A Structural Model of Social Determinants of the Metabolic Syndrome

Abstract

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.Methods: Structural equation modeling of MetS incorporating the effects of race/eth­nicity, racial discrimination, socioeconomic position (SEP), and selected mediating variables.Main Outcome Measure: Latent MetS score and MetS status based on the five-point scale developed by the National Cholesterol Education Panel (NCEP).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.Ethn Dis. 2020;30(2):331-338; doi:10.18865/ ed.30.2.331