Understanding socioeconomic differences in remitted metabolic syndrome among adults: what is the mediating role of health behaviors?

Metabolic syndrome (MetS) incidence strongly varies by socioeconomic status (SES). To date, no studies have examined the SES-MetS remission relationship. The aims are to longitudinally assess the associations between the SES measures, education, income and occupational prestige, and remitted MetS and whether these associations are mediated by health behaviors, including physical activity, smoking, alcohol intake and diet quality.
Methods: 
A subsample (n=16 818) of the adult Lifelines Cohort Study with MetS at baseline was used. MetS remission was measured at the second assessment (median follow-up time 3.8 years) defined according to the NCEP-ATPIII criteria. Direct associations between SES, health behaviors and remitted MetS were estimated using multivariable logistic regression analyses. The mediating percentages of health behaviors explaining the SES-MetS remission relationship were estimated using the Karlson-Holm-Breen method. Analyses were adjusted for age, sex, the other SES measures and follow-up time.
Results: 
At the second assessment, MetS remitted for 42.7% of the participants. Education and income were positively associated with MetS remission. Occupational prestige was not associated with MetS remission. The association between education and MetS remission could partly (11.9%) be explained by health behaviors. The association between income and MetS remission was not explained by health behaviors.
Conclusion: 
Individuals with more years of education remitted more often from MetS, mainly because higher educated are more likely to have healthier behaviors. Individuals with a higher income remitted more often from MetS, regardless of their health behaviors. The occupational prestige of individuals was not associated with MetS remission.