An unhealthy lifestyle explains solely a small fraction of the well being inequalities amongst adults within the US and the UK


Unhealthy lifestyles alone explain only a small fraction of the socioeconomic health inequalities among adults in the United States and the United Kingdom. This suggests data from two large studies published today by the BMJ.

The results show that the poorest people with the least healthy lifestyles are 2.7 to 3.5 times more likely to die than the wealthiest people with the healthiest lifestyles.

While healthy lifestyles play an important role in reducing the burden of disease, researchers caution that promoting healthy lifestyles alone “may not substantially reduce socioeconomic inequality in health and other measures to combat social determinants of health may be warranted” .

It is known that disadvantaged socio-economic status (the measure of a person’s social and economic standing) and an unhealthy lifestyle are associated with poor health.

Lifestyle factors are widely viewed as intermediaries between socioeconomic status and health, but it is not clear to what extent a healthy lifestyle can alleviate socioeconomic health inequalities.

To investigate this further, an international research team used data from the US National Health and Nutrition Examination Survey (US NHANES) and the UK Biobank to assess the complex relationships between lifestyle and socioeconomic status with death and heart disease.

Their results are based on 44,462 US adults aged 20 years or older and 399,537 UK adults aged 37 to 73 years.

Socio-economic status was defined in terms of family income, occupational or employment status, educational level in both groups, and health insurance for US participants. A healthy lifestyle score was derived using information on smoking, alcohol consumption, physical activity, and diet.

Medical records were then used to track all cause deaths (“all cause mortality”) in both adults in the US and the UK, and cases of cardiovascular disease (CVD) and CVD deaths in adults in the UK.

In an average follow-up period of 9 to 11 years, the US NHANES documented 8,906 deaths and the British biobank 22,309 deaths and 6,903 CVD cases.

For adults with low socioeconomic status, the age-adjusted risk of death in the US NHANES and UK biobank were 22.5 and 7.4 per 1000 person-years, respectively, and the age-adjusted CVD risk in the UK biobank was 2.5 per 1000 person-years.

The corresponding risks in adults with high socioeconomic status were 11.4, 3.3 and 1.4 per 1000 person-years.

Compared to adults with high socioeconomic status, those with low socioeconomic status consistently had higher risks for mortality and CVD, and lifestyle factors only explained 3% to 12% of the excessive risks.

The highest mortality and CVD risks were seen in adults with low socioeconomic status and the least healthy lifestyle.

Compared to adults with high socioeconomic status and three or four healthy lifestyle factors, those with low socioeconomic status and no or one healthy lifestyle factor had a 2.09 to 3.53 fold higher risk of mortality and CVD.

This is an observational study, so no cause can be determined. Socio-economic level and lifestyle information was self-reported and therefore may not be completely accurate. However, its strengths included the large sample size from two well-established statewide databases, and the results were similar upon further analysis, suggesting that they are robust.

Unhealthy lifestyles mediated a small fraction of the socioeconomic inequality in terms of health among adults in both the US and the UK. Therefore, promoting healthy lifestyles, while essential, may not by itself be essential to reducing socioeconomic inequalities for health, and other measures to address social determinants of health are warranted, the researchers say.

They call for government policies “to address upstream social and environmental determinants of health,” but also point out that healthy lifestyles are associated with lower mortality and lower risk of CVD in various socio-economic groups, “to play an important role to assist healthy lifestyles in reducing the burden of disease “.


External appraisal? Yes

Evidence type: observational

Subjects: US and UK adults

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