Socioeconomic status of healthcare professionals is associated with health outcomes, with health behaviours playing a role

1. In three cohorts of healthcare professionals, diet was associated with long-term health after adjusting for individual- and neighbourhood-level socioeconomic status (SES). 

2. Health behaviours such as dietary patterns accounted for a significant portion of the relationship between neighbourhood SES and health outcomes. 

Evidence Rating Level: 1 (Excellent) 

Study Rundown: Diet plays a crucial role in long-term health outcomes, however, it is difficult to understand the complex relationship between socioeconomic status (SES), dietary patterns, and health outcomes. Previous studies have been observational since randomized clinical trials have not been feasible. Although they have suggested strong associations, the studies have been limited by confounding factors. To address this gap in literature, this study compiled data from 3 cohorts of health professionals to understand how SES influences diet and health outcomes, and the role that behavioural factors have in mediating the associations. The cohorts included the Nurses’ Health Study (NHS), the NHS II, and the Health Professionals Follow-Up Study. To assess dietary intake, participants completed a food-frequency questionnaire every 4 years. Their addresses were used to derive neighbourhood SES factors, while questionnaires were used to assess their individual SES factors. The primary outcomes were incident major CVD, T2D and mortality, while the secondary outcome was cause-specific mortality. Individual- and neighbourhood-socioeconomic factors both have the ability to alter diet quality. When adjusting for them, there were minimal changes in the association between dietary patterns and health outcomes.  The generalizability of this study may be limited since only healthcare professionals were included, with majority of them being women. Despite this, the study showed that between health behaviours accounted for some of the association between SES and health. This study highlights the significance of dietary interventions in reducing health disparities linked to neighbourhood SES. 

Click here to read the study in JAMA Network Open 

Relevant reading: Socioeconomic Status and Cardiovascular Outcomes: Challenges and Interventions 

In-Depth [prospective cohort study]: This prospective cohort study was conducted to understand the associations between neighbourhood and individual level SES and dietary patterns. Participants were excluded if they had a history of cardiovascular disease (CVD), type 2 diabetes (T2D), or cancer, or if they died during the study period. If data was missing for participants, or their energy intake was implausible, they were also excluded.  A total of 152 192 health professionals were included for major CVD analysis (mean [SD] age, 52.0 [8.7] years)), 151 217 for T2D analysis (mean [SD] age, 52.0 [8.6] years), and 141 145 for mortality analysis (mean [SD] age, 51.6 [8.5] years). Over an average follow-up period of 22.0 years (SD, 5.2) there were 8038 major CVD cases, 11 572 T2D cases, and 19 788 deaths. There was an inverse association between a healthy diet and risk for major CVD (HR, 0.87 [95% CI, 0.82-0.93]), T2D (HR, 0.79 [95% CI, 0.75-0.84]), and mortality (HR, 0.84 [95% CI, 0.81-0.88]). Similarly, there was also an inverse relationship between neighbourhood SES and major CVD (HR, 0.90 [95% CI, 0.85-0.95]), T2D (HR, 0.92 [95% CI, 0.88-0.97]), and mortality (HR, 0.91 [95% CI, 0.88-0.94]). Adjusting for SES had minimal impact on the associations between diet and health outcomes. When not adjusting for SES, the HRs were 0.85 (5% CI, 0.80-0.91), 0.78 (95% CI, 0.74-0.82), and 0.82 (95% CI, 0.79-0.85) for CVD, T2D, and mortality, respectively. A significant portion of the associations with risk for major CVD (46.3% [95% CI, 32.5%-60.6%]), T2D (77.4% [95% CI, 64.5%-86.6%]), and mortality (42.8% [95% CI, 32.9%-53.3%]) are explained by behavioural factors. Overall, in this prospective cohort study of health professionals, the association between dietary pattern and long-term health persisted even after adjusting for neighbourhood- and individual-level SES. 

Image: PD

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