title: Lower educational level and unemployment increase the impact of cardiometabolic conditions on the quality of life: results of a population-based study in South Australia.
abstract: To investigate if sociodemographic characteristics increase the adverse effects of cardiovascular diseases (CVD) and cardiometabolic risk factors (CMRF) on health-related quality of life (HRQoL).
  
  
  
  Cross-sectional, face-to-face survey investigating 2379 adults living in South Australia in 2015 (57.1 ± 14 years; 51.7% females). Questions included diagnosis of CMRF (obesity, diabetes, hypertension, dyslipidaemia) and CVD. Physical and mental HRQoL were assessed using the SF-12v1 questionnaire. Multiple linear regression models including confounders (sociodemographic, lifestyle, use of preventive medication) and interaction terms between sociodemographic variables and cardiometabolic conditions were used in adjusted analysis.
  
  
  
  The prevalence of CMRF (one or more) was 54.6% and CVD was 13.0%. The physical HRQoL reduced from 50.8 (95%CI 50.2-51.4) in healthy individuals to 45.1 (95%CI 44.4-45.9) and 39.1 (95%CI 37.7-40.5) among those with CMRF and CVD, respectively. Adjustment for sociodemographic variables reduced these differences in 33%, remaining stable after controlling for lifestyle and use of preventive medications (p < 0.001). Differences in physical HRQoL according to cardiometabolic conditions were twice as high among those with lower educational level, or if they were not working. Among unemployed, having a CMRF or a CVD had the same impact on the physical HRQoL (9.7 lower score than healthy individuals). The inverse association between cardiometabolic conditions and mental HRQoL was subtle (p = 0.030), with no evidence of disparities due to sociodemographic variables.
  
  
  
  A lower educational level and unemployment increase the adverse effects of cardiometabolic conditions on the physical HRQoL. Targeted interventions for reducing CMRF and/or CVD in these groups are necessary to improve HRQoL.
authors.affiliation: Discipline of General Practice, School of Medicine, NHMRC Centre of Research Excellence to Reduce Inequality in Heart Disease, The University of Adelaide, 178 North Terrace, Level 11, MDP DX 650 550, Adelaide, SA, 5005, Australia. david.gonzalez@adelaide.edu.au.
authors.forename: David Alejandro
authors.initials: DA
authors.lastname: González-Chica
authors.affiliation: The Health Observatory, Discipline of Medicine, The University of Adelaide, The Queen Elizabeth Hospital Campus, Woodville, SA, Australia.
authors.forename: Robert
authors.initials: R
authors.lastname: Adams
authors.affiliation: Population Research and Outcome Studies, Discipline of Medicine, School of Medicine, The University of Adelaide, Adelaide, SA, Australia.
authors.forename: Eleonora
authors.initials: E
authors.lastname: Dal Grande
authors.affiliation: Population Research and Outcome Studies, Discipline of Medicine, School of Medicine, The University of Adelaide, Adelaide, SA, Australia.
authors.forename: Jodie
authors.initials: J
authors.lastname: Avery
authors.affiliation: Centre for Health Research, School of Medicine, University of Western Sydney, Sydney, NSW, Australia.
authors.forename: Phillipa
authors.initials: P
authors.lastname: Hay
authors.affiliation: Discipline of General Practice, School of Medicine, NHMRC Centre of Research Excellence to Reduce Inequality in Heart Disease, The University of Adelaide, 178 North Terrace, Level 11, MDP DX 650 550, Adelaide, SA, 5005, Australia.
authors.forename: Nigel
authors.initials: N
authors.lastname: Stocks
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000453:epidemiology*; D003430:Cross-Sectional Studies; D004493:Education / Q000639:trends*; D005260:Female; D054624:Health Status Disparities; D006801:Humans; D008019:Life Style; D008297:Male; D008659:Metabolic Diseases / Q000453:epidemiology*; D008875:Middle Aged; D009765:Obesity / Q000453:epidemiology; D011788:Quality of Life / Q000523:psychology*; D012307:Risk Factors; D012959:Socioeconomic Factors; D013021:South Australia; D011795:Surveys and Questionnaires; D014478:Unemployment / Q000639:trends*
keywords: Cardiovascular disease; Health status disparities; Metabolic disease; Quality of life; Socioeconomic factors