Elucidating the Multidimensionality of Socioeconomic Status in Relation to Metabolic Syndrome in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL)
Socioeconomic (SES) factors underlying disparities in the prevalence of metabolic syndrome (MetSyn) and consequently, type 2 diabetes among Hispanics/Latino populations are of considerable clinical and public health interest. However, incomplete and/or imprecise measurement of the multidimensional SES construct has impeded a full understanding of how SES contributes to disparities in metabolic disease. Consequently, a latent-variable model of the SES-MetSyn association was investigated and compared with the more typical proxy-variable model.
A community-based cross-sectional probability sample (2008–2011) of 14,029 Hispanic/Latino individuals of Puerto Rican, Cuban, Dominican, Central American, South American, and Mexican ancestry living in the USA was used. SES proxy’s education, income, and employment were examined as effect indicators of a latent variable, and as individual predictors. MetSyn was defined using 2009 harmonized guidelines, and MetSyn components were also examined individually.
In multivariate regression analyses, the SES latent variable was associated with 9% decreased odds of MetSyn (95% confidence interval: 0.85, 0.96, P < .001) and was associated with all MetSyn components, except diastolic blood pressure. Additionally, greater income, education, and employment status were associated with 4%, 3%, and 24% decreased odds of having MetSyn, respectively (Ps < .001). The income-MetSyn association was only significant for women and those with current health insurance.
Hispanic/Latinos exhibit an inverse association between SES and MetSyn of varying magnitudes across SES variables. Public health research is needed to further probe these relationships, particularly among Hispanic/Latina women, to ultimately improve healthcare access to prevent diabetes in this underserved population.
KeywordsHealth disparities Hispanics/Latinos Latent models Metabolic syndrome Socioeconomic status Women’s health
The authors thank the more than 250 staff members of the HCHS/SOL for their dedication and expertise. The study website is http://www.cscc.unc.edu/hchs/.
The HCHS/SOL was carried out as a collaborative study supported by contracts from the National Heart, Lung, and Blood Institute (NHLBI) to the University of North Carolina (N01-HC25233), University of Miami (N01-HC65234), Albert Einstein College of Medicine (N01-HC65235), Northwestern University (N01-HC65236), and San Diego State University (N01-HC65237). The following institutes/centers contributed to the baseline HCHS/SOL funding period through a transfer of funds to the NHLBI: National Institute on Minority Health and Health Disparities, National Institute on Deafness and Other Communication Disorders, National Institute of Dental and Craniofacial Research, National Institute of Diabetes and Digestive and Kidney Diseases, National Institute of Neurological Disorders and Stroke, and National Institute of Health Office of Dietary Supplements. T.E., T.K., A.M., S.R., and D.V. were supported by T32 HL07426. These funding sources were not involved in the study design, data collection, analysis and interpretation of data, in the writing of this manuscript, or in the decision to submit it for publication.
Compliance with Ethical Standards
Conflict of Interest
The authors declare that they have no conflict of interest.
The study protocol was approved by the Institutional Review Board (IRB) at each field center, namely the University of Miami IRB, the University of North Carolina IRB, Albert Einstein College of Medicine IRB, San Diego State University IRB, and Northwestern University IRB. Written informed consent was obtained from all participants.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
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