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Int. J. Environ. Res. Public Health 2014, 11(1), 830-848; doi:10.3390/ijerph110100830
Article

Area-Level Socioeconomic Characteristics, Prevalence and Trajectories of Cardiometabolic Risk

1,†,* , 2,3
,
2
,
2
,
4
,
5
 and
2,6
1 Clinical and Population Perinatal Research, Kolling Institute of Medical Research, University of Sydney at Royal North Shore Hospital, St Leonards, New South Wales, NSW 2065, Australia 2 Social Epidemiology and Evaluation Research Group, School of Population Health and Sansom Institute for Health Research, University of South Australia, Adelaide, SA 5001, Australia 3 Research Centre of the Douglas Mental Health University Institute, Verdun, QC H4H 1R2, Canada 4 Population Research and Outcome Studies, Discipline of Medicine, The University of Adelaide, Adelaide, SA 5005, Australia 5 The Health Observatory, Discipline of Medicine, The University of Adelaide, Adelaide, SA 5005, Australia 6 Department of Medicine, The University of Melbourne, St Vincent's Hospital, Melbourne, VIC 3065, Australia The paper was written while the first author was based at the Social Epidemiology and Evaluation Research Group, School of Population Health and Sansom Institute for Health Research, University of South Australia, Adelaide, SA 5001.
* Author to whom correspondence should be addressed.
Received: 1 October 2013 / Revised: 10 December 2013 / Accepted: 20 December 2013 / Published: 8 January 2014
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Abstract

This study examines the relationships between area-level socioeconomic position (SEP) and the prevalence and trajectories of metabolic syndrome (MetS) and the count of its constituents (i.e., disturbed glucose and insulin metabolism, abdominal obesity, dyslipidemia, and hypertension). A cohort of 4,056 men and women aged 18+ living in Adelaide, Australia was established in 2000–2003. MetS was ascertained at baseline, four and eight years via clinical examinations. Baseline area-level median household income, percentage of residents with a high school education, and unemployment rate were derived from the 2001 population Census. Three-level random-intercepts logistic and Poisson regression models were performed to estimate the standardized odds ratio (SOR), prevalence risk ratio (SRR), ratio of SORs/SRRs, and (95% confidence interval (CI)). Interaction between area- and individual-level SEP variables was also tested. The odds of having MetS and the count of its constituents increased over time. This increase did not vary according to baseline area-level SEP (ratios of SORs/SRRs ≈ 1; p ≥ 0.42). However, at baseline, after adjustment for individual SEP and health behaviours, median household income (inversely) and unemployment rate (positively) were significantly associated with MetS prevalence (SOR (95%CI) = 0.76 (0.63–0.90), and 1.48 (1.26–1.74), respectively), and the count of its constituents (SRR (95%CI) = 0.96 (0.93–0.99), and 1.06 (1.04–1.09), respectively). The inverse association with area-level education was statistically significant only in participants with less than post high school education (SOR (95%CI) = 0.58 (0.45–0.73), and SRR (95%CI) = 0.91 (0.88–0.94)). Area-level SEP does not predict an elevated trajectory to developing MetS or an elevated count of its constituents. However, at baseline, area-level SEP was inversely associated with prevalence of MetS and the count of its constituents, with the association of area-level education being modified by individual-level education. Population-level interventions for communities defined by area-level socioeconomic disadvantage are needed to reduce cardiometabolic risks.
Keywords: metabolic syndrome; trajectories; socioeconomic position; income; education; cohort study; residence characteristics metabolic syndrome; trajectories; socioeconomic position; income; education; cohort study; residence characteristics
This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Ngo, A.D.; Paquet, C.; Howard, N.J.; Coffee, N.T.; Taylor, A.W.; Adams, R.J.; Daniel, M. Area-Level Socioeconomic Characteristics, Prevalence and Trajectories of Cardiometabolic Risk. Int. J. Environ. Res. Public Health 2014, 11, 830-848.

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