Educational inequalities in metabolic syndrome prevalence, timing, and duration amongst adults over the life course: a microsimulation analysis based on the Lifelines Cohort Study

Background: Educational inequalities in metabolic syndrome (MetS) are a growing problem in the public health domain. Intervening on modifiable factors may help reduce these inequalities, but there is a need for evidence on the long-term impact of these interventions. For this reason, we simulate the development of educational inequalities in MetS across the life course, and assess the impact of intervening on the modifiable factors that contribute to these inequalities.
Methods: We used data from the prospective multigenerational Dutch Lifelines Cohort Study to estimate the required input for a continuous-time microsimulation. The microsimulation projects the development of educational inequalities in MetS across the life course, and assesses the potential benefit of intervening on smoking, alcohol use, diet quality, and health literacy.
Findings: On average, an additional 27·6% of individuals with low education will ever experience MetS compared to those with high education. This exceeds the prevalence of MetS at each individual age. Additionally, individuals with low education generally will develop MetS 2·3 years earlier, and will spend an additional 2·6 years living with MetS, compared to individuals with high education. Changes to smoking behaviours in individuals with low education produced the largest effect; it would reduce inequalities in prevalence, timing and duration by an average of 7·5%, 9·5%, and 6·9%, respectively. 
Interpretation: Interventions targeting the modifiable factors included in this study, especially smoking, could help reduce the estimated educational inequalities in MetS over the life course.
Funding: The Netherlands Organization for Health Research and Development (ZonMw)
Keywords: Metabolic Syndrome, Education, Smoking, Alcohol Drinking, Diet, Health Literacy, Longitudinal Studies, Microsimulation