Socioeconomic differences in metabolic syndrome remission in adults: mediation of health behaviors

Introduction: Metabolic syndrome (MetS) incidence strongly varies by socioeconomic status (SES). Each SES measure comprises different resources of an individual, including cultural, economic and social resources. To date, no studies have examined the SES - MetS remission relationship. Understanding the role of each SES measure for MetS remission could shed light on resources needed to reverse adverse health conditions. The aim is to longitudinally assess the associations between the SES measures years of education, household equivalent income and occupational prestige and remitted MetS and whether these associations are mediated by health behaviors, including physical activity, smoking, alcohol drinking and diet quality.Methods: A subsample of the adult Lifelines Cohort Study, including 16,818 participants with MetS at baseline was used. MetS remission was measured at the second assessment (follow-up time 3.8 years) defined according to the NCEP-ATPIII criteria. Direct associations between SES, health behaviors and remitted MetS were estimated using multivariable logistic regression analyses. The mediating percentages of health behaviors explaining the associations between SES and remitted MetS were estimated using the Karlson-Holm-Breen method. Analyses were independent of age, sex, the other SES measures and follow-up time.Results: At the second assessment MetS remitted for 42.7% of the participants. Education (OR 1.04, 99% CI: 1.02-1.06) and income (OR 1.01, 99% CI: 1.00-1.02) were associated with MetS remission, occupational prestige was not. Health behaviors (11.9%) only explained the association between education and MetS remission. For the explanation of the association between income and MetS remission, health behaviors played no role.Conclusions: More education years increase MetS remission, mainly because higher educated are more likely to have healthier behaviors. Higher income increases MetS remission, regardless of the health behaviors.Key messages: Education and income are positively associated with MetS remission. Health behaviors explain a relatively small part of the SES – MetS remission pathway