Open access Protocol Can socioeconomic health differences

Open Access Protocol Can Socioeconomic Health Differences-Free PDF

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Open access, BMJ Open first published as 10 1136 bmjopen 2018 023379 on 28 October 2018 Downloaded from http bmjopen bmj com on January 9 2021 by guest Protected by copyright. neighbourhood conditions 3 6 However socioeco allows for the possibility of identifying relevant subgroups. nomic health differences remain poorly understood as and the ability to test mechanistic pathways 25 26 Moreover. they cannot be fully attributed to these factors A recent an IPD meta analysis has the benefit of a larger number. systematic review showed that psychosocial factors explain of data points facilitating more statistically powerful and. 4 49 behavioural factors 7 45 while material sound conclusions based on careful evaluation of model. factors explain 11 76 of health differences 7 ling assumptions An IPD meta analysis also allows us to. To date physical activity is considered an important and account for missing data at the individual participant. significant behaviour for the prevention of premature death level and to standardise analytical techniques inclusion. from many lifestyle related diseases 8 The health implica criteria and outcome definitions across studies. tions of engagement in different domains of physical activity In this manuscript we describe the rationale and. according to common PA research leisure time work protocol of the active worker study an IPD meta analysis. household and transport9 are considered to be positive carried out by the active worker consortium The primary. and alike Workers who are physically active at work most aim of this study is to explore socioeconomic health. of them with low socioeconomic status could therefore differences related to physical activity at work and during. be expected to be healthier and live longer Surprisingly leisure time To do so we will. however recent evidence suggests that workers who are 1 Assess the combined effect of occupational and lei. highly physically active at work are less healthy and die earlier sure time physical activity on cardiovascular and all. than those who are less physically active at work 10 11 This cause mortality. evidence shows a consistently reduced risk of lifestyle related 2 Identify subgroups eg with pre existing hypertension. diseases associated with high doses of leisure time physical or obesity that are particularly vulnerable for this ef. activity but an increased risk of cardiovascular diseases12 15 fect. and mortality16 18 with high doses of occupational physical 3 Identify subgroups eg with high levels of cardiorespi. activity even when adjusted for current health status other ratory fitness that have a differential association be. lifestyle factors and socioeconomic status suggesting a tween occupational and leisure time physical activity. physical activity paradox 19 We have recently found evidence and cardiovascular and all cause mortality. for this paradox in a systematic review showing an increased 4 Assess the independent contribution of occupation. risk of premature mortality among men who are highly phys al and leisure time physical activity to socioeconomic. ically active at work compared with those who engage in low health differences. doses of occupational physical activity HR with 95 CI 1 18 Figure 1 presents a comprehensive conceptual model. 1 05 to 1 34 20 for the hypothesised pathway of the association of socio. Moreover workers from lower socioeconomic status are economic status with health outcomes in which also rele. often physically inactive during their leisure time 21 as these vant other factors including demographic behavioural. workers spend most of their daily physical activity time at psychosocial and material factors and pre existing condi. work 22 The above suggests that workers with a lower socio tions are considered Socioeconomic status is hypoth. economic status may be exposed to the negative health esised to be associated with physical activity with more. consequences of occupational physical activity and may occupational physical activity and less leisure time phys. only benefit to a limited extent from the positive health ical activity among those with a low socioeconomic status. consequences of leisure time physical activity As such the and vice versa Physical activity which is inter related with. differential effects of physical activity at work and leisure a range of relevant other factors including demographic. time may be an important driver of socioeconomic health behavioural psychosocial and material factors and pre ex. differences 23 isting conditions is subsequently associated with health. To improve the health of workers with a lower socio outcomes such as cardiovascular and all cause mortality. economic status and to maintain a sustainable workforce As such it is hypothesised that physical activity at work. more knowledge on the opposing health effects of occu and during leisure time plays an important mediating. pational and leisure time physical activity is urgently moderating role in socioeconomic health differences. required Presently a knowledge gap exists as to what type. of interventions may work for whom and when It is there. fore important to identify workers who may benefit the Methods design. most from physical activity interventions to indicate what The current manuscript is prepared in accordance with. elements such interventions should consist of and to thePreferred Reporting Items for Systematic Reviews. identify barriers and facilitators of certain interventions and Meta Analyses Protocols PRISM statement 27 The. Such knowledge can inform physical activity based inter described IPD meta analysis has been a priori regis. ventions and public health guidelines thus contributing tered in PROSPERO 28 Conducting and reporting of the. to a reduction of socioeconomic health differences An proposed IPD meta analysis will be done in accordance. individual participant data IPD meta analysis is essential with methods described by the Cochrane IPD Meta anal. to fill the knowledge gap indicated above In contrast to a ysis Methods Group25 and the PRISMA IPD statement 29. study level meta analysis an IPD meta analysis also allows Methodologies for this IPD meta analysis were based on. for testing of interaction mediation or moderation 24 This previous work 30 31. 2 Coenen P et al BMJ Open 2018 8 e023379 doi 10 1136 bmjopen 2018 023379. Open access, BMJ Open first published as 10 1136 bmjopen 2018 023379 on 28 October 2018 Downloaded from http bmjopen bmj com on January 9 2021 by guest Protected by copyright. Figure 1 Conceptual model for the pathway of the combined role of occupational and leisure time physical activity in. socioeconomic health differences Socioeconomic status is hypothesised to be associated with physical activity with more. leisure time physical activity and less occupational physical activity among those with a high socioeconomic status and vice. versa Physical activity which is inter related with a range of relevant other factors including demographic behavioural. psychosocial and material factors as well as pre existing conditions is subsequently associated with health outcomes hence. resulting in socioeconomic health differences To address aim 1 we will assess the combined association of occupational and. leisure time physical activity with the primary outcome pathway a For aims 2 and 3 we will additionally consider potential. modifying effects To address research aim 4 we will study the mediating effects of occupational and leisure time physical. activity on the association of socioeconomic status and the primary outcome To do so we will provide an estimate of the. relative strength of the mediation effect axb and we will be comparing this to the total direct effect c using the product of. coefficients test In all these models potential confounders will be considered BMI body mass index. The consortium data sources and study selection studies in which the association of both occupational and. Several strategies have been used to identify published leisure time physical activity on cardiovascular or all cause. and unpublished eligible studies including literature mortality in adult workers ie 18 65 years of age at the. searches in electronic databases and scoping searches time of physical activity assessment was assessed taking. through personal communication with experts in the field workers socioeconomic status ie expressed as educa. collaborators and colleagues The literature was searched tion occupational class and or income into account. systematically in the bibliographic databases of PubMed Studies assessing physical activity at the level of the indi. Embase CINAHL PsycINFO and Evidence Based Medi vidual were included Studies were excluded that had. cine Reviews from database inception to 14 September assessed occupational physical activity based on task and. 2017 Search terms included terms expressing physical or job classification eg a binary distinction of blue collar. activity and mortality see online supplementary material vs white collar workers or manual vs non manual work. 1 for more details We searched for original prospective Only studies in which cardiovascular or all cause mortality. Coenen P et al BMJ Open 2018 8 e023379 doi 10 1136 bmjopen 2018 023379 3. Open access, BMJ Open first published as 10 1136 bmjopen 2018 023379 on 28 October 2018 Downloaded from http bmjopen bmj com on January 9 2021 by guest Protected by copyright. was expressed as a time to event variable ie occurrence A total of 174 full text articles were retrieved of which. of the event yes no and the time to the possible event 76 were excluded for various reasons online supple. were included to allow for the execution of survival mentary material 2 After adding 35 articles from other. analysis sources 49 unique studies from 106 articles were iden. The literature search generated 2490 unique refer tified meeting our inclusion criteria for being eligible. ences that were screened on their title and or abstract to participate in the active worker consortium figure 2. Figure 2 Flow chart depicting the study selection procedure CVD cardiovascular disease LTPA leisure time physical activity. OPA occupational physical activity, 4 Coenen P et al BMJ Open 2018 8 e023379 doi 10 1136 bmjopen 2018 023379. Open access, BMJ Open first published as 10 1136 bmjopen 2018 023379 on 28 October 2018 Downloaded from http bmjopen bmj com on January 9 2021 by guest Protected by copyright.
online supplementary material 3 From these eligible. Table 1 Overview of variables that will be requested from. studies corresponding authors principal investigators eligible studies. and or researchers from the network of the consortium. Variable group Variables Relevant details, members will be invited to collaborate in our active worker. study consortium Invitations will be sent by email After Predicting variables Occupational Self reports If possible. physical activity frequency duration, no response a reminder email will be sent and or a tele Leisure time and intensity of. phone call will be made to achieve participation Partic physical activity physical activity will be. considered, ipation in the consortium includes sharing of data and. Socioeconomic status Education level, ideas and manuscript preparation Reasons for refusal to Occupational class. participate will be noted Income, After agreeing to collaborate potential collaborators Primary outcomes All cause mortality Time to occurrence.
ascertained by national, will be asked to fill out our data request form in order for or local registers. us to obtain more information on the respective cohorts. Secondary outcomes Cardiovascular Time to occurrence. eg regarding contact details of principal investigators mortality ascertained by national. study design and available data Also researchers will be Cardiovascular or local registers or self. diseases in general reports, asked to sign a policy document after which they will be Specific. asked to transfer their anonymised and encrypted data cardiovascular. diseases eg,ischaemic heart, Data acquisition and harmonisation disease myocardial. Data on occupational and leisure time physical activity infarction or stroke. predictor variables typically not including the domains Pre existing conditions Adiposity eg body. mass index waist, of transport and household all cause mortality primary circumference or fat. outcomes or cardiovascular diseases or mortality percentage. Blood pressure and, secondary outcomes socioeconomic status and rele or hypertension.
vant other factors including demographic behavioural Blood lipids. psychosocial and material factors and pre existing condi cholesterol and or. tions will be retrieved from each of the participating Cardiorespiratory. studies as described in more detail in table 1 and fitness. Self reported health, figure 1 Study data with at least the predictor variables Other non. primary outcome variables and socioeconomic status will communicable. diseases eg, be used for further analysis For each of the variables diabetes cancer. the most detailed level of data ie continuous variables pulmonary diseases. rather than categorical ones will be requested mental health. Collaborators will be asked to supply raw data that can. Other relevant factors, be transferred in any electronic format eg SPSS SAS. Demographic factors Gender, Stata or Excel in an anonymised file ie only labelling Age. participants by a unique identification number Data of Ethnicity. Such knowledge can inform physical activity based inter ventions and public health guidelines thus contributing to a reduction of socioeconomic health differences An individual participant data IPD meta analysis is essential to fill the knowledge gap indicated above In contrast to a study level meta analysis an IPD meta analysis also allows for testing of interaction mediation or

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