The Relationship between Socioeconomic Status and Metabolic Syndrome, Using Structural Equation Modelling

Article information

Korean J Health Promot. 2016;16(2):92-100

Publication date (electronic) : 2016 January 20

doi : https://doi.org/10.15384/kjhp.2016.16.2.92

Department of Family Medicine, Daegu Catholic University Hospital, Daegu, Korea

Corresponding author: Sung Hi Kim, MD, PhD Department of Family Medicine, Daegu Catholic University Hospital, 33 Duryugongwon-ro 17-gil, Nam-gu, Daegu 42472, Korea Tel: +82-53-650-4247, Fax: +82-53-650-4122 E-mail: khmksh@cu.ac.kr

Received 2016 January 20; Accepted 2016 May 17.

Abstract

Background

This study aimed to investigate the complexity of the relationships between socioeconomic status, health behaviors, stress and risks of metabolic syndrome. By applying structural equational modelling, modified generalized conceptual model had described the associations and interactions among them.

Methods

24,210 participants (8,242 men, 15,968 women) registered with the Korean Health Examinee Cohort (KOEX) between 2004 to 2008. This study collected data on the socioeconomic status, health behaviors, and stress through individual interviews. Socioeconomic status (education, house income, occupation), health behaviors (diet, physical activity, smoking, alcohol consumption) and stress level were defined as exogenous factors. Endogenous variables were risks of metabolic syndrome based on modified National Cholesterol Education Program Adult Treatment Panel-lll (NCEP ATP-lll, 2006).

Results

According to model fitness test, these proposed model were acceptable in men, comparative fit in-dex=0.877, incremental fit Index=0.877, Tucker-Lewis index=0.757, root-mean-squared error associated=0.055. These were compatible also in women as comparative fit index=0.924, incremental fit index=0.924, Tucker-Lewis index=0.851, root-mean-squared error associated=0.050. There were sex difference related to risks of metabolic syndrome: in men socioeconomic status (β=-0.08), health behaviors (β=-0.25) and stress (β =-0.25) were relevant, but in women only socioeconomic status (β=-0.25) was relevant (P<0.05).

Conclusions

A conceptual model properly explains how Socioeconomic status may influence on health behaviors, stress, and risks of metabolic syndrome. Health behaviors in men and socioeconomic status in women had the strongest associations with risks of metabolic syndrome. In addition, socioeconomic status was strongly associated with health behaviors, stress and age.

Keywords: Socioeconomic status; Metabolic syndrome

Figure 1.

Modified generalized conceptual model of potential pathway through which social status is linked to health.

Figure 2.

Modified conceptual model; a summary of the interactions of Socioeconomic status (SES) influencing metabolic syndrome risk, in men Path coefficients are presented as standardised regression weight; dashed lines represent relationships that were non significant, model fitincluded in the exploratory analysis, but were non-significant. Model fit: X²=40.395, d.f=28, P<0.001, CFI=0.924, IFI=0.924 TLI=0.851, RMSEA=0.050.

Figure 3.

Modified conceptual model; a summary of the interactions of Socioeconomic status (SES) influencing metabolic syndrome risk, in men path coefficients are presented as standardised regression weight; dashed lines represent relationships that were non significant, model fit included in the exploratory analysis, but were non-significant. Model fit: X²=35.843, d.f=28, P<0.001, CFI=0.877, IFI=0.877, TLI=0.757, RMSEA=0.055.

Table 1.

Health behaviors, stress, and socioeconomic status of study population

Table 2.

Comparison of metabolic syndrome and it's components, and prevalence of diabetes and cardiovascular disease according to gender

Table 3.

Confirmatory factor analysis and pathway analysis: regression weight and standarized regression weight for measures of Metabolic syndrome risk

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Figure 1.

Modified generalized conceptual model of potential pathway through which social status is linked to health.

Figure 2.

Figure 3.

Table 1.

Health behaviors, stress, and socioeconomic status of study population

Variables		Total (n=24,210)
Variables		Men (n=8,242)	Women (n=15,968)	P
General characteristics and health behaviors^a
Age, y		52.9±8.1	50.8±7.1	<0.001
Smoking, pack years		15.4±16.0	0.2±1.9	<0.001
Alcohol intake^b, g/day		25.9±36.5	2.4±8.8	<0.001
Exercise^c, Kcal/day		201.0±250.9	180.3±203.3	<0.001
Diet score^d		13.9±2.7	15.7±2.9	<0.001
Score of psychosocial wellbeing index (PWI)^e		16.0±7.8	18.5±8.2	<0.001
Socioeconomic status^e
Education, y	None	49 (0.6)	207 (1.3)	<0.001
	< 6	66 (0.8)	271 (1.7)
	6–8	626 (7.6)	2,187 (13.7)
	9–11	963 (11.7)	2,763 (17.3)
	12–13	2,840 (34.5)	6,324 (39.6)
	14	338 (4.1)	479 (3.0)
	15	247 (3.0)	335 (2.1)
	16–17	2,273 (27.6)	2,907 (18.2)
	≥ 18	840 (10.1)	495 (3.1)
House income, 10,000 won	<50 50–99	362 (4.4) 342 (4.1)	984 (6.2) 1,022 (6.4)	<0.001
	100–149	666 (8.1)	1,435 (9.0)
	150–199	812 (9.9)	1,472 (9.2)
	200–299	1,886 (22.9)	3,399 (21.3)
	300–300	1,777 (21.6)	3,109 (19.5)
	400–599	1,643 (19.9)	3,103 (19.4)
	≥600	754 (9.1)	1,444 (9.0)
Job	Managers, Professionals	1,541 (18.7)	1,319 (8.3)	<0.001
	Office workers	1,285 (15.6)	855 (5.3)
	Sales workers	729 (8.8)	1,705 (10.7)
	Service workers	651 (7.9)	917 (5.7)
	Operatives	2,724 (33.1)	1,712 (10.7)
	Soldier	82 (1.0)	0
	House wife	0	9,197 (57.6)
	Unemployed	1,183 (14.3)	137 (0.9)
	Non response	47 (0.6)	126 (0.8)

Values were presented as mean±SD or n (%).

Aanalyzed by t-test.

Daily alcohol intake.

Leisure-time physical activity.

Based on daily consumption amount of 5 food groups (fruits, vegetables, crude fibers, red meats and sodium) from Food Frequency Questionnaire (FFQ).

Analyzed by chi-square test.

Table 2.

Comparison of metabolic syndrome and it's components, and prevalence of diabetes and cardiovascular disease according to gender

Variables	Total (n=24,210)
Variables	Men (n=8,242)	Women (n=15,968)	P
Component of MetS, BMI and number of MetS component^a
Waist	85.9±7.3	78.9±7.8	<0.000
BP systolic, mmHg	125.9±14.8	118.9±15.2	<0.001
diastolic, mmHg	79.1±10.2	73.8±10.0	<0.001
TG, mg/dL	150.0±105.7	105.7±69.1	<0.001
FBS, mg/dL	95.4±16.6	89.6±14.1	<0.001
HDL, mg/dL	49.2±11.5	56.2±12.4	<0.001
BMI, kg/m²	24.4±2.7	23.5±2.8	<0.001
Number of MetS	1.6±1.2	1.1±1.1	<0.001
Prevalence of chronic disease and metabolic syndrome^b
CVA	140 (1.7)	128 (0.8)	<0.001
MI	297 (3.6)	287 (1.8)	<0.001
Diabetes	717 (8.7)	737 (4.6)	<0.001
MetS	2,291 (27.8)	2,650 (16.6)	<0.001

Abbreviations: Mets, metabolic syndrome; BMI, body mass index; BP, blood pressure; TG, triglyceride; FBS, fasting blood sugar; HDL, high density lipoprotein cholesterol; CVA, cerebrovasculr accident; MI, myocardial infarction. Values were presented as mean±SD or n (%).

Analyzed by t-test.

Analyzed by chi-square test.

Table 3.

Confirmatory factor analysis and pathway analysis: regression weight and standarized regression weight for measures of Metabolic syndrome risk

Variables	Total (n=24,210)
	Men (n=8,242)			Women (n=15,968)
	Regression	Standarized	P	Regression	Standarized	P
	weight	regression weight	P	weight	regression weight	P
Factor loading of latent variables
SES
Job	1	0.63	<0.001	1	0.35	<0.001
House income	0.14	0.71	<0.001	0.29	0.71	<0.001
Education	0.13	0.65	<0.001	0.27	0.72	<0.001
Health behavior
Diet score^a	1	0.37	<0.001	1	0.36	<0.001
LTPA, Kcal/day	75.69	0.31	<0.001	56.32	0.28	<0.001
Pack year	4.10	0.26	<0.001	0.30	0.16	<0.001
Alcohol intake^b, g/day	10.8	0.30	<0.001	1.74	0.20	<0.001
Pathway coefficients
SES
Age	–0.52	–0.45	<0.001	0.39	–0.57	<0.001
Health behavior
Age	0.05	0.37	<0.001	0.06	0.14	<0.001
SES ^c	0.04	0.37	<0.001	0.07	0.32	<0.001
Stress^c	–0.04	–0.30	<0.001	–0.04	–0.33	<0.001
Stress^c
Age	–0.15	–0.16	<0.001	–0.18	–0.16	<0.001
SES	–0.16	–0.20	<0.001	–0.37	–0.22	<0.001
MetS risk
Age	0.02	0.15	<0.001	0.03	0.19	<0.001
SES	0.01	0.07	<0.001	–0.05	–0.20	<0.001
Health behavior	–0.31	–0.25	<0.001	–0.01	–0.01	0.54
Stress^c	–0.01	–0.08	<0.001	–0.00	–0.02	0.06

Abbreviations: SES, socioeconomic status; LTPA, leisure time physical activity; MetS, metabolic syndrome.

Based on daily consumption amount of 5 food groups(fruits, vegetables, crude fibers, red meats, and sodium) from Food Frequency Questionnaire (FFQ).

Daily alcohol intake.

Psychosocial wellbeing index.