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Do associations of physical activity and sedentary behaviour with cardiovascular disease and mortality differ across socioeconomic groups? A prospective analysis of device-measured and self-reported UK Biobank data
  1. Susan Paudel1,2,
  2. Matthew Ahmadi2,3,
  3. Philayrath Phongsavan3,4,
  4. Mark Hamer5,
  5. Emmanuel Stamatakis2,3
  1. 1 Institute for Physical Activity and Nutrition (IPAN), Deakin University, Burwood, Victoria, Australia
  2. 2 School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
  3. 3 Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
  4. 4 School of Public Health, Prevention Research Collaboration, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
  5. 5 Institute of Sport Exercise and Health, Division of Surgery and Interventional Science, University College London, London, UK
  1. Correspondence to Dr Susan Paudel, Institute for Physical Activity and Nutrition (IPAN), Deakin University, Burwood, Victoria, Australia; replysusan{at}gmail.com

Abstract

Objective To examine if individual-level and area-level socioeconomic status (SES) modifies the association of moderate-to-vigorous physical activity (MVPA), domain-specific physical activity and sedentary behaviour with all-cause mortality (ACM) and incident cardiovascular disease (CVD).

Methods We used self-reported (International Physical Activity Questionnaire short form) and accelerometer-measured physical activity and sedentary behaviour data from the UK Biobank. We created an individual-level composite SES index using latent class analysis of household income, education and employment status. The Townsend Index was the measure of area-level SES. Cox proportional hazards regression models stratified across SES were used.

Results In 328 228 participants (mean age 55.9 (SD 8.1) years, 45% men) with an average follow-up of 12.1 (1.4) years, 18 033 deaths and 98 922 incident CVD events occurred. We found an increased ACM risk of low physical activity and high sedentary behaviour and an increased incident CVD risk of low accelerometer-measured moderate-to-vigorous physical activity (ACCEL_MVPA) and high sitting time. We observed statistically significant interactions for all exposures in ACM analyses by individual-level SES (p<0.05) but only for screen time in area-level SES–ACM analysis (p<0.001). Compared with high self-reported moderate-to-vigorous physical activity (IPAQ_MVPA), adjusted ACM HRs for low IPAQ_MVPA were 1.14 (95% CI 1.05 to .25), 1.15 (95% CI 1.06 to 1.24) and 1.22 (95% CI 1.13 to 1.31) in high, medium and low individual-level SES, respectively. There were higher detrimental associations of low ACCEL_MVPA with decreasing area-level SES for both outcomes and of high screen time with ACM in low area-level SES.

Conclusion We found modest evidence suggesting that the detrimental associations of low MVPA and high screen time with ACM and incident CVD are accentuated in low SES groups.

  • Physical activity
  • Sedentary Behavior

Data availability statement

Data may be obtained from a third party and are not publicly available.

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Data availability statement

Data may be obtained from a third party and are not publicly available.

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Footnotes

  • Twitter @SusanPaudel8, @M_Stamatakis

  • Contributors SP and ES conceptualised the study. SP carried out the analysis and prepared the original manuscript. MA, PP, MH and ES contributed to the composition and editing of the full manuscript over several rounds of revisions. All authors have read and agreed on the final version of the manuscript. SP is the guarantor and accepts full responsibility for the work and the conduct of the study.

  • Funding This work was supported by a National Health and Medical Research Council Leadership Level 2 Investigator Grant (ES, grant code APP1194510).

  • Competing interests None declared.

  • Patient and public involvement Patients and the public were not involved in the design, conduct, reporting or dissemination plans of this research.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.