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dc.contributor.authorTiwari, Sweta
dc.contributor.authorCerin, Ester
dc.contributor.authorWilsgaard, Tom
dc.contributor.authorLøvsletten, Ola
dc.contributor.authorNjølstad, Inger
dc.contributor.authorGrimsgaard, Sameline
dc.contributor.authorHopstock, Laila Arnesdatter
dc.contributor.authorSchirmer, Henrik
dc.contributor.authorRosengren, Annika
dc.contributor.authorKristoffersen, Kathrine
dc.contributor.authorLøchen, Maja-Lisa
dc.description.abstractIntroduction: Cardiovascular disease (CVD) is a leading cause of death and disability and living in areas with low socio-economic status (SES) is associated with increased risk of CVD. Lifestyle factors such as smoking, physical inactivity, an unhealthy diet and harmful alcohol use are main risk factors that contribute to other modifiable risk factors, such as hypertension, raised blood cholesterol, obesity, and diabetes. The potential impact of arealevel socio-economic status (ASES) on metabolic CVD risk factors via lifestyle behaviors independent of individual SES has not been investigated previously.<p> <p>Aims: To estimate associations of ASES with CVD risk factors and the mediating role of lifestyle behaviors independent of individual-level SES. <p>Methods: In this cross-sectional study, we included 19,415 participants (52% women) from the seventh survey of the Tromsø Study (2015–2016) (Tromsø7). The exposure variable ASES was created by aggregating individuallevel SES variables (education, income, housing ownership) at the geographical subdivision level. Individuallevel SES data and geographical subdivision of Tromsø municipality (36 areas) were obtained from Statistics Norway. Variables from questionnaires and clinical examinations obtained from Tromsø7 were used as mediators (smoking, snuff, alcohol, and physical activity), while the outcome variables were body mass index (BMI), total/ high-density lipoprotein (HDL) cholesterol ratio, waist circumference, hypertension, diabetes. Mediation and mediated moderation analysis were performed with age as a moderator, stratified by sex. <p>Results: ASES was significantly associated with all outcome variables. CVD risk factor level declined with an increase in ASES. These associations were mediated by differences in smoking habits, alcohol use and physical activity. The associations of ASES with total/HDL cholesterol ratio and waist circumference (women) were moderated by age, and the moderating effects were mediated by smoking and physical activity in both sexes. The largest mediated effects were seen in the associations of ASES with total/HDL cholesterol ratio, with the mediators accounting for 43% of the observed effects. <p>Conclusions: Living in lower SES areas is associated with increased CVD risk due to unhealthy lifestyle behaviors, such as smoking, alcohol use and physical inactivity. These associations were stronger in women and among older participants.en_US
dc.identifier.citationTiwari, Cerin, Wilsgaard, Løvsletten, Njølstad, Grimsgaard, Hopstock, Schirmer, Rosengren, Kristoffersen, Løchen. Lifestyle factors as mediators of area-level socio-economic differentials in cardiovascular disease risk factors. The Tromsø Study. SSM - Population Health. 2022;19en_US
dc.identifier.cristinIDFRIDAID 2062223
dc.relation.journalSSM - Population Health
dc.relation.projectIDNorges forskningsråd: 289440en_US
dc.rights.holderCopyright 2022 The Author(s)en_US
dc.rightsAttribution 4.0 International (CC BY 4.0)en_US
dc.titleLifestyle factors as mediators of area-level socio-economic differentials in cardiovascular disease risk factors. The Tromsø Studyen_US
dc.typeJournal articleen_US
dc.typePeer revieweden_US

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Attribution 4.0 International (CC BY 4.0)
Except where otherwise noted, this item's license is described as Attribution 4.0 International (CC BY 4.0)