Association Of Lifestyle And Socioeconomic Status With Incident Cardiometabolic Multimorbidity

Objective:Cardiometabolic multimorbidity（CMM）refers to suffering from two or more kinds of cardiometabolic diseases including coronary heart disease,type 2 diabetes,and stroke,which is an important cause of increasing disease burden worldwide.Previous studies have shown that single cardiometabolic disease risk factors may not affect the risk of CMM,so further research on CMM-related risk factors is needed to provide a theoretical basis for the prevention of comorbidities.In recent years,more and more studies have shown that sleep and sedentary behavior have an important impact on population health.However,previous studies mostly evaluated the correlation between lifestyle and disease through population smoking,dietary habits,alcohol consumption and physical activity.So far,no studies have included sleep and sedentary behavior in lifestyle evaluation to explore the correlation between lifestyle and CMM risk.In addition,it is unclear whether socioeconomic status,as an important factor affecting health,influences CMM susceptibility.Therefore,the purpose of this study was to use the UK Biobank（UKB）,a large prospective cohort study,to investigate the association of lifestyle added risk factors（sleep and sedentary behavior）and socioeconomic status with the risk of developing CMM,and to further analyze the effect of the combined effect of lifestyle and socioeconomic status on the development of CMM.Methods:This study used data from the prospective cohort study（UKB）.Follow-up started at the time participants entered the cohort（2006-2010）,the outcome event was the occurrence of two cardiometabolic diseases in hospital-diagnosed participants,and the follow-up ended at the date the assessment center completed the data review（February 28,2018）.A total of 138776 participants were included in the study.All participants had complete baseline information and no history of cardiometabolic disease or cancer at baseline.According to smoking,dietary habits,alcohol consumption,physical activity,sleep duration and sedentary behavior,lifestyle health grade was evaluated.The Townsend Deprivation Index（TDI）distribution was used to evaluate participants’socioeconomic status.Associations between lifestyle and socioeconomic status and risk of CMM were assessed using hazard ratios（HRs）and 95%confidence intervals（CIs）calculated by Cox multivariate regression models.In addition,multiple sensitivity analyses were used to verify the robustness of the association analysis,and the interaction between lifestyle and socioeconomic status was also explored.Results:Of the 138776 participants,1745 developed CMM（cumulative incidence:1.26%）at a median follow-up time of 8.92 years（interquartile interval:8.25-9.67）.After adjusting for confounding factors such as gender and age,the moderately healthy and unhealthy group had a higher risk of morbidity than those who adhered to a healthy lifestyle,with a HR of 1.42（95%CI=1.26-1.59）and 1.75（95%CI=1.48-2.08）(P_-trend<0.001).respectively.At the same time,the risk of CMM was higher in males and non-elderly（aged less than 60 years）with unhealthy lifestyles(P_-interaction<0.05).Compared with high socioeconomic status participants,the risk of CMM increased with decreasing socioeconomic status,reaching 1.33（95%CI=1.18-1.51）and 1.58 times（95%CI=1.39-1.79）(P_-trend<0.001)for middle and low socioeconomic status participants.In the subgroup analysis,there was no interaction between socioeconomic status and different subgroups(P_-interaction>0.05).In different socioeconomic status subgroups,unhealthy lifestyle increased the risk of CMM in all three socioeconomic status groups(P_-trend<0.001).In the pooled analysis,participants with low socioeconomic status and unhealthy lifestyle had 2.65 times（95%CI=2.02-3.48）the risk of developing CMM compared with those with high socioeconomic status and healthy lifestyle.No significant interaction between lifestyle and socioeconomic status was found in our study(P_-interaction=0.543).Conclusion:Lifestyle and socioeconomic status are associated with the risk of CMM.Unhealthy lifestyle is an increased risk factor for CMM,and the risk is more severe in men and people younger than 60 years of age.In contrast to"new"lifestyle measures that include sleep duration and sedentary behavior,"traditional"measures that rely solely on smoking,alcohol consumption,diet and physical activity may underestimate the association between lifestyle and disease.Low socioeconomic status is a risk factor for the increase of CMM.There was no interaction between lifestyle and socioeconomic status,but people of different socioeconomic status could reduce the risk of CMM by changing lifestyle.At the same time,there is a need to integrate integrated lifestyle interventions into the health management of people of different socioeconomic status.