title: Clustering of behavior-related risk factors and its association with subjective health.
abstract: OBJECTIVE
  To describe the clustering of behavior-related risk factors in the adult population of the Autonomous Community of Madrid (Spain) and evaluate the association between the level of aggregation of these factors and suboptimal subjective health.
  
  
  METHODS
  Data were drawn from the Non-communicable Disease Risk-Factor Surveillance System (Sistema de Vigilancia de Factores de Riesgo asociados a Enfermedades No Transmisibles [SIVFRENT]). We studied the associations between smoking, high-risk alcohol consumption, leisure-time sedentariness and unbalanced diet in 16,043 persons aged 18-64 years and compared the observed against the expected proportions. Logistic regression was used to estimate the association between clustering of risk factors and suboptimal health (fair, poor and very poor).
  
  
  RESULTS
  Almost 20% of subjects had 3 or 4 risk factors simultaneously. Most combinations of 3 risk factors exceeded expectations and, in particular, 4 factor clustering yielded observed/expected quotients of 2.15 (95% confidence interval [CI]: 1.93-2.38) in men and 2.96 (95% CI, 2.46-3.46) in women. In both sexes, the individual factor most closely associated with the remaining risk factors was smoking. Aggregation of risk factors was more frequent among men, younger age groups and subjects with low educational level. Compared with persons with none of the 4 risk factors, those that simultaneously had 3 or 4 more frequently reported suboptimal subjective health (OR = 2.49; 95% CI, 1.59-3.90 in men and OR = 1.96; 95% CI, 1.29-2.97 in women).
  
  
  CONCLUSIONS
  Behavior-related risk factors tend to aggregate, and this accumulation is higher among men, younger age groups, and subjects with a low educational level. A greater level of clustering is associated with a higher frequency of suboptimal perceived health.
authors.affiliation: Servicio de Epidemiología. Instituto de Salud Pública. Consejería de Sanidad y Consumo de la Comunidad de Madrid, Madrid, España. inaki.galan@saludmadrid.org
authors.forename: Iñaki
authors.initials: I
authors.lastname: Galán
authors.forename: Fernando
authors.initials: F
authors.lastname: Rodríguez-Artalejo
authors.forename: Aurelio
authors.initials: A
authors.lastname: Tobías
authors.forename: Lucía
authors.initials: L
authors.lastname: Díez-Gañán
authors.forename: Ana
authors.initials: A
authors.lastname: Gandarillas
authors.forename: Belén
authors.initials: B
authors.lastname: Zorrilla
mesh_terms: D000293:Adolescent; D000328:Adult; D001519:Behavior; D016000:Cluster Analysis; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012649:Self Concept; D013030:Spain; D014505:Urban Population