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Individual and Neighborhood Socioeconomic Status Characteristics and Prevalence of Metabolic Syndrome: The Atherosclerosis Risk in Communities (ARIC) Study

From the Department of Epidemiology (K.L.C., K.M.R., G.H.), School of Public Health, the University of North Carolina at Chapel Hill, North Carolina; Department of Epidemiology (A.V.D.-R.), University of Michigan School of Public Health, Ann Arbor, Michigan; Department of Medicine (S.H.G.), Johns Hopkins University School of Medicine, Baltimore, Maryland; and Merck and Co. (A.M.M.), North Wales, Pennsylvania.

Address correspondence and reprint requests to Kristal Chichlowska, MPH, Bank of America Center, 137 E Franklin St, Ste 306, Chapel Hill, NC 27514. E-mail: raymon{at}email.unc.edu

Objective: The objective of this study was to examine the association of individual socioeconomic status (iSES) and neighborhood SES (nSES) on the prevalence of metabolic syndrome (MetS) in the Atherosclerosis Risk in Communities Study (1987–1999).

Methods: Participants included 2932 black and 9777 white men and women aged 45 to 64 years without diabetes at baseline. Total combined family income for the past 12 months and six census tract socioeconomic measures combined into a composite index were used to quantify iSES and nSES, respectively. Poisson regression was used to assess associations of the joint contribution of iSES and nSES on the MetS, stratified by gender and race and adjusting for multiple covariates. For analyses that included nSES, hierarchical modeling techniques were used.

Results: Using 2005 Third Report of the Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults criteria, MetS was identified in 40% of black women, 30% of white women, 28% of black men, and 35% of white men. Among black and white men, there was no association between MetS and iSES or nSES. In contrast, after adjustment for risk factors, black and white women with low (L)-iSES and medium (M)-iSES were more likely to have MetS than those with high (H)-iSES. Similar but weaker patterns were noted for L-nSES and M-nSES.

Conclusions: In summary, both iSES and nSES were independently associated with an increased prevalence of MetS among women but not men. Efforts aimed at understanding the causes of these gender differences may offer insight into avenues for reducing the prevalence of the MetS and its chronic disease sequelae.

Key Words: SES • income • neighborhood • metabolic syndrome • syndrome X • insulin resistance • stress

Abbreviations: MetS = metabolic syndrome; CVD = cardiovascular disease; SES = socioeconomic status; iSES = individual-level socioeconomic status; nSES = neighborhood-level socioeconomic status; ARIC = atherosclerosis risk in communities study; NC = North Carolina; MS = Mississippi; MN = Minnesota; MD = Maryland; L = low; M = middle; H = high; LDL-C = low-density lipoprotein cholesterol; PR = prevalence ratio; CI = confidence interval.