Socioeconomic Disparities in Metabolic Syndrome Differ by Gender: Evidence from NHANES III
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
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This work was supported by a fellowship from the Harvard Center for Society and Health.