International Journal of Public Health

, Volume 62, Issue 5, pp 551–562 | Cite as

Relative contribution of health-related behaviours and chronic diseases to the socioeconomic patterning of low-grade inflammation

  • Marialaura BonaccioEmail author
  • Augusto Di Castelnuovo
  • George Pounis
  • Amalia De Curtis
  • Simona Costanzo
  • Mariarosaria Persichillo
  • Chiara Cerletti
  • Maria Benedetta Donati
  • Giovanni de Gaetano
  • Licia Iacoviello
  • On behalf of the Moli-sani Study Investigators
Original Article



To test the association of low-grade inflammation with socioeconomic status (SES) and determine the relative contribution of prevalent chronic diseases and health-related behaviours in explaining such association.


Cross-sectional analysis on 19,867 subjects (age ≥35, 48.1% men) recruited within the Moli-sani study from 2005 to 2010 (Italy). A score of low-grade inflammation, including platelet and leukocyte counts, the granulocyte-to-lymphocyte ratio, and C-reactive protein was applied. SES was measured by education, household income, and occupational social class.


Low SES was associated with elevated levels of low-grade inflammation. Health behaviours (including adiposity, smoking, physical activity, and Mediterranean diet adherence) explained 53.5, 53.9, and 84.9% of the association between social class, income, and education with low-grade inflammation, respectively. Adiposity and body mass index showed a prominent role, while prevalent chronic diseases and conditions only marginally attenuated SES inequalities in inflammation.


Low-grade inflammation was socioeconomically patterned in a large Mediterranean population. Potentially modifiable behavioural factors explained the greatest part of this association with a leading contribution of adiposity, body mass index, and physical activity.


Moli-sani study Socioeconomic status Low-grade inflammation Health-related behaviours Chronic diseases 



The Moli-sani research group thanks the Associazione Cuore Sano Onlus (Campobasso, Italy) for its financial and cultural support.

Moli-sani Study Investigators: The enrolment phase of the Moli-sani Project was conducted at the Research Laboratories of the Catholic University in Campobasso (Italy), the follow-up of the Moli-sani cohort is being conducted at the IRCCS Neuromed, Pozzilli, Italy.

Steering Committee: Licia Iacoviello (Neuromed, Pozzilli, Italy), Chairperson, Maria Benedetta Donati, and Giovanni de Gaetano (Neuromed, Pozzilli, Italy).

Safety and data monitoring Committee: Jos Vermylen (Catholic Univesity, Leuven, Belgio), Chairman, Ignacio De Paula Carrasco (Accademia Pontificia Pro Vita, Rome, Italy), Simona Giampaoli (Istituto Superiore di Sanità, Roma, Italy), Antonio Spagnuolo (Catholic University, Rome, Italy).

Event adjudicating Committee: Deodato Assanelli (Brescia, Italy), Vincenzo Centritto (Campobasso, Italy), Pasquale Spagnuolo, and Dante Staniscia (Termoli, Italy).

Scientific and organizing secretariat: Francesco Zito (Coordinator), Americo Bonanni, Chiara Cerletti, Amalia De Curtis, Augusto Di Castelnuovo, Licia Iacoviello, Roberto Lorenzet, Antonio Mascioli, Marco Olivieri, and Domenico Rotilio.

Data management and analysis: Augusto Di Castelnuovo (Coordinator), Marialaura Bonaccio, Simona Costanzo, and Francesco Gianfagna.

Informatics: Marco Olivieri (Coordinator), Maurizio Giacci, Antonella Padulo, and Dario Petraroia.

Biobank and biomedical analyses: Amalia De Curtis (Coordinator), Sara Magnacca, Federico Marracino, Maria Spinelli, and Christian Silvestri.

Communication and Press Office: Americo Bonanni (Coordinator), Marialaura Bonaccio, and Francesca De Lucia.

Moli-family Project: Francesco Gianfagna, Branislav Vohnout.

Recruitment staff: Franco Zito (General Coordinator), Secretariat: Mariarosaria Persichillo (Coordinator), Angelita Verna, Maura Di Lillo, Irene Di Stefano, Blood sample: Agnieszka Pampuch; Branislav Vohnout, Agostino Pannichella, Antonio Rinaldo Vizzarri, Spirometry: Antonella Arcari (Coordinator), Daniela Barbato, Francesca Bracone, Simona Costanzo, Carmine Di Giorgio, Sara Magnacca, Simona Panebianco, Antonello Chiovitti, Federico Marracino, Sergio Caccamo, Vanesa Caruso; Electrocardiograms : Livia Rago (Coordinator), Daniela Cugino, Francesco Zito, Francesco Gianfagna, Alessandra Ferri, Concetta Castaldi, Marcella Mignogna; Tomasz Guszcz, Questionnaires: Romina di Giuseppe (Coordinator), Paola Barisciano, Lorena Buonaccorsi, Floriana Centritto, Antonella Cutrone, Francesca De Lucia, Francesca Fanelli, Iolanda Santimone, Anna Sciarretta, Maura Di Lillo, Isabella Sorella, Irene Di Stefano, Emanuela Plescia, Alessandra Molinaro, and Christiana Cavone.

Call Center: Giovanna Galuppo, Maura Di Lillo, Concetta Castaldi, Dolores D’Angelo, and Rosanna Ramacciato.

Follow-up: Simona Costanzo (Coordinator); Data management: Simona Costanzo, and Marco Olivieri; Event adjudication: Livia Rago (Coordinator), Simona Costanzo, Amalia de Curtis, Licia Iacoviello, and Mariarosaria Persichillo.

Regional Health Institutions: Azienda Sanitaria Regionale del Molise (ASReM, Campobasso, Italy), UOC Servizio Igiene e Sanità Pubblica - Dipartimento di Prevenzione; Offices of vital statistics of the Molise region and Molise Dati Spa (Campobasso, Italy).

Hospitals: Presidi Ospedalieri ASReM (Presidio Ospedaliero A. Cardarelli—Campobasso, Ospedale F. Veneziale—Isernia, Ospedale San Timoteo—Termoli (CB), Ospedale Ss. Rosario—Venafro (IS), Ospedale Vietri—Larino (CB), Ospedale San Francesco Caracciolo—Agnone (IS); Istituto di cura Villa Maria—Campobasso; Fondazione di Ricerca e Cura Giovanni Paolo II—Campobasso; IRCCS Neuromed—Pozzilli (IS).

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.


The enrolment phase of the Moli-sani Study (2005–2010) was performed at the Research Laboratories, Catholic University of Campobasso, Italy, and was supported by research grants from Pfizer Foundation (Rome, Italy), the Italian Ministry of University and Research (MIUR, Rome, Italy)—Programma Triennale di Ricerca, Decreto no.1588 and Instrumentation Laboratory, Milan, Italy. Marialaura Bonaccio is presently supported by a Fondazione Umberto Veronesi Fellowship. The analyses reported here were partially supported by the Italian Ministry of Health [Grant number GR-2013-02356060]. Funders had no role in study design, collection, analysis, and interpretation of data; in the writing of the manuscript and in the decision to submit the article for publication. All authors were and are independent from funders.

Ethical approval

All procedures performed in the present study, involving human participants, were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Written informed consent was obtained from all individual participants included in the study.

Supplementary material

38_2016_939_MOESM1_ESM.doc (82 kb)
Supplementary material 1 (DOC 81 KB)


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Copyright information

© Swiss School of Public Health (SSPH+) 2017

Authors and Affiliations

  • Marialaura Bonaccio
    • 1
    Email author
  • Augusto Di Castelnuovo
    • 1
  • George Pounis
    • 1
  • Amalia De Curtis
    • 1
  • Simona Costanzo
    • 1
  • Mariarosaria Persichillo
    • 1
  • Chiara Cerletti
    • 1
  • Maria Benedetta Donati
    • 1
  • Giovanni de Gaetano
    • 1
  • Licia Iacoviello
    • 1
  • On behalf of the Moli-sani Study Investigators
  1. 1.Department of Epidemiology and PreventionIRCCS Istituto Neurologico Mediterraneo NEUROMEDPozzilliItaly

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