Background
Methods
Study Subjects
Follow-up and outcome
Predictors
Statistical analysis
Results
Educational level | Low | Middle | High | Total | ||||
---|---|---|---|---|---|---|---|---|
Men
| N | % | N | % | N | % | N | % |
Dyslipidemia | 2237 | 58.8 | 614 | 57.7 | 1262 | 52.2 | 4113 | 56.5 |
Hyperuricemia | 708 | 19.0 | 140 | 13.3 | 275 | 11.5 | 1123 | 15.7 |
Diabetes mellitus all | 643 | 16.9 | 129 | 12.1 | 241 | 10.0 | 1013 | 13.9 |
insulin dependent | 131 | 3.4 | 23 | 2.2 | 50 | 2.1 | 204 | 2.8 |
Thyroid disease | 271 | 7.2 | 91 | 8.7 | 183 | 7.6 | 545 | 7.6 |
Hypertension | 2175 | 57.1 | 594 | 55.8 | 1188 | 49.2 | 3957 | 54.3 |
Stroke | 204 | 5.4 | 41 | 3.9 | 78 | 3.2 | 323 | 4.4 |
Myocardial infarction (MI) | 377 | 9.9 | 71 | 6.7 | 120 | 5.0 | 568 | 7.8 |
Heart diseases (except MI) | 770 | 21.0 | 220 | 21.3 | 491 | 20.1 | 1481 | 21.0 |
Lung diseases | 261 | 7.0 | 80 | 7.7 | 169 | 7.1 | 510 | 7.1 |
Gastrointestinal diseases | 1298 | 34.6 | 322 | 30.6 | 657 | 27.6 | 2277 | 31.7 |
Pancreatic disease | 62 | 1.7 | 10 | 1.0 | 22 | 0.9 | 94 | 1.3 |
Liver/kidney diseases | 116 | 3.1 | 20 | 1.9 | 50 | 2.1 | 186 | 2.6 |
Muscle/bone diseases | 607 | 16.6 | 88 | 8.6 | 206 | 8.8 | 901 | 12.8 |
Central nervous system | 30 | 0.8 | 9 | 0.9 | 15 | 0.6 | 54 | 0.8 |
Cancer | 575 | 15.1 | 146 | 13.7 | 277 | 11.5 | 998 | 13.7 |
Women
| ||||||||
Dyslipidemia | 1958 | 56.1 | 879 | 52.6 | 631 | 47.7 | 3468 | 53.5 |
Hyperuricemia | 234 | 6.8 | 70 | 4.3 | 50 | 3.8 | 354 | 5.6 |
Diabetes mellitus all | 390 | 11.2 | 112 | 6.7 | 55 | 4.2 | 557 | 8.6 |
insulin dependent | 80 | 2.3 | 24 | 1.4 | 10 | 0.8 | 114 | 1.8 |
Thyroid disease | 934 | 27.3 | 465 | 28.3 | 314 | 24.2 | 1713 | 30.0 |
Hypertension | 1916 | 54.9 | 799 | 47.8 | 544 | 41.2 | 3259 | 50.3 |
Stroke | 119 | 3.4 | 33 | 2.0 | 21 | 1.6 | 173 | 2.7 |
Myocardial infarction (MI) | 106 | 3.0 | 39 | 2.3 | 25 | 1.9 | 170 | 2.6 |
Heart diseases (except MI) | 560 | 16.8 | 286 | 17.8 | 212 | 16.5 | 1058 | 17.0 |
Lung diseases | 279 | 8.1 | 126 | 7.7 | 104 | 8.0 | 509 | 8.0 |
Gastrointestinal diseases | 1146 | 33.3 | 514 | 31.3 | 356 | 27.3 | 2016 | 31.6 |
Pancreatic diseases | 46 | 1.3 | 21 | 1.3 | 18 | 1.4 | 85 | 1.3 |
Liver/kidney diseases | 66 | 1.9 | 28 | 1.7 | 30 | 2.3 | 124 | 2.0 |
Muscle/bone diseases | 828 | 25.1 | 329 | 20.9 | 232 | 18.2 | 1389 | 22.6 |
Central nervous system | 20 | 0.6 | 8 | 0.5 | 7 | 0.5 | 35 | 0.5 |
Cancer | 452 | 12.9 | 220 | 13.2 | 179 | 13.5 | 851 | 13.1 |
Men | Women | |||||
---|---|---|---|---|---|---|
Educational level | Low | Middle | High | Low | Middle | High |
N
| 3810 | 1065 | 2418 | 3492 | 1670 | 1322 |
Multimorbidity1: yes (%) | 71.0 | 68.0 | 61.4 | 71.0 | 64.9 | 61.5 |
Metabolic disease2: yes (%) | 81.1 | 81.3 | 74.6 | 78.7 | 73.4 | 66.4 |
Deceased (%) | 10.1 | 6.8 | 5.0 | 4.0 | 2.9 | 2.8 |
Continuous variables
| Median (Q1, Q3)* | Median (Q1, Q3)* | Median (Q1, Q3)* | Median (Q1, Q3)* | Median (Q1, Q3)* | Median (Q1, Q3)* |
Age at recruitment (years) | 58 (54, 61) | 56 (53, 60) | 56 (53, 59) | 58 (54, 61) | 56 (52, 60) | 55 (52, 59) |
Height (m) | 173.30 (169.20, 177.50) | 176.00 (171.80, 180.00) | 177.00 (172.50, 181.00) | 161.10 (157.10, 165.20) | 163.60 (159.55, 167.75) | 164.90 (161.00, 169.00) |
Weight (kg) | 83.30 (83.30, 91.40) | 82.50 (75.70, 90.50) | 81.20 (75.50, 90.00) | 70.00 (63.00, 79.05) | 67.25 (60.50, 75.60) | 65.00 (59.00, 72.00) |
Body mass index (kg/m2) | 27.6 (25.6, 30.0) | 26.7 (24.7, 29.1) | 25.9 (24.1, 28.1) | 26.9 (24.3, 30.3) | 25.1 (22.7, 28.0) | 23.9 (21.8, 26.6) |
Total energy intake (kcal/d) | 2036 (1678, 2488) | 2006 (1672, 2432) | 2072 (1725, 2467) | 1603 (1316, 1935) | 1608 (1350, 1938) | 1677 (1406, 2000) |
Fat intake (g/d) | 74.10 (57.60, 95.97) | 74.67 (58.37, 93.68) | 75.06 (59.66, 95.02) | 61.77 (48.64, 77.96) | 61.81 (48.79, 76.42) | 62.49 (50.48, 78.44) |
Fruit consumption (g/d) | 94.71 (57.64, 136.07) | 95.86 (57.97, 147.56) | 100.97 (66.16 156.21) | 103.42 (81.05, 181.39) | 109.20 (85.98, 194.81) | 121.45 (91.43, 196.77) |
Vegetable consumption (g/d) | 99.27 (74.74, 131.09) | 103.02 (78.33, 131.53) | 108.72 (84.14, 140.74) | 106.10 (81.29, 143.60) | 110.02 (85.67, 146.44) | 122,11 (93.19, 161.12) |
Alcohol consumption (g/d) | 18.13 (6.93, 39.77) | 19.99 (7.80, 39.16) | 20.93 (8.89, 38.97) | 4.04 (1.06, 11.39) | 6.89 (2.18, 17.31) | 9.05 (2.80, 21.82) |
Categorical variables
| % | % | % | % | % | % |
Smoking status | ||||||
Never smokers | 29.34 | 30.99 | 33.75 | 63.83 | 54.37 | 49.55 |
Former smokers | 48.35 | 47.79 | 52.23 | 20.36 | 29.46 | 35.33 |
Current Smokers | 22.31 | 21.22 | 14.02 | 15.81 | 16.17 | 15.13 |
Combined total physical activity index | ||||||
Active | 8.50 | 3.10 | 2.70 | 9.68 | 5.95 | 7.34 |
Moderately active | 42.11 | 26.57 | 18.96 | 62.59 | 55.88 | 43.23 |
Moderately inactive | 33.94 | 30.97 | 29.69 | 21.96 | 25.42 | 29.70 |
Inactive | 15.44 | 39.36 | 48.65 | 5.76 | 12.75 | 19.72 |
Men | Women | |||||||||
---|---|---|---|---|---|---|---|---|---|---|
Educational Level | Middle | Low | Middle | Low | ||||||
N | OR | 95%-CI | OR | 95%-CI | N | OR | 95%-CI | OR | 95%-CI | |
Age-adjusted
| ||||||||||
Morbidity
1
| ||||||||||
0
| 657 | 1 | 576 | 1 | ||||||
1
| 1439 | 1.35 | 1.01–1.81 | 1.08 | 0.89–1.32 | 1249 | 1.31 | 1.00–1.71 | 1.41 | 1.11–1.80 |
2
| 1595 | 1.51 | 1.14–2.02 | 1.18 | 0.97–1.44 | 1458 | 1.22 | 0.94–1.59 | 1.50 | 1.19–1.91 |
3
| 1246 | 1.65 | 1.22–2.23 | 1.44 | 1.16–1.77 | 1124 | 1.29 | 0.98–1.71 | 1.64 | 1.28–2.11 |
4
| 800 | 1.69 | 1.21–2.36 | 1.72 | 1.37–2.17 | 634 | 1.67 | 1.22–2.31 | 1.85 | 1.38–2.48 |
5
| 374 | 2.00 | 1.30–3.09 | 2.55 | 1.88–3.45 | 335 | 1.77 | 1.16–2.68 | 2.33 | 1.61–3.39 |
≥ 6
| 293 | 1.96 | 1.19–3.23 | 3.08 | 2.18–4.33 | 218 | 1.54 | 0.89–2.66 | 3.31 | 2.08–5.27 |
P for trend | <0.001 | 0.002 | 0.015 | 0.003 | ||||||
Multivariate-adjusted
#
| ||||||||||
Morbidity
1
| ||||||||||
0
| 647 | 1 | 566 | 1 | ||||||
1
| 1392 | 1.32 | 0.98–1.78 | 1.02 | 0.82–1.27 | 1182 | 1.26 | 0.96–1.66 | 1.31 | 1.01–1.71 |
2
| 1511 | 1.44 | 1.07–1.93 | 1.11 | 0.89–1.38 | 1344 | 1.17 | 0.89–1.53 | 1.30 | 1.00–1.68 |
3
| 1142 | 1.43 | 1.04–1.95 | 1.19 | 0.94–1.49 | 1000 | 1.11 | 0.82–1.48 | 1.31 | 1.00–1.73 |
4
| 744 | 1.50 | 1.06–2.12 | 1.39 | 1.07–1.79 | 551 | 1.50 | 1.06–2.12 | 1.30 | 0.94–1.81 |
5
| 353 | 1.64 | 1.04–2.57 | 1.76 | 1.26–2.45 | 285 | 1.47 | 0.94–2.32 | 1.60 | 1.05–2.43 |
≥ 6
| 253 | 1.44 | 0.83–2.49 | 2.24 | 1.52–3.29 | 186 | 1.47 | 0.78–2.76 | 2.53 | 1.45–4.41 |
P for trend | 0.039 | 0.003 | 0.021 | 0.039 | ||||||
Age-adjusted
| ||||||||||
Metabolic diseases
2
| ||||||||||
0
| 1504 | 1 | 1606 | 1 | ||||||
1
| 2480 | 1.36 | 1.11–1.66 | 1.10 | 0.96–1.27 | 2562 | 1.28 | 1.08–1.53 | 1.39 | 1.19–1.63 |
2
| 2121 | 1.53 | 1.24–1.88 | 1.41 | 1.22–1.63 | 1749 | 1.43 | 1.17–1.75 | 1.85 | 1.55–2.22 |
3/4
| 1054 | 1.81 | 1.39–2.36 | 2.40 | 1.99–2.89 | 454 | 1.72 | 1.18–2.50 | 3.08 | 2.23–4.26 |
P for trend | 0.009 | 0.089 | 0.007 | 0.042 | ||||||
Multivariate-adjusted
#
| ||||||||||
Metabolic diseases
2
| ||||||||||
0
| 1422 | 1 | 1483 | 1 | ||||||
1
| 2334 | 1.30 | 1.06–1.61 | 0.99 | 0.85–1.16 | 2329 | 1.19 | 0.99–1.43 | 1.24 | 1.04–1.48 |
2
| 2004 | 1.36 | 1.09–1.69 | 1.16 | 0.98–1.37 | 1602 | 1.29 | 1.04–1.60 | 1.38 | 1.13–1.69 |
3/4
| 999 | 1.51 | 1.14–2.02 | 1.62 | 1.31–2.00 | 402 | 1.40 | 0.93–2.12 | 1.76 | 1.21–2.55 |
P for trend | 0.043 | 0.113 | 0.012 | 0.018 |
Men | Women | ||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|
Educational level | High | Middle | Low | High | Middle | Low | |||||
OR | OR | 95%-CI | OR | 95%-CI | OR | 95%-CI | OR | 95%-CI | |||
Multimorbidity: yes
1
| |||||||||||
Age-adjusted | 1 | 1.32 | 1.12–1.55 | 1.43 | 1.28–1.61 | 1 | 1.13 | 0.97–1.33 | 1.33 | 1.18–1.57 | |
Smoking status -adjusted * | 1 | 1.34 | 1.14–1.58 | 1.46 | 1.30–1.64 | 1 | 1.14 | 0.97–1.34 | 1.38 | 1.20–1.60 | |
BMI- adjusted ** | 1 | 1.23 | 1.05–1.45 | 1.24 | 1.10–1.40 | 1 | 1.05 | 0.89–1.23 | 1.12 | 0.96–1.30 | |
Fully adjusted # | 1 | 1.21 | 1.02–1.43 | 1.28 | 1.12–1.46 | 1 | 1.06 | 0.89–1.25 | 1.16 | 0.99–1.36 | |
Metabolic diseases: yes
2
| |||||||||||
Age-adjusted | 1 | 1.48 | 1.23–1.77 | 1.38 | 1.22–1.57 | 1 | 1.35 | 1.15–1.59 | 1.64 | 1.42–1.90 | |
Smoking status -adjusted * | 1 | 1.51 | 1.26–1.81 | 1.41 | 1.25–1.61 | 1 | 1.36 | 1.16–1.60 | 1.67 | 1.44–1.93 | |
BMI- adjusted ** | 1 | 1.34 | 1.11–1.61 | 1.09 | 0.96–1.25 | 1 | 1.21 | 1.03–1.42 | 1.25 | 1.18–1.46 | |
Fully adjusted # | 1 | 1.37 | 1.13–1.66 | 1.15 | 1.00–1.33 | 1 | 1.24 | 1.04–1.47 | 1.33 | 1.13–1.56 | |
HR | HR | 95%-CI | HR | 95%-CI | HR | 95%-CI | HR | 95%-CI | |||
All-cause mortality: yes
| |||||||||||
Age-adjusted | 1 | 1.38 | 1.02–1.85 | 1.90 | 1.54–2.34 | 1 | 1.04 | 0.67–1.61 | 1.30 | 0.89–1.90 | |
Smoking status -adjusted * | 1 | 1.26 | 0.94–1.69 | 1.69 | 1.37–2.09 | 1 | 1.05 | 0.68–1.62 | 1.33 | 0.92–1.95 | |
BMI- adjusted ** | 1 | 1.36 | 1.01–1.83 | 1.82 | 1.46–2.25 | 1 | 0.99 | 0.64–1.54 | 1.23 | 0.83–1.81 | |
Fully adjusted # | 1 | 1.26 | 0.91–1.74 | 1.60 | 1.25–2.05 | 1 | 1.32 | 0.78–2.22 | 1.49 | 0.92–2.41 |
Men | Women | |||||||||
---|---|---|---|---|---|---|---|---|---|---|
Educational Level | High | Middle | Low | High | Middle | Low | ||||
OR | OR | 95%-CI | OR | 95%-CI | OR | OR | 95%-CI | OR | 95%-CI | |
Multimorbidity: yes
1
| ||||||||||
Age <= 60 years at recruitment #
| 1 | 1.24 | 1.03–1.50 | 1.36 | 1.17–1.59 | 1 | 1.05 | 0.87–1.26 | 1.20 | 1.00–1.43 |
Age > 60 years at recruitment #
| 1 | 0.95 | 0.65–1.39 | 0.90 | 0.68–1.19 | 1 | 1.08 | 0.70–1.67 | 0.93 | 0.64–1.35 |
Metabolic diseases: yes
2
| ||||||||||
Age <= 60 years at recruitment #
| 1 | 1.38 | 1.12–1.71 | 1.18 | 1.00–1.38 | 1 | 1.24 | 1.03–1.49 | 1.32 | 1.11–1.58 |
Age > 60 years at recruitment#
| 1 | 1.16 | 0.74–1.83 | 0.97 | 0.71–1.32 | 1 | 1.16 | 0.74–1.82 | 1.24 | 0.84–1.83 |