A Structural Model of Social Determinants of the Metabolic Syndrome.

OBJECTIVES

The metabolic syndrome (MetS) refers to a cluster of interrelated physiological characteristics that are associated with an increased risk of cardiovascular disease and diabetes. While the clinical usefulness of the MetS has been the subject of controversy for years, increasingly sophisticated methods are being used to measure the concept.

PARTICIPANTS

Study of community health center patients who were not diabetic; study group was evenly divided between Black and White adults.

MAIN OUTCOME MEASURES: Latent MetS score and MetS status based on the five-point scale developed by the National Cholesterol Education Panel (NCEP).

METHODS

Structural equation modeling of MetS incorporating the effects of race/ethnicity, racial discrimination, socioeconomic position (SEP), and selected mediating variables.

RESULTS

The largest influences on latent MetS scores were SEP (negative relationship) and male gender (higher scores for men). Two mediating variables, physical activity and stress-related eating, had smaller impacts. Self-reported racial discrimination was associated with cynical hostility but did not influence the MetS level among nondiabetics. Despite higher NCEP scores and MetS prevalence rates for Blacks compared with Whites, race did not have direct effect on MetS levels when adjusted for the other characteristics in our model.

CONCLUSIONS

Neither race nor self-reported racial discrimination had direct effects on MetS level in our structural model. The large effects of socioeconomic position and male gender were not mediated by the other variables in the model.