When examining human epidemiological data, a web of correlations link health, life span, education, wealth, intelligence, and socioeconomic status. One can hypothesize about why these correlations exist, and to what degree different mechanisms contribute to the overall effect, but it remains challenging to draw firm conclusions from the data. For example, reasonably compelling evidence suggests that intelligence is related to physical resilience via biological mechanisms, and so relationships between intelligence and health outcomes may not be entirely a matter of behavior. How much is behavior versus physiology is up for debate. The paper noted here is focused on socioeconomic status and is illustrative of much of the research into such correlations, in that it suggests that a differing distribution of lifestyle choices across the socioeconomic spectrum is not the only mechanism at play in producing differences in health outcomes.
Lifestyle factors significantly influence the risk of developing non-communicable diseases like type 2 diabetes, cancer, and cardiovascular diseases and can modify health trajectories towards multimorbidity. Separately, socioeconomic position (SEP) is a key determinant of health outcomes and is recognised as a driver of inequalities in the risk of multimorbidity. Multimorbidity is socially patterned, with lower SEP linked to higher risk.
We examined whether a Healthy Lifestyle Index (HLI) mediates the SEP-multimorbidity association. 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.
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 for those with low SEP compared with high SEP, in women 1.74. The study suggests that lifestyle factors partially mediate the relationship between SEP and the development of multimorbidity. However, this also indicates that other factors beyond lifestyle, such as biological or social determinants, may be at play.
Link: https://doi.org/10.1136/jech-2025-224476
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