Association between socioeconomic status and health behaviour change before and after non-communicable disease diagnoses: a multicohort study,The Lancet Public Health

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Association between socioeconomic status and health behaviour change before and after non-communicable disease diagnoses: a multicohort study
The Lancet Public Health ( IF 25.4 ) Pub Date : 2022-07-27 , DOI: 10.1016/s2468-2667(22)00157-8
Danyang Wang ₁ , Xiaochen Dai ₂ , Shiva Raj Mishra ₃ , Carmen C W Lim ₄ , Rodrigo M Carrillo-Larco ₅ , Emmanuela Gakidou ₆ , Xiaolin Xu ₇

Affiliation

Department of Big Data in Health Science School of Public Health, and Center of Clinical Big Data and Analytics of The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.
Department of Health Metrics Sciences, School of Medicine, School of Public Health, University of Washington, Seattle, USA; Institute for Health Metrics and Evaluation, School of Public Health, University of Washington, Seattle, USA.
Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia; Academy for Data Sciences and Global Health, Kathmandu, Nepal.
National Centre for Youth Substance Use Research, The University of Queensland, Brisbane, QLD, Australia; School of Psychology, Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, QLD, Australia.
Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK; CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru.
Department of Health Metrics Sciences, School of Medicine, School of Public Health, University of Washington, Seattle, USA; Institute for Health Metrics and Evaluation, School of Public Health, University of Washington, Seattle, USA; Department of Global Health, School of Public Health, University of Washington, Seattle, USA; Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle, USA.
Department of Big Data in Health Science School of Public Health, and Center of Clinical Big Data and Analytics of The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China; School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia.

Background

Behavioural risk factors of non-communicable diseases (NCDs) are socially patterned. However, the direction and the extent to which socioeconomic status (SES) influences behaviour changes before and after the diagnosis of NCDs is not clearly understood. We aimed to investigate the influence of SES on behaviour changes (physical inactivity and smoking) before and after the diagnosis of major NCDs.

Methods

In this multicohort study, we pooled individual-level data from six prospective cohort studies across 17 countries. We included participants who were diagnosed with either diabetes, cardiovascular disease, chronic lung disease, or cancer after recruitment. Participants were surveyed every 2 years. Education and total household wealth were used to construct SES. We measured behaviour changes as whether or not participants continued or initiated physical inactivity or smoking after NCD diagnosis. We used multivariable logistic regression models to estimate odds ratios (ORs), prevalence ratios (PRs), and 95% CIs for the associations between SES and continuation or initiation of unfavourable behaviours.

Findings

We included 8107 individuals recruited between March, 2002, and January, 2016. Over the 4-year period before and after NCD diagnosis, 886 (60·4%) of 1466 individuals continued physical inactivity and 1018 (68·8%) of 1480 participants continued smoking; 1047 (15·8%) of 6641 participants with physical activity before diagnosis initiated physical inactivity after diagnosis and 132 (2·0%) of 6627 non-smokers before diagnosis initiated smoking after diagnosis. Compared with participants with high SES, those with low SES were more likely to continue physical inactivity (244 [70·3%] of 347 vs 23 [50.0%] of 46; PR 1·41 [95% CI 1·05–1·99]; OR 2·28 [1·18–4·41]), continue smoking (214 [75·4%] of 284 vs 39 [60·9%] of 64; PR 1·27 [1·03–1·59]; OR 2·08 [1·14–3·80]), but also to initiate physical inactivity (188 [26·1%] of 720 vs 47 [7·4%] of 639; PR 3·59 [2·58–4·85]; OR 4·31 [3·02 – 6·14]).

Interpretation

Low SES was associated with continuing or initiating physical inactivity and continuing smoking after NCD diagnosis. Reducing socioeconomic inequality in health behaviour changes should be prioritised and integrated into NCD-prevention programmes.

Funding

Zhejiang University and Fundamental Research Funds for the Central Universities.

中文翻译：

非传染性疾病诊断前后社会经济地位与健康行为变化之间的关联：一项多队列研究

背景

非传染性疾病 (NCD) 的行为危险因素具有社会模式。然而，社会经济地位（SES）在非传染性疾病诊断前后影响行为变化的方向和程度尚不清楚。我们旨在调查 SES 对主要非传染性疾病诊断前后行为变化（缺乏运动和吸烟）的影响。

方法

在这项多队列研究中，我们汇集了来自 17 个国家/地区的六项前瞻性队列研究的个人水平数据。我们纳入了在招募后被诊断患有糖尿病、心血管疾病、慢性肺病或癌症的参与者。每 2 年对参与者进行一次调查。教育和家庭总财富被用来构建 SES。我们测量了参与者在 NCD 诊断后是否继续或开始缺乏身体活动或吸烟的行为变化。我们使用多变量逻辑回归模型来估计 SES 与不利行为的持续或开始之间关联的比值比 (OR)、流行率 (PR) 和 95% CI。

发现

我们纳入了 2002 年 3 月至 2016 年 1 月期间招募的 8107 人。在 NCD 诊断前后的 4 年期间，1466 人中的 886 人 (60·4%) 和 1480 人中的 1018 人 (68·8%) 继续缺乏运动参与者继续吸烟；6641 名诊断前进行体育锻炼的参与者中有 1047 名 (15·8%) 在诊断后开始缺乏身体活动，6627 名诊断前不吸烟的参与者中有 132 名 (2·0%) 在诊断后开始吸烟。与 SES 高的参与者相比，SES 低的参与者更有可能继续缺乏身体活动（347 人中的 244 [70·3%] vs 46 人中的 23 [50.0%]；PR 1·41 [95% CI 1·05–1 ·99]；或 2·28 [1·18–4·41]），继续吸烟（214 [75·4%] of 284 vs64 的 39 [60·9%]；公关 1·27 [1·03–1·59]；OR 2·08 [1·14–3·80]），但也开始缺乏身体活动（720 人中的 188 [26·1%]对639 人中的 47 [7·4%]；PR 3·59 [2·58 –4·85]；或 4·31 [3·02 – 6·14]）。