Life-course social mobility and cardiometabolic disease: evidence from five international cohorts

AIMS: To investigate the associations of life course social determinants of health (SDOH) and social mobility with cardiometabolic disease (CMD) risk and to quantify the contributions of repeatedly measured lifestyle and psychosocial factors. METHODS: Data were pooled from five prospective cohorts across USA, Europe, China, South Korea, and England. Eight SDOH indicators covering education, financial circumstances, healthcare access, and social context were assessed across childhood, early and middle-late adulthood to define stage-specific and cumulative SDOH levels (high, medium, low). 27 social mobility patterns and six mobility trajectories were derived from life course SDOH transitions. CMDs were ascertained through self-reported physician-diagnosed heart diseases, diabetes, or stroke. Cox proportional hazard models were used to estimate hazard ratios (HRs) and 95% confidence intervals (95% CIs). The difference method was applied to estimate the proportion of associations explained by lifestyle and psychosocial factors, and their combined effects with cumulative SDOH on CMD risk were also examined. RESULTS: Among 51 002 participants (mean age 63.2 years; 57.2% women), low SDOH in childhood, early adulthood, middle-late adulthood, and cumulatively across the life course were each associated with higher risks of overall CMDs. Stable low, downward, and increase-then-decline social mobility trajectories were similarly associated with elevated CMD risk. Lifestyle and psychosocial factors accounted for 13.3%-50.5% and 15.8%-73.7% of these associations, respectively. The greatest attenuation was observed for heart diseases. At equivalent cumulative SDOH levels, alcohol consumption, physical activity, depressive symptoms, and social participation each contributed significantly to explaining the association between cumulative SDOH and CMD risk. CONCLUSION: Low life course SDOH and adverse social mobility trajectories increase CMDs risk, whereas maintaining healthy lifestyles and favorable psychosocial wellbeing may mitigate the risk.