kjhp Korean Journal of Health Promotion Korean J Health Promot 2234-2141 2093-5676 The Korean Society of Health Promotion and Disease Prevention 10.15384/kjhp.2016.16.2.92 kjhp-16-92 Original Article The Relationship between Socioeconomic Status and Metabolic Syndrome, Using Structural Equation Modelling KimSung Hi Department of Family Medicine, Daegu Catholic University Hospital, Daegu, Korea Corresponding author: Sung Hi Kim, MD, PhD Department of Family Medicine, Daegu Catholic University Hospital, 33 Duryugongwon-ro 17-gil, Nam-gu, Daegu 42472, Korea Tel: +82-53-650-4247, Fax: +82-53-650-4122 E-mail: khmksh@cu.ac.kr 01 2016 20 01 2016 16 2 92 100 20012016 17052016 Copyright © 2016 The Korean Society of Health Promotion and Disease Prevention 2016 This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Background

This study aimed to investigate the complexity of the relationships between socioeconomic status, health behaviors, stress and risks of metabolic syndrome. By applying structural equational modelling, modified generalized conceptual model had described the associations and interactions among them.

 Methods

24,210 participants (8,242 men, 15,968 women) registered with the Korean Health Examinee Cohort (KOEX) between 2004 to 2008. This study collected data on the socioeconomic status, health behaviors, and stress through individual interviews. Socioeconomic status (education, house income, occupation), health behaviors (diet, physical activity, smoking, alcohol consumption) and stress level were defined as exogenous factors. Endogenous variables were risks of metabolic syndrome based on modified National Cholesterol Education Program Adult Treatment Panel-lll (NCEP ATP-lll, 2006).

 Results

According to model fitness test, these proposed model were acceptable in men, comparative fit in-dex=0.877, incremental fit Index=0.877, Tucker-Lewis index=0.757, root-mean-squared error associated=0.055. These were compatible also in women as comparative fit index=0.924, incremental fit index=0.924, Tucker-Lewis index=0.851, root-mean-squared error associated=0.050. There were sex difference related to risks of metabolic syndrome: in men socioeconomic status (β=-0.08), health behaviors (β=-0.25) and stress (β =-0.25) were relevant, but in women only socioeconomic status (β=-0.25) was relevant (P<0.05).

 Conclusions

A conceptual model properly explains how Socioeconomic status may influence on health behaviors, stress, and risks of metabolic syndrome. Health behaviors in men and socioeconomic status in women had the strongest associations with risks of metabolic syndrome. In addition, socioeconomic status was strongly associated with health behaviors, stress and age.

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Modified generalized conceptual model of potential pathway through which social status is linked to health.

Modified conceptual model; a summary of the interactions of Socioeconomic status (SES) influencing metabolic syndrome risk, in men Path coefficients are presented as standardised regression weight; dashed lines represent relationships that were non significant, model fitincluded in the exploratory analysis, but were non-significant. Model fit: X2=40.395, d.f=28, P<0.001, CFI=0.924, IFI=0.924 TLI=0.851, RMSEA=0.050.

Modified conceptual model; a summary of the interactions of Socioeconomic status (SES) influencing metabolic syndrome risk, in men path coefficients are presented as standardised regression weight; dashed lines represent relationships that were non significant, model fit included in the exploratory analysis, but were non-significant. Model fit: X2=35.843, d.f=28, P<0.001, CFI=0.877, IFI=0.877, TLI=0.757, RMSEA=0.055.

Health behaviors, stress, and socioeconomic status of study population

Variables   Total (n=24,210)
  Men (n=8,242) Women (n=15,968) P
General characteristics and health behaviorsa        
Age, y   52.9±8.1 50.8±7.1 <0.001
Smoking, pack years   15.4±16.0 0.2±1.9 <0.001
Alcohol intakeb, g/day   25.9±36.5 2.4±8.8 <0.001
Exercisec, Kcal/day   201.0±250.9 180.3±203.3 <0.001
Diet scored   13.9±2.7 15.7±2.9 <0.001
Score of psychosocial wellbeing index (PWI)e   16.0±7.8 18.5±8.2 <0.001
Socioeconomic statuse        
Education, y None 49 (0.6) 207 (1.3) <0.001
  < 6 66 (0.8) 271 (1.7)  
  6–8 626 (7.6) 2,187 (13.7)  
  9–11 963 (11.7) 2,763 (17.3)  
  12–13 2,840 (34.5) 6,324 (39.6)  
  14 338 (4.1) 479 (3.0)  
  15 247 (3.0) 335 (2.1)  
  16–17 2,273 (27.6) 2,907 (18.2)  
  ≥ 18 840 (10.1) 495 (3.1)  
House income, 10,000 won <50 50–99 362 (4.4) 342 (4.1) 984 (6.2) 1,022 (6.4) <0.001
  100–149 666 (8.1) 1,435 (9.0)  
  150–199 812 (9.9) 1,472 (9.2)  
  200–299 1,886 (22.9) 3,399 (21.3)  
  300–300 1,777 (21.6) 3,109 (19.5)  
  400–599 1,643 (19.9) 3,103 (19.4)  
  ≥600 754 (9.1) 1,444 (9.0)  
Job Managers, Professionals 1,541 (18.7) 1,319 (8.3) <0.001
  Office workers 1,285 (15.6) 855 (5.3)  
  Sales workers 729 (8.8) 1,705 (10.7)  
  Service workers 651 (7.9) 917 (5.7)  
  Operatives 2,724 (33.1) 1,712 (10.7)  
  Soldier 82 (1.0) 0  
  House wife 0 9,197 (57.6)  
  Unemployed 1,183 (14.3) 137 (0.9)  
  Non response 47 (0.6) 126 (0.8)  

Values were presented as mean±SD or n (%).

Aanalyzed by t-test.

Daily alcohol intake.

Leisure-time physical activity.

Based on daily consumption amount of 5 food groups (fruits, vegetables, crude fibers, red meats and sodium) from Food Frequency Questionnaire (FFQ).

Analyzed by chi-square test.

Comparison of metabolic syndrome and it's components, and prevalence of diabetes and cardiovascular disease according to gender

Variables Total (n=24,210)
Men (n=8,242) Women (n=15,968) P
Component of MetS, BMI and number of MetS componenta      
Waist 85.9±7.3 78.9±7.8 <0.000
BP systolic, mmHg 125.9±14.8 118.9±15.2 <0.001
diastolic, mmHg 79.1±10.2 73.8±10.0 <0.001
TG, mg/dL 150.0±105.7 105.7±69.1 <0.001
FBS, mg/dL 95.4±16.6 89.6±14.1 <0.001
HDL, mg/dL 49.2±11.5 56.2±12.4 <0.001
BMI, kg/m2 24.4±2.7 23.5±2.8 <0.001
Number of MetS 1.6±1.2 1.1±1.1 <0.001
Prevalence of chronic disease and metabolic syndromeb      
CVA 140 (1.7) 128 (0.8) <0.001
MI 297 (3.6) 287 (1.8) <0.001
Diabetes 717 (8.7) 737 (4.6) <0.001
MetS 2,291 (27.8) 2,650 (16.6) <0.001

Abbreviations: Mets, metabolic syndrome; BMI, body mass index; BP, blood pressure; TG, triglyceride; FBS, fasting blood sugar; HDL, high density lipoprotein cholesterol; CVA, cerebrovasculr accident; MI, myocardial infarction. Values were presented as mean±SD or n (%).

Analyzed by t-test.

Analyzed by chi-square test.

Confirmatory factor analysis and pathway analysis: regression weight and standarized regression weight for measures of Metabolic syndrome risk

Variables Total (n=24,210)
Men (n=8,242) Women (n=15,968)
Regression Standarized P Regression Standarized P
weight regression weight weight regression weight
Factor loading of latent variables            
SES            
Job 1 0.63 <0.001 1 0.35 <0.001
House income 0.14 0.71 <0.001 0.29 0.71 <0.001
Education 0.13 0.65 <0.001 0.27 0.72 <0.001
Health behavior            
Diet scorea 1 0.37 <0.001 1 0.36 <0.001
LTPA, Kcal/day 75.69 0.31 <0.001 56.32 0.28 <0.001
Pack year 4.10 0.26 <0.001 0.30 0.16 <0.001
Alcohol intakeb, g/day 10.8 0.30 <0.001 1.74 0.20 <0.001
Pathway coefficients            
SES            
Age –0.52 –0.45 <0.001 0.39 –0.57 <0.001
Health behavior            
Age 0.05 0.37 <0.001 0.06 0.14 <0.001
SES c 0.04 0.37 <0.001 0.07 0.32 <0.001
Stressc –0.04 –0.30 <0.001 –0.04 –0.33 <0.001
Stressc            
Age –0.15 –0.16 <0.001 –0.18 –0.16 <0.001
SES –0.16 –0.20 <0.001 –0.37 –0.22 <0.001
MetS risk            
Age 0.02 0.15 <0.001 0.03 0.19 <0.001
SES 0.01 0.07 <0.001 –0.05 –0.20 <0.001
Health behavior –0.31 –0.25 <0.001 –0.01 –0.01 0.54
Stressc –0.01 –0.08 <0.001 –0.00 –0.02 0.06

Abbreviations: SES, socioeconomic status; LTPA, leisure time physical activity; MetS, metabolic syndrome.

Based on daily consumption amount of 5 food groups(fruits, vegetables, crude fibers, red meats, and sodium) from Food Frequency Questionnaire (FFQ).

Daily alcohol intake.

Psychosocial wellbeing index.