Exposures to social and environmental stressors arise individual behavioural response and thus indirectly affect cardiometabolic health. The aim of this study was to investigate several social and environmental stressors and the paths of their influence on cardiometabolic health. The data of 2154 participants (aged 25-64 years) from the cross-sectional population-based study were analysed. The composite score of metabolic disorders (MS score) was calculated based on 5 biomarkers: waist circumference, blood pressure, fasting blood glucose, HDL-cholesterol, triglycerides. The effects of social stressors (education level, income), environmental stressors (NO2, noise) and behavioural factors (unhealthy diet, smoking, alcohol consumption, sedentary behaviours) on MS score were assessed using a structural model. We observed a direct effect of education on MS score, as well as an indirect effect mediated via an unhealthy diet, smoking, and sedentary behaviours. We also observed a significant indirect effect of income via sedentary behaviours. The only environmental stressor predicting MS was noise, which also mediated the effect of education. In summary, the effect of social stressors on the development of cardiometabolic risk had a higher magnitude than the effect of the assessed environmental factors. Social stressors lead to an individual's unhealthy behaviour and might predispose individuals to higher levels of environmental stressors exposures.

Department of Epidemiology and Public Health University College London London UK

Department of Global Health and Population Harvard TH Chan School of Public Health Harvard University Boston MA USA

International Clinical Research Centre Brno Czech Republic

RECETOX Faculty of Science Masaryk University Kotlarska 2 Brno Czech Republic

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Roth GA, et al. Global burden of cardiovascular diseases and risk factors, 1990–2019: Update from the GBD 2019 study. J. Am. Coll. Cardiol. 2020;76:2982–3021. doi: 10.1016/j.jacc.2020.11.010. PubMed DOI PMC

Institute for Health Metrics and Evaluation (IHME). GBD Compare. University of Washington. https://vizhub.healthdata.org/gbd-compare/ (2015).

Dzúrová D. Mortality differentials in the Czech Republic during the post-1989 socio–political transformation. Health Place. 2000;6:351–362. doi: 10.1016/S1353-8292(00)00016-2. PubMed DOI

Žejglicová K, Kratěnová J, Lustigová M, Malý M. Trends in health indicators in the urban middle-aged population in the Czech Republic in 1998–2010. Public Health. 2016;137:81–87. doi: 10.1016/j.puhe.2015.11.022. PubMed DOI

Cífková R, et al. 30-year trends in major cardiovascular risk factors in the Czech population, Czech MONICA and Czech post-MONICA, 1985–2016/17. PLoS One. 2020;15:e0232845. doi: 10.1371/journal.pone.0232845. PubMed DOI PMC

Juarez PD, Hood DB, Song MA, Ramesh A. Use of an exposome approach to understand the effects of exposures from the natural, built, and social environments on cardio-vascular disease onset, progression, and outcomes. Front. Public Health. 2020 doi: 10.3389/fpubh.2020.00379. PubMed DOI PMC

Vrijheid M. The exposome: A new paradigm to study the impact of environment on health. Thorax. 2014;69:876–878. doi: 10.1136/thoraxjnl-2013-204949. PubMed DOI

Wild CP. The exposome: From concept to utility. Int. J. Epidemiol. 2012;41:24–32. doi: 10.1093/ije/dyr236. PubMed DOI

Marmot M, Allen JJ. Social determinants of health equity. Am. J. Public Health. 2014;104:S517–S519. doi: 10.2105/AJPH.2014.302200. PubMed DOI PMC

Lustigova M, Dzurova D, Pikhart H, Kubinova R, Bobak M. Cardiovascular health among the Czech population at the beginning of the 21st century: A 12-year follow-up study. J. Epidemiol. Community Health. 2018;1978(72):442–448. doi: 10.1136/jech-2017-209967. PubMed DOI PMC

Marmot M, Bell R. Social determinants and non-communicable diseases: time for integrated action. BMJ. 2019 doi: 10.1136/bmj.l251. PubMed DOI PMC

Wang T, Li Y, Zheng X. Association of socioeconomic status with cardiovascular disease and cardiovascular risk factors: A systematic review and meta-analysis. J. Public Health (Bangkok) 2023 doi: 10.1007/s10389-023-01825-4. PubMed DOI PMC

Wang S, Zhai H, Wei L, Shen B, Wang J. Socioeconomic status predicts the risk of stroke death: A systematic review and meta-analysis. Prev. Med. Rep. 2020;19:101124. doi: 10.1016/j.pmedr.2020.101124. PubMed DOI PMC

Siew RVK, Nabe-Nielsen K, Turner AI, Bujtor M, Torres SJ. The role of combined modifiable lifestyle behaviors in the association between exposure to stressors and allostatic load: A systematic review of observational studies. Psychoneuroendocrinology. 2022;138:105668. doi: 10.1016/j.psyneuen.2022.105668. PubMed DOI

Bowen W. An analytical review of environmental justice research: What do we really know? Environ. Manag. 2002;29:3–15. doi: 10.1007/s00267-001-0037-8. PubMed DOI

Chandrabose M, et al. Built environment and cardio-metabolic health: Systematic review and meta-analysis of longitudinal studies. Obes. Rev. 2019;20:41–54. doi: 10.1111/obr.12759. PubMed DOI

Yang B-Y, et al. Greenspace and human health: An umbrella review. The Innovation. 2021;2:100164. doi: 10.1016/j.xinn.2021.100164. PubMed DOI PMC

González Ortiz, A., Guerreiro, C., Soares, J. & European Environment Agency. Air Quality in Europe : 2020 Report.

Li X, et al. Obesity and the relation between joint exposure to ambient air pollutants and incident type 2 diabetes: A cohort study in UK Biobank. PLoS Med. 2021;18:e1003767. doi: 10.1371/journal.pmed.1003767. PubMed DOI PMC

Yang BY, et al. Global association between ambient air pollution and blood pressure: A systematic review and meta-analysis. Environ. Pollut. 2018;235:576–588. doi: 10.1016/j.envpol.2018.01.001. PubMed DOI

An R, Ji M, Yan H, Guan C. Impact of ambient air pollution on obesity: A systematic review. Int. J. Obes. 2018;42:1112–1126. doi: 10.1038/s41366-018-0089-y. PubMed DOI

Dzhambov AM, Dimitrova DD. Residential road traffic noise as a risk factor for hypertension in adults: Systematic review and meta-analysis of analytic studies published in the period 2011–2017. Environ. Pollut. 2018;240:306–318. doi: 10.1016/j.envpol.2018.04.122. PubMed DOI

Bolm-Audorff U, et al. Occupational noise and hypertension risk: A systematic review and meta-analysis. Int. J. Environ. Res. Public Health. 2020;17:6281. doi: 10.3390/ijerph17176281. PubMed DOI PMC

Zare Sakhvidi MJ, Zare Sakhvidi F, Mehrparvar AH, Foraster M, Dadvand P. Association between noise exposure and diabetes: A systematic review and meta-analysis. Environ. Res. 2018;166:647–657. doi: 10.1016/j.envres.2018.05.011. PubMed DOI

An R, Wang J, Ashrafi SA, Yang Y, Guan C. Chronic noise exposure and adiposity: A systematic review and meta-analysis. Am. J. Prev. Med. 2018;55:403–411. doi: 10.1016/j.amepre.2018.04.040. PubMed DOI

Oftedal B, et al. Road traffic noise and markers of obesity—A population-based study. Environ. Res. 2015;138:144–153. doi: 10.1016/j.envres.2015.01.011. PubMed DOI

Christensen JS, et al. Long-term exposure to residential traffic noise and changes in body weight and waist circumference: A cohort study. Environ. Res. 2015;143:154–161. doi: 10.1016/j.envres.2015.10.007. PubMed DOI

Christensen JS, et al. Road traffic and railway noise exposures and adiposity in adults: A cross-sectional analysis of the danish diet, cancer, and health cohort. Environ. Health Perspect. 2016;124:329–335. doi: 10.1289/ehp.1409052. PubMed DOI PMC

Dzhambov A, et al. Association between community noise and adiposity in patients with cardiovascular disease. Noise Health. 2017;19:270. doi: 10.4103/nah.NAH_78_16. PubMed DOI PMC

Frank LD, Iroz-Elardo N, MacLeod KE, Hong A. Pathways from built environment to health: A conceptual framework linking behavior and exposure-based impacts. J. Transp. Health. 2019;12:319–335. doi: 10.1016/j.jth.2018.11.008. DOI

Williams PRD, Dotson GS, Maier A. Cumulative risk assessment (CRA): Transforming the way we assess health risks. Environ. Sci. Technol. 2012;46:10868–10874. doi: 10.1021/es3025353. PubMed DOI PMC

Beulens JWJ, et al. Environmental risk factors of type 2 diabetes—An exposome approach. Diabetologia. 2022;65:263–274. doi: 10.1007/s00125-021-05618-w. PubMed DOI

Movsisyan NK, et al. Kardiovize Brno 2030, a prospective cardiovascular health study in Central Europe: Methods, baseline findings and future directions. Eur. J. Prev. Cardiol. 2018;25:54–64. doi: 10.1177/2047487317726623. PubMed DOI

Nilsson PM, Tuomilehto J, Rydén L. The metabolic syndrome—What is it and how should it be managed? Eur. J. Prev. Cardiol. 2019;26:33–46. doi: 10.1177/2047487319886404. PubMed DOI

Eurostat. Glossary: Equivalised disposable income (2021).

Šulc L, et al. City-scale assessment of long-term air quality impacts on the respiratory and cardiovascular health. Front. Public Health. 2022 doi: 10.3389/fpubh.2022.1006536. PubMed DOI PMC

ČHMU. Pětileté průměrné koncentrace. https://www.chmi.cz/files/portal/docs/uoco/isko/ozko/ozko_CZ.html (2022).

Škáchová, H. & Vlasáková, L. Air pollution in the Czech Republic in 2019 overall editing (2020).

The European parliament and The Council of the European Union. Directive 2002/49/EC Of The European Parliament And Of The Council (2002).

Afshin A, et al. Health effects of dietary risks in 195 countries, 1990–2017: A systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2019;393:1958–1972. doi: 10.1016/S0140-6736(19)30041-8. PubMed DOI PMC

Craig CL, et al. International physical activity questionnaire: 12-country reliability and validity. Med. Sci. Sports Exerc. 2003;35:1381–1395. doi: 10.1249/01.MSS.0000078924.61453.FB. PubMed DOI

StataCorp. Stata Statistical Software: Release 16 (2019).

Muthén, L. K. & Muthén, B. O. Statistical analysis with latent variables user’s guide. www.StatModel.com (2017).

Cohen S, Doyle WJ, Baum A. Socioeconomic status is associated with stress hormones. Psychosom. Med. 2006;68:414–420. doi: 10.1097/01.psy.0000221236.37158.b9. PubMed DOI

Pampel FC, Krueger PM, Denney JT. Socioeconomic disparities in health behaviors. Annu. Rev. Sociol. 2010;36:349–370. doi: 10.1146/annurev.soc.012809.102529. PubMed DOI PMC

Svendsen MT, et al. Associations of health literacy with socioeconomic position, health risk behavior, and health status: A large national population-based survey among Danish adults. BMC Public Health. 2020 doi: 10.1186/s12889-020-08498-8. PubMed DOI PMC

Coutinho SR, Andersen OK, Lien N, Gebremariam MK. Neighborhood deprivation, built environment, and overweight in adolescents in the city of Oslo. BMC Public Health. 2023;23:812. doi: 10.1186/s12889-023-15261-2. PubMed DOI PMC

Gordon-Larsen P, Nelson MC, Page P, Popkin BM. Inequality in the built environment underlies key health disparities in physical activity and obesity. Pediatrics. 2006;117:417–424. doi: 10.1542/peds.2005-0058. PubMed DOI

Estabrooks PA, Lee RE, Gyurcsik NC. Resources for physical activity participation: Does availability and accessibility differ by neighborhood socioeconomic status? Ann. Behav. Med. 2003;25:100–104. doi: 10.1207/S15324796ABM2502_05. PubMed DOI

Black C, Moon G, Baird J. Dietary inequalities: What is the evidence for the effect of the neighbourhood food environment? Health Place. 2014;27:229–242. doi: 10.1016/j.healthplace.2013.09.015. PubMed DOI PMC

Pinho MGM, et al. Recent changes in the Dutch foodscape: Socioeconomic and urban-rural differences. Int. J. Behav. Nutr. Phys. Act. 2020;17:43. doi: 10.1186/s12966-020-00944-5. PubMed DOI PMC

Maguire ER, Burgoine T, Monsivais P. Area deprivation and the food environment over time: A repeated cross-sectional study on takeaway outlet density and supermarket presence in Norfolk, UK, 1990–2008. Health Place. 2015;33:142–147. doi: 10.1016/j.healthplace.2015.02.012. PubMed DOI PMC

Hemphill E, Raine K, Spence JC, Smoyer-Tomic KE. Exploring obesogenic food environments in Edmonton, Canada: The association between socioeconomic factors and fast-food outlet access. Am. J. Health Promot. 2008;22:426–431. doi: 10.4278/ajhp.22.6.426. PubMed DOI

López-Valenciano A, et al. Changes in sedentary behaviour in European Union adults between 2002 and 2017. BMC Public Health. 2020 doi: 10.1186/s12889-020-09293-1. PubMed DOI PMC

U.S. Environmental Protection Agency. Plan Environmental Justice 2014 (2011).

Klompmaker JO, et al. Associations of combined exposures to surrounding green, air pollution, and road traffic noise with cardiometabolic diseases. Environ. Health Perspect. 2019 doi: 10.1289/EHP3857. PubMed DOI PMC

Chen X, et al. Environmental noise exposure and health outcomes: An umbrella review of systematic reviews and meta-analysis. Eur. J. Public Health. 2023 doi: 10.1093/eurpub/ckad044. PubMed DOI PMC