Separate and combined effects of individual and neighbourhood socio-economic disadvantage on health-related lifestyle risk factors: a multilevel analysis.

Autor:	Zhu Y; Department of Internal Medicine, Division of Nephrology, University Medical Centre Groningen, Groningen, The Netherlands., Duan MJ; Department of Internal Medicine, Division of Nephrology, University Medical Centre Groningen, Groningen, The Netherlands., Riphagen IJ; Department of Laboratory Medicine, University Medical Centre Groningen, Groningen, The Netherlands., Minovic I; Department of Laboratory Medicine, University Medical Centre Groningen, Groningen, The Netherlands., Mierau JO; Faculty of Economics and Business, University of Groningen, The Netherlands.; Aletta Jacobs School of Public Health, University of Groningen, The Netherlands., Carrero JJ; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden., Bakker SJL; Department of Internal Medicine, Division of Nephrology, University Medical Centre Groningen, Groningen, The Netherlands., Navis GJ; Department of Internal Medicine, Division of Nephrology, University Medical Centre Groningen, Groningen, The Netherlands., Dekker LH; Department of Internal Medicine, Division of Nephrology, University Medical Centre Groningen, Groningen, The Netherlands.; Aletta Jacobs School of Public Health, University of Groningen, The Netherlands.
Jazyk:	angličtina
Zdroj:	International journal of epidemiology [Int J Epidemiol] 2022 Jan 06; Vol. 50 (6), pp. 1959-1969. Date of Electronic Publication: 2021 Apr 24.
DOI:	10.1093/ije/dyab079
Abstrakt:	Background: Socio-economic disadvantage at both individual and neighbourhood levels has been found to be associated with single lifestyle risk factors. However, it is unknown to what extent their combined effects contribute to a broad lifestyle profile. We aimed to (i) investigate the associations of individual socio-economic disadvantage (ISED) and neighbourhood socio-economic disadvantage (NSED) in relation to an extended score of health-related lifestyle risk factors (lifestyle risk index); and to (ii) investigate whether NSED modified the association between ISED and the lifestyle risk index. Methods: Of 77 244 participants [median age (IQR): 46 (40-53) years] from the Lifelines cohort study in the northern Netherlands, we calculated a lifestyle risk index by scoring the lifestyle risk factors including smoking status, alcohol consumption, diet quality, physical activity, TV-watching time and sleep time. A higher lifestyle risk index was indicative of an unhealthier lifestyle. Composite scores of ISED and NSED based on a variety of socio-economic indicators were calculated separately. Linear mixed-effect models were used to examine the association of ISED and NSED with the lifestyle risk index and to investigate whether NSED modified the association between ISED and the lifestyle risk index by including an interaction term between ISED and NSED. Results: Both ISED and NSED were associated with an unhealthier lifestyle, because ISED and NSED were both positively associated with the lifestyle risk index {highest quartile [Q4] ISED beta-coefficient [95% confidence interval (CI)]: 0.64 [0.62-0.66], P < 0.001; highest quintile [Q5] NSED beta-coefficient [95% CI]: 0.17 [0.14-0.21], P < 0.001} after adjustment for age, sex and body mass index. In addition, a positive interaction was found between NSED and ISED on the lifestyle risk index (beta-coefficient 0.016, 95% CI: 0.011-0.021, Pinteraction < 0.001), which indicated that NSED modified the association between ISED and the lifestyle risk index; i.e. the gradient of the associations across all ISED quartiles (Q4 vs Q1) was steeper among participants residing in the most disadvantaged neighbourhoods compared with those who resided in the less disadvantaged neighbourhoods. Conclusions: Our findings suggest that public health initiatives addressing lifestyle-related socio-economic health differences should not only target individuals, but also consider neighbourhood factors. (© The Author(s) 2021. Published by Oxford University Press on behalf of the International Epidemiological Association.)
Databáze:	MEDLINE
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