌症死亡率/发病率。
纳入了五项队列研究中的六项研究（n = 42467 - 399537；年龄46.5 - 56.8岁；女性占54.6 - 59.3%）。所有研究均考察了全因死亡率；三项研究评估了心血管疾病/癌症结局。四项研究观察到生活方式因素与社会经济地位之间存在相乘交互作用，但方向相反。两项研究检验了相加交互作用；在一个队列（英国生物银行）中观察到了交互作用，而在另一个队列（国家健康与营养检查调查（NHANES））中未观察到。最具优势的社会经济地位群体中不健康生活方式因素（相对于健康生活方式因素）的全因死亡率HR（95%置信区间）范围为0.68（0.32 - 1.45）至4.17（2.27 - 7.69）。最不具优势群体的等效估计值范围为1.30（1.13 - 1.50）至4.00（2.22 - 7.14）。在对生活方式因素、社会经济地位和全因死亡率之间联合关联的19项分析（包括敏感性分析）中，观察到在最不健康生活方式因素 - 最不具优势群体中全因死亡率最高，提示存在相加效应。
有限且异质性的文献表明，社会经济地位对不健康生活方式因素组合与不良健康之间关联的影响可能是相加的，但仍不清楚。更多的前瞻性分析将有助于阐明社会经济地位是否会改变不健康生活方式因素组合与健康结局之间的关联。
方案已在PROSPERO注册（CRD42020172588；2020年6月25日）。
