Does lifestyle explain the relationship between socioeconomic position and multimorbidity of cancer and cardiometabolic diseases? A mediation analysis applied to the European Prospective Investigation into Cancer and Nutrition
Year: 2025
Type: article
Abstract: BACKGROUND: Multimorbidity is socially patterned, with lower socioeconomic position (SEP) linked to higher risk. We examined whether a Healthy Lifestyle Index (HLI) mediates the SEP-multimorbidity association and whether pathways differ by sex. METHODS: We used data from 244 886 participants in the European Prospective Investigation into Cancer and Nutrition study. HLI was derived from smoking, alcohol consumption, physical activity, body mass index and diet. SEP was categorised into low, medium and high-SEP based on education. Multimorbidity was defined as the coexistence of at least two diseases among cancer, type 2 diabetes and cardiovascular diseases. Logistic regression assessed SEP-HLI association, Cox regression SEP-multimorbidity and HLI-multimorbidity associations. Counterfactual mediation analysis estimated the natural indirect effect (NIE) and pure direct effect (PDE). Analyses were stratified by sex. RESULTS: Participants from lower SEP categories were older with worse health outcomes. Women had a healthier lifestyle than men across all SEP levels. In men, the hazard ratio of developing multimorbidity was 1.40 (95% CI: 1.26 to 1.54) for those with low SEP compared with high SEP, in women 1.74 (95% CI: 1.52 to 2.00). Comparing low versus high SEP, PDE for men was 1.28 (95% CI: 1.15 to 1.41), NIE was 1.09 (95% CI: 1.07 to 1.11) (proportion mediated (PM)=29%). In women, PDE was 1.65 (95% CI: 1.47 to 1.90), NIE 1.05 (95% CI: 1.03 to 1.06) (PM=11%). CONCLUSIONS: Lifestyle behaviours partly mediated the SEP-multimorbidity association, underscoring the need to integrate considerations of socioeconomic disparities into the planning of lifestyle interventions.
Authors: Luca Manfredi, Federica Buscema, Maria Teresa Giraudo, Barbara Sodano, Lisa Padroni, Cinzia Destefanis, Heinz Freisling, Pietro Ferrari, Giulia Cesaroni, Sergio Uzzau, Matthias B Schulze, Calogero Saieva, Rosario Tumino, Elisabete Weiderpass, Komodo Matta, Salvatore Vaccarella, Marcela Guevara, Jytte Halkjær, Anne Tjønneland, Marta Crous-Bou, Verena Katzke, Toktam Pour, Salvatore Panico, Valeria Pala, Ioanna Tzoulaki, Sandar Tin Tin, Christina C Dahm, MªDolores Chirlaque, Carlotta Sacerdote, Fulvio Ricceri
Institutions: University of Turin, University of Florence, Centre international de recherche sur le cancer, Regione Lazio, University of Sassari, University of Potsdam, German Institute of Human Nutrition, Associazione Iblea per la Ricerca Epidemiologica E.T.S., Instituto de Salud Pública de Navarra, Navarre Institute of Health Research, Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, Danish Cancer Society, Harvard University, Institut Català d'Oncologia, German Cancer Research Center, University of Naples Federico II, Fondazione IRCCS Istituto Nazionale dei Tumori, Academy of Athens, Biomedical Research Foundation of the Academy of Athens, Imperial College London, University of Oxford, Aarhus University, Instituto Murciano de Investigación Biosanitaria, Universidad de Murcia, Università degli Studi del Piemonte Orientale “Amedeo Avogadro”
Language: English
Subfield: Health
Field: Social Sciences
Domain: Social Sciences
Open Access status: hybrid
OpenAlex ID: W4414435359