Association of life-course socioeconomic status with lifestyle changes after diagnosis of non-communicable disease: a prospective study using data from European, US and Chinese cohorts

Life-course socioeconomic inequalities existed in non-communicable diseases (NCDs) and lifestyles, but whether life-course socioeconomic status (SES) and social mobility affects changes in lifestyles after diagnosis of NCDs remains unknown. We investigated the association of life-course SES and social mobility with two lifestyle changes after the diagnosis of NCD, using data from 8,907 adults in the US, Europe and China. Life-course SES and social mobility were constructed using parental education, participant education and participant total household wealth. Physical inactivity and smoking were measured before and after diagnosis of NCDs. After NCD diagnosis, 6,131 (68.8%) of participants had no unfavourable changes in lifestyles, while 313 (3.5%) participants reported to have unfavourable changes in both physical inactivity and smoking. Lower life-course SES increased the likelihood of physical inactivity [odds ratio (OR)=3.01, 95% CI=2.55-3.56, average marginal effect (AME)=0.166, 95% CI=0.142-0.190] and smoking (2.43, 2.01-2.94, AME=0.091, 95% CI=0.072-0.111) after NCD diagnosis. Compared to stable high SES, stable low (8.66, 4.37-17.17), upward (3.01, 1.42-6.38), downward (6.88, 3.45-13.73) and varied SES mobility (3.76, 1.79-7.90) were all associated with unfavourable changes in lifestyles after NCD diagnosis. These findings support the notion that social patterning of unfavourable lifestyles extends beyond the onset of disease, potentially accelerating disease progression.