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      Socioeconomic status and metabolic syndrome in the general population of China: a cross-sectional study

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          Abstract

          Background

          Individual socioeconomic status (SES) has been found to be associated with cardiovascular diseases in developed countries, but the association between individual SES and metabolic syndrome (MetS) is still unclear in China. The objective of this study was to investigate the association between individual SES and MetS in China.

          Methods

          A cross-sectional study of 10054 community residents was performed from May to August 2007 using multistage stratified random sampling. SES was assessed in terms of education, personal monthly income, and household monthly income. The association between SES and MetS was determined by logistic regression models.

          Results

          After the adjustments regarding age, marital status, smoking, drinking, physical activity, body mass index (BMI), and community type, odds ratios (ORs) for MetS of individuals with education level of 7~12 years and >12 years were 0.87 (95% confidence interval [CI]: 0.75 to 0.99) and 0.83 (95% CI: 0.62 to 0.91) respectively compared with those with education level of <7 years in women. Following the adjustments as above, ORs for MetS of individuals with household monthly income level of middle and higher were 0.94 (95% CI: 0.86 to 0.97), and 0.72 (95% CI: 0.65 to 0.88) respectively compared with those with lower household monthly income level in women. The association between SES and MetS was not significant in men.

          Conclusions

          Gender had an influence on the association between individual SES and MetS. Lower education and household monthly income level were associated with higher risk of MetS among community residents in women, while such association was not significant in men.

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          Most cited references23

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          Socioeconomic status and health: how education, income, and occupation contribute to risk factors for cardiovascular disease.

          Socioeconomic status (SES) is usually measured by determining education, income, occupation, or a composite of these dimensions. Although education is the most commonly used measure of SES in epidemiological studies, no investigators in the United States have conducted an empirical analysis quantifying the relative impact of each separate dimension of SES on risk factors for disease. Using data on 2380 participants from the Stanford Five-City Project (85% White, non-Hispanic), we examined the independent contribution of education, income, and occupation to a set of cardiovascular disease risk factors (cigarette smoking, systolic and diastolic blood pressure, and total and high-density lipoprotein cholesterol). The relationship between these SES measures and risk factors was strongest and most consistent for education, showing higher risk associated with lower levels of education. Using a forward selection model that allowed for inclusion of all three SES measures after adjustment for age and time of survey, education was the only measure that was significantly associated with the risk factors (P less than .05). If economics or time dictate that a single parameter of SES be chosen and if the research hypothesis does not dictate otherwise, higher education may be the best SES predictor of good health.
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            Socioeconomic status and cardiovascular disease: risks and implications for care.

            Socioeconomic status (SES) refers to an individual's social position relative to other members of a society. Low SES is associated with large increases in cardiovascular disease (CVD) risk in men and women. The inverse association between SES and CVD risk in high-income countries is the result of the high prevalence and compounding effects of multiple behavioral and psychosocial risk factors in people of low SES. However, strong and consistent evidence shows that parental SES, childhood and early-life factors, and inequalities in health services also contribute to elevated CVD risk in people of low SES who live in high-income countries. In addition, place of residence can affect CVD risk, although the data on the influence of wealth distribution and work-related factors are inconsistent. Studies on the effects of SES on CVD risk in low-income and middle-income countries is scarce, but evidence is emerging that the increasing wealth of these countries is beginning to lead to replication of the patterns seen in high-income countries. Clinicians should address the association between SES and CVD by incorporating SES into CVD risk calculations and screening tools, reducing behavioral and psychosocial risk factors via effective and equitable primary and secondary prevention, undertaking health equity audits to assess inequalities in care provision and outcomes, and by use of multidisciplinary teams to address risk factors over the life course.
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              Socioeconomic status is associated with stress hormones.

              We assess whether socioeconomic status (SES) is associated with basal levels of cortisol and catecholamines and determine if any association between SES and these hormones can be explained (is mediated) by behavioral, social, and emotional differences across the SES gradient. One hundred ninety-three adult subjects, including men and women and whites and African-Americans, provided 24-hour urine catecholamine samples on each of 2 days and seven saliva cortisol samples on each of 3 days beginning 1 hour after wake-up and ending 14 to 16 hours later. Values for both hormones were averaged across days to obtain basal levels. Lower SES (income and education) was associated with higher levels of cortisol and epinephrine and marginally higher levels of norepinephrine. These associations were independent of race, age, gender, and body mass. Low SES was also associated with a greater likelihood of smoking, of not eating breakfast, and with less diverse social networks. Further analyses provided evidence consistent with the hypothesis that these behavioral and social variables mediate the link between SES and the three stress hormones. Lower SES was associated in a graded fashion with higher basal levels of cortisol and catecholamines. These associations occurred independent of race, and the data were consistent with mediation by health practices and social factors.
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                Author and article information

                Contributors
                Journal
                BMC Public Health
                BMC Public Health
                BMC Public Health
                BioMed Central
                1471-2458
                2012
                30 October 2012
                : 12
                : 921
                Affiliations
                [1 ]Institute of Clinical Epidemiology, Key Laboratory of Public Health Safety (Ministry of Education), Fudan University, Shanghai, 200032, PR, China
                [2 ]Heart Center, Peking University People’s Hospital, Beijing, 100044, PR, China
                Article
                1471-2458-12-921
                10.1186/1471-2458-12-921
                3526583
                23110697
                07cc7ef3-ff07-4807-a893-2155d7d0183b
                Copyright ©2012 Zhan et al.; licensee BioMed Central Ltd.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 14 March 2012
                : 2 October 2012
                Categories
                Research Article

                Public health
                socioeconomic status,metabolic syndrome,cross-sectional study
                Public health
                socioeconomic status, metabolic syndrome, cross-sectional study

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