Socioeconomic Status, Diet, and Behavioral Factors and Cardiometabolic Diseases and Mortality
Authors' conclusion
In this prospective cohort study of health professionals, associations between diet and health outcomes remained similar without adjusting for SES factors, while health behaviors, including diet, accounted for a large proportion of the associations between neighborhood SES and health. These findings highlight the importance of health behaviors, particularly high-quality diets, in promoting individual health and possibly reducing health disparities associated with SES.
Study context
- Population
- US health professionals without chronic diseases at baseline in the Health Professionals Follow-Up Study (1988–2018), Nurses' Health Study (1992–2018) and Nurses' Health Study II (2001–2019)152,192 analysed for cardiovascular disease (CVD)
- Exposure
- Healthy dietary pattern, neighborhood and individual socioeconomic status (SES) and behavioral factors (hazard ratios (HRs) per 10th- to 90th-percentile increments)
- Outcome
- Incident major CVD, T2D and total mortality
Methodological detailsHealth Professionals Follow-Up Study, Nurses' Health Study and Nurses' Health Study II, repeated questionnaires, multivariable Cox proportional hazards regression, Analysed: 152 192 for major CVD, 151 217 for T2D, 141 145 for mortality
- Health Professionals Follow-Up Study, Nurses' Health Study and Nurses' Health Study II
- Repeated questionnaires
- Multivariable Cox proportional hazards regression
- Analysed: 152 192 for major CVD, 151 217 for T2D, 141 145 for mortality
Main finding
As reported in the abstract
Major CVD, HR
0.87 (0.82-0.93) (95% CI)
T2D, HR
0.79 (0.75-0.84) (95% CI)
Total mortality, HR
0.84 (0.81-0.88) (95% CI)
Observational data: associations, not effects.
Further findings
Healthy dietary pattern without adjusting for neighborhood and individual SES
- Major CVD, HR
- 0.85 (0.80-0.91) (95% CI)
- T2D, HR
- 0.78 (0.74-0.82) (95% CI)
- Total mortality, HR
- 0.82 (0.79-0.85) (95% CI)
Neighborhood SES and outcomes
- Major CVD, HR
- 0.90 (0.85-0.95) (95% CI)
- T2D, HR
- 0.92 (0.88-0.97) (95% CI)
- Total mortality, HR
- 0.91 (0.88-0.94) (95% CI)
- Inverse associations
Proportion of associations accounted for by behavioral factors
- Major CVD
- 46.3% (32.5%-60.6%) (95% CI)
- T2D
- 77.4% (64.5%-86.6%) (95% CI)
- Total mortality
- 42.8% (32.9%-53.3%) (95% CI)
Original publication
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