Elsevier

Annals of Epidemiology

Volume 17, Issue 1, January 2007, Pages 19-26
Annals of Epidemiology

Socioeconomic Disparities in Metabolic Syndrome Differ by Gender: Evidence from NHANES III

https://doi.org/10.1016/j.annepidem.2006.07.002Get rights and content

Purpose

The aim of the study is to examine whether socioeconomic position (SEP) is associated with metabolic syndrome and whether the association differs by gender and race/ethnicity.

Methods

Study participants were from the Third National Health and Nutrition Examination Survey. SEP was measured by using education and poverty income ratio (PIR). Metabolic syndrome was measured according to the National Institutes of Health guidelines. Multivariable-adjusted logistic regression analyses were performed.

Results

Low education (<12 years) was associated with metabolic syndrome in women (odds ratio [OR], 1.77; 95% confidence interval [CI], 1.39–2.24) and less so in men (OR, 1.27; 95% CI, 0.97–1.66) versus more than 12 years of education. For income, low PIR (≤1) was related to metabolic syndrome in women (OR, 1.81; 95% CI, 1.37–2.40) and not men (OR, 0.98; 95% CI, 0.74–1.29) versus PIR greater than 3. SEP was associated with metabolic syndrome in white, black, and Mexican-American women. Education was associated with all five metabolic syndrome components in women and only three components (abdominal obesity, hypertension, and hyperglycemia) in men.

Conclusions

SEP is associated with metabolic syndrome in white, black, and Mexican-American women and is associated less strongly in men. The findings provide biologic mechanistic evidence of previously documented associations between SEP and such clinical disorders as type 2 diabetes and coronary heart disease. These results underscore the clinical significance of SEP, particularly for women.

Introduction

Several prospective observational studies showed that low socioeconomic position (SEP; measured as education, income, or occupational class) was associated with increased risk for type 2 diabetes (1) and coronary heart disease (CHD) (2). There is current interest in understanding the biologic mechanisms by which SEP may influence type 2 diabetes and CHD. One candidate mechanism is metabolic syndrome, for which a number of studies, primarily of white participants, showed an association with SEP 3, 4, 5, 6, 7, 8.

Metabolic syndrome is a clustering of risk factors that include abdominal obesity, atherogenic dyslipidemia, increased blood pressure, insulin resistance, proinflammatory state, and prothrombotic state 9, 10. Metabolic syndrome was shown to be a risk factor for type 2 diabetes and CHD 11, 12, although the etiology by which it may contribute to type 2 diabetes and CHD (over and above its individual components) remains to be well understood (10).

Most 3, 4, 5, 6, 7, 8, but not all (13), studies showed inverse relations between SEP and metabolic syndrome. Evidence for gender differences in relations between SEP and metabolic syndrome has emerged. Some 3, 5, 7, 8, although not all 4, 13, studies showed slight to substantially stronger relations between SEP and metabolic syndrome in women compared with men. However, very little is known about which components of metabolic syndrome (e.g., obesity, hypertension, elevated triglyceride levels, hyperglycemia, and/or low high-density lipoprotein [HDL] cholesterol levels) may account for gender differences. Furthermore, almost all studies to date focused on white participants. Consequently, little is understood about whether SEP and metabolic syndrome are associated in particular races or ethnicities.

The objectives of this study are to examine whether SEP is related to prevalence of metabolic syndrome in men and women from a representative sample of the noninstitutionalized US population. Second, we investigated whether particular components of metabolic syndrome may account for gender differences in the relation between SEP and metabolic syndrome. Finally, we aim to elucidate whether the association between SEP and metabolic syndrome differs by race/ethnicity.

Section snippets

Study Sample

The study sample included participants from the Third National Health and Nutrition Examination Survey, a cross-sectional sample representative of the US civilian noninstitutionalized population obtained through a complex multistage probability sample design. Between 1988 and 1994, participants received a household interview and physical examination, including phlebotomy.

Our investigation focuses on the subset of 7895 men and 8821 nonpregnant women aged 25 years and older. Of these 16,716

Results

Characteristics of the study sample, stratified by gender, are listed in Table 1. The sample included 11,107 participants; 5766 (51.9%) were women and 5341 (48.1%) were men. Men were more likely to consume alcohol and dietary fiber, smoke, be physically active, have more years of education, have a higher income, and be younger in comparison to women. Men consumed greater proportions of total fat as a percentage of total caloric consumption and lower proportions of carbohydrates compared with

Discussion

This report shows that SEP, measured by education or income, is associated with metabolic syndrome in women. As a whole SEP and metabolic syndrome are related inversely in white, black and Mexican-American women, with the exception of education in black women, for which women with 12 years of education, but not less than 12 years, have greater odds for having metabolic syndrome compared with those with less than 12 years of education. In men of all races/ethnicities, the association between SEP

References (29)

  • A. Drewnowski et al.

    Poverty and obesity: The role of energy density and energy costs

    Am J Clin Nutr

    (2004)
  • E.E. Agardh et al.

    Explanations of socioeconomic differences in excess risk of type 2 diabetes in Swedish men and women

    Diabetes Care

    (2004)
  • G.A. Kaplan et al.

    Socioeconomic factors and cardiovascular disease: A review of the literature

    Circulation

    (1993)
  • M.R. Carnethon et al.

    Risk factors for the metabolic syndrome: The Coronary Artery Risk Development in Young Adults (CARDIA) Study, 1985-2001

    Diabetes Care

    (2004)
  • K. Silventoinen et al.

    Educational inequalities in the metabolic syndrome and coronary heart disease among middle-aged men and women

    Int J Epidemiol

    (2005)
  • E.J. Brunner et al.

    Social inequality in coronary risk: Central obesity and the metabolic syndrome. Evidence from the Whitehall II Study

    Diabetologia

    (1997)
  • S.P. Wamala et al.

    Education and the metabolic syndrome in women

    Diabetes Care

    (1999)
  • J. Dallongeville et al.

    Household income is associated with the risk of metabolic syndrome in a sex-specific manner

    Diabetes Care

    (2005)
  • Y.W. Park et al.

    The metabolic syndrome: Prevalence and associated risk factor findings in the US population from the Third National Health and Nutrition Examination Survey, 1988-1994

    Arch Intern Med

    (2003)
  • National Cholesterol Education Panel

    Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III)

    (2002)
  • R. Kahn et al.

    The metabolic syndrome: Time for a critical appraisal: Joint statement from the American Diabetes Association and the European Association for the Study of Diabetes

    Diabetes Care

    (2005)
  • S. Malik et al.

    Impact of the metabolic syndrome on mortality from coronary heart disease, cardiovascular disease, and all causes in United States adults

    Circulation

    (2004)
  • D.E. Laaksonen et al.

    Metabolic syndrome and development of diabetes mellitus: Application and validation of recently suggested definitions of the metabolic syndrome in a prospective cohort study

    Am J Epidemiol

    (2002)
  • L. Parker et al.

    A lifecourse study of risk for hyperinsulinaemia, dyslipidaemia and obesity (the central metabolic syndrome) at age 49-51 years

    Diabet Med

    (2003)
  • Cited by (179)

    • Socioeconomic differences in metabolic syndrome development among males and females, and the mediating role of health literacy and self-management skills

      2022, Preventive Medicine
      Citation Excerpt :

      An explanation for the finding that male MetS development was not influenced by occupational prestige may be that, compared to females, males with low occupational prestige are more likely to have physically active occupations (Beenackers et al., 2012), which could protect them from developing MetS (Hoveling et al., 2021). In contrast to other studies (Dallongeville et al., 2005; Loucks et al., 2007), our study showed the effect of income on MetS development to be only marginal, which may also explain the absence of sex differences in this association. In the Netherlands, compared to other countries, weaker associations between income and health outcomes have previously been described (Vart et al., 2013), and may be explained by the fact that the Netherlands is a welfare state in which access to health care is not strongly dependent on material resources.

    • The Lancet women and cardiovascular disease Commission: reducing the global burden by 2030

      2021, The Lancet
      Citation Excerpt :

      Similarly, an analysis from the 2006 Health and Retirement Study151 found a strong association between low socioeconomic status and six of seven cardiovascular risk factors in women older than 50 years. Another study suggested a strong relationship between low socioeconomic status and metabolic syndrome in women.152 In addition, data from the Jackson Heart Study153 in 5301 African American people showed that adult socioeconomic position was more consistently associated with cardiovascular disease risk in women than in men: age-adjusted hazard ratios for low versus high wealth were 2·14 (95% CI 1·39–3·29) in women and 1·06 (95% CI 0·62–1·81) in men (pinteraction=0·0224).

    • The Metabolic Syndrome, a Human Disease

      2024, International Journal of Molecular Sciences
    View all citing articles on Scopus

    This work was supported by a fellowship from the Harvard Center for Society and Health.

    View full text