Department of Community Medicine, UiT The Artic University of Norway, Tromsø, Norway.
Department of Health and Care Sciences, UiT The Arctic University of Norway, Tromsø, Norway.
BMC Womens Health. 2024 Apr 17;24(1):244. doi: 10.1186/s12905-024-03060-9.
Socioeconomic status as measured by education, income, or occupation, has been associated with fibromyalgia but the underlying mechanism and the role of lifestyle factors are unclear. Thus, we examine the role of modifiable lifestyle factors (body mass index, physical activity, alcohol consumption and smoking) in the association between education and self-reported fibromyalgia.
We used data from 74,157 participants in the population-based prospective Norwegian Women and Cancer (NOWAC) study. Socioeconomic position, operationalized as years of educational attainment, and lifestyle factors were assessed via self-reported questionnaires. Multiple mediation analysis was used to decompose total effects into direct and indirect effects. Estimates were reported as hazard ratios (HRs) with 95% confidence intervals (CIs).
The cumulative incidence of fibromyalgia was 3.2% after a median follow up time of 13 years. Fibromyalgia was inversely associated with years of educational attainment for ≤ 9 years (HR = 2.56; 95% CI 2.32-2.91) and for 10-12 years (HR = 1.84; 95% CI 1.72-2.02), compared with ≥ 13 years of education. Overall, all lifestyle factors together jointly mediated 17.3% (95% CI 14.3-21.6) and 14.1% (95% CI 11.3-18.9) of the total effect for ≤ 9 years and 10-12 years of education, respectively. Smoking and alcohol consumption contributed the most to the proportion mediated, for ≤ 9 years (5.0% and 7.0%) and 10-12 years (5.6% and 4.5%) of education.
The association between education and self-reported fibromyalgia was partly explained through lifestyle factors, mainly smoking and alcohol consumption.
社会经济地位可通过教育、收入或职业来衡量，它与纤维肌痛有关，但潜在机制和生活方式因素的作用尚不清楚。因此，我们研究了可改变的生活方式因素（体重指数、身体活动、饮酒和吸烟）在教育程度与自我报告的纤维肌痛之间的关联中的作用。
我们使用了来自基于人群的挪威女性与癌症（NOWAC）研究的 74157 名参与者的数据。社会经济地位，通过受教育年限来操作化，以及生活方式因素通过自我报告的问卷进行评估。使用多中介分析将总效应分解为直接和间接效应。估计值以危害比（HR）和 95%置信区间（CI）报告。
中位随访 13 年后，纤维肌痛的累积发病率为 3.2%。与 ≥ 13 年受教育程度相比，≤ 9 年（HR=2.56；95%CI 2.32-2.91）和 10-12 年（HR=1.84；95%CI 1.72-2.02）受教育程度与纤维肌痛呈负相关。总体而言，所有生活方式因素共同介导了 17.3%（95%CI 14.3-21.6）和 14.1%（95%CI 11.3-18.9）的总效应，分别用于 ≤ 9 年和 10-12 年的教育。吸烟和饮酒对 ≤ 9 年（5.0%和 7.0%）和 10-12 年（5.6%和 4.5%）的教育程度的中介比例贡献最大。
教育程度与自我报告的纤维肌痛之间的关联部分通过生活方式因素来解释，主要是吸烟和饮酒。
