Do associations of physical activity and sedentary behaviour with cardiovascular disease and mortality differ across socioeconomic groups? A prospective analysis of device-measured and self-reported UK Biobank data

OBJECTIVE: To examine if individual-level and area-level socioeconomic status (SES) modifies the association of moderate-to-vigorous physical activity (MVPA), domain-specific physical activity and sedentary behaviour with all-cause mortality (ACM) and incident cardiovascular disease (CVD). METHODS: We used self-reported (International Physical Activity Questionnaire short form) and accelerometer-measured physical activity and sedentary behaviour data from the UK Biobank. We created an individual-level composite SES index using latent class analysis of household income, education and employment status. The Townsend Index was the measure of area-level SES. Cox proportional hazards regression models stratified across SES were used. RESULTS: In 328 228 participants (mean age 55. 9 (SD 8. 1) years, 45% men) with an average follow-up of 12. 1 (1. 4) years, 18 033 deaths and 98 922 incident CVD events occurred. We found an increased ACM risk of low physical activity and high sedentary behaviour and an increased incident CVD risk of low accelerometer-measured moderate-to-vigorous physical activity (ACCELMVPA) and high sitting time. We observed statistically significant interactions for all exposures in ACM analyses by individual-level SES (p<0. 05) but only for screen time in area-level SES-ACM analysis (p<0. 001). Compared with high self-reported moderate-to-vigorous physical activity (IPAQMVPA), adjusted ACM HRs for low IPAQMVPA were 1. 14 (95% CI 1. 05 to. 25), 1. 15 (95% CI 1. 06 to 1. 24) and 1. 22 (95% CI 1. 13 to 1. 31) in high, medium and low individual-level SES, respectively. There were higher detrimental associations of low ACCELMVPA with decreasing area-level SES for both outcomes and of high screen time with ACM in low area-level SES. CONCLUSION: We found modest evidence suggesting that the detrimental associations of low MVPA and high screen time with ACM and incident CVD are accentuated in low SES groups.