Socioeconomic differences in metabolic syndrome development: examining the mediating role of chronic stress using the Lifelines Cohort Study

Liza A Hoveling; Aart C Liefbroer; Ute Bültmann; Nynke Smidt

doi:10.1186/s12889-022-12684-1

Socioeconomic differences in metabolic syndrome development: examining the mediating role of chronic stress using the Lifelines Cohort Study

BMC Public Health. 2022 Feb 8;22(1):261. doi: 10.1186/s12889-022-12684-1.

Authors

Liza A Hoveling¹, Aart C Liefbroer^{2

3

4}, Ute Bültmann⁵, Nynke Smidt²

Affiliations

¹ Department of Epidemiology, University of Groningen, University Medical Center Groningen, PO Box 30.001, Groningen, 9700 RB, The Netherlands. l.a.hoveling@umcg.nl.
² Department of Epidemiology, University of Groningen, University Medical Center Groningen, PO Box 30.001, Groningen, 9700 RB, The Netherlands.
³ Netherlands Interdisciplinary Demographic Institute, PO Box 11650, The Hague, 2502 AR, The Netherlands.
⁴ Department of Sociology, Vrije Universiteit Amsterdam, De Boelelaan 1105, Amsterdam, 1081 HV, The Netherlands.
⁵ Department of Health Sciences, Community and Occupational Medicine, University of Groningen, University Medical Center Groningen, PO Box 30.001, Groningen, 9700 RB, The Netherlands.

Abstract

Background: Metabolic syndrome (MetS) development strongly varies based on individuals' socioeconomic position (SEP), but to date, no studies have assessed the mediating role of perceived stress from long-term difficulties (chronic stress) in this association. The aim of this study is to examine the mediating role of chronic stress in the associations of the SEP measures education, occupational prestige and income, with MetS development, and whether associations between chronic stress and MetS are moderated by sex.

Methods: We used an adult subsample (n = 53,216) from the Lifelines Cohort Study without MetS at baseline. MetS development was measured 3.9 years after baseline (follow-up), and defined according to National Cholesterol Education Program's Adult Treatment Panel III (NCEP-ATPIII) criteria. Direct associations between SEP, chronic stress and MetS development were estimated using multivariable logistic and linear regression analyses, and were adjusted for age, sex, the other SEP measures, and time between baseline and follow-up. The mediating percentages of chronic stress explaining the associations between SEP and MetS development were estimated using the Karlson-Holm-Breen method.

Results: Upon follow-up, 7.4% of the participants had developed MetS. Years of education and occupational prestige were inversely associated with MetS development. Chronic stress suppressed the association between education and MetS development (5.6%), as well as the association between occupational prestige and MetS development (6.2%). No effect modification of sex on the chronic stress-MetS pathway was observed.

Conclusions: Chronic stress does not explain educational and occupational differences in developing MetS. In fact, individuals with more years of education or higher occupational prestige perceive more chronic stress than their lower SEP counterparts. Further, no difference between males and females was observed regarding the relationship between chronic stress and MetS development.

Keywords: Long-term difficulties inventory; Longitudinal studies; Mediation; Metabolic syndrome; Socioeconomic factors.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Cohort Studies
Educational Status
Female
Humans
Income
Male
Metabolic Syndrome* / complications
Metabolic Syndrome* / epidemiology
Risk Factors