Socioeconomic Disparities and Smoking Habits in Metabolic Syndrome: Evidence from Isfahan Healthy Heart Program

Background: Metabolic syndrome (MetS) is a clustering of risk factors for cardiovascular disease (CVD), which includes obesity, hypertension, diabetes, dyslipidemia, and unhealthy lifestyle. A combination of these risk factors has been shown to predict type 2 diabetes and CVD. To examine the association between socioeconomic determinants and smoking behavior in a population-based sample of Iranians with MetS. Patients and Methods: This cross-sectional survey comprised 12,600 randomly selected men and women aged ≥ 19 years living in 3 counties in the central part of Iran. These subjects had participated in the baseline survey of a communitybased program for CVD prevention, entitled “Isfahan Healthy Heart Program,” conducted in 2000–2001. Subjects with MetS were selected on the basis of the National Centers for Environmental Prediction–Adult Treatment Panel III (NCEP– ATPIII) criteria. Data for demographic factors, medical history, medication use, and lifestyle behaviors were obtained using questionnaires, and physical examination and fasting blood sampling were performed to measure blood pressure, obesity indices, and serum lipid levels. Smokers were defined as persons smoking at least 1 cigarette per day at the time of the study. Five social determinants were used: education, income, marital status, place of residency, and car ownership. Logistic regression analysis was performed to assess the association between socioeconomic determinants and smoking habits and other health-related behaviors. Results: The mean age of subjects with MetS was significantly higher than that of subjects without MetS. In both MetS and non-MetS groups, the mean ages of smokers were higher than those of non-smokers. However, smokers in both groups showed lower waist circumference (WC) and waist–hip ratio (WHR). Our data showed that marital status, age category, and residency were not significantly different in smokers and non-smokers with MetS. Smoking was more common (12.4 %) in the group with intermediate educational level (6–12 years of education), the same as the high percentage of smokers (12.3 %) in the middle economic group by the income category (Quartile 1–3). MetS is significantly related to age, sex, and education. On the basis of the results of logistic regression analysis, middle-aged and elderly smokers were at approximately 4–5 times higher risk of developing MetS than nonsmokers. Low levels of education