TY  - JOUR
AU  - Manfredi, Luca
AU  - Buscema, Federica
AU  - Giraudo, Maria Teresa
AU  - Sodano, Barbara
AU  - Padroni, Lisa
AU  - Destefanis, Cinzia
AU  - Freisling, Heinz
AU  - Ferrari, Pietro
AU  - Cesaroni, Giulia
AU  - Uzzau, Sergio
AU  - Schulze, Matthias B
AU  - Saieva, Calogero
AU  - Tumino, Rosario
AU  - Weiderpass, Elisabete
AU  - Matta, Komodo
AU  - Vaccarella, Salvatore
AU  - Guevara, Marcela
AU  - Halkjær, Jytte
AU  - Tjønneland, Anne
AU  - Crous-Bou, Marta
AU  - Katzke, Verena
AU  - Pour, Toktam
AU  - Panico, Salvatore
AU  - Pala, Valeria
AU  - Tzoulaki, Ioanna
AU  - Tin Tin, Sandar
AU  - Dahm, Christina C
AU  - Chirlaque, MªDolores
AU  - Sacerdote, Carlotta
AU  - Ricceri, Fulvio
TI  - Does lifestyle explain the relationship between socioeconomic position and multimorbidity of cancer and cardiometabolic diseases? A mediation analysis applied to the European Prospective Investigation into Cancer and Nutrition.
JO  - Journal of epidemiology and community health
VL  - 80
IS  - 1
SN  - 0143-005X
CY  - London
PB  - BMJ Publ. Group
M1  - DKFZ-2025-01955
SP  - 3-9
PY  - 2025
N1  - 2025 Dec 10;80(1):3-9
AB  - Multimorbidity is socially patterned, with lower socioeconomic position (SEP) linked to higher risk. We examined whether a Healthy Lifestyle Index (HLI) mediates the SEP-multimorbidity association and whether pathways differ by sex.We used data from 244 886 participants in the European Prospective Investigation into Cancer and Nutrition study. HLI was derived from smoking, alcohol consumption, physical activity, body mass index and diet. SEP was categorised into low, medium and high-SEP based on education. Multimorbidity was defined as the coexistence of at least two diseases among cancer, type 2 diabetes and cardiovascular diseases. Logistic regression assessed SEP-HLI association, Cox regression SEP-multimorbidity and HLI-multimorbidity associations. Counterfactual mediation analysis estimated the natural indirect effect (NIE) and pure direct effect (PDE). Analyses were stratified by sex.Participants from lower SEP categories were older with worse health outcomes. Women had a healthier lifestyle than men across all SEP levels. In men, the hazard ratio of developing multimorbidity was 1.40 (95
KW  - EPIDEMIOLOGY (Other)
KW  - Health inequalities (Other)
KW  - Healthy Aging (Other)
KW  - LIFE STYLE (Other)
KW  - PUBLIC HEALTH (Other)
LB  - PUB:(DE-HGF)16
C6  - pmid:40987569
DO  - DOI:10.1136/jech-2025-224476
UR  - https://inrepo02.dkfz.de/record/304849
ER  -