{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,9]],"date-time":"2026-06-09T12:10:22Z","timestamp":1781007022592,"version":"3.54.1"},"reference-count":36,"publisher":"BMJ","issue":"2","license":[{"start":{"date-parts":[[2026,6,9]],"date-time":"2026-06-09T00:00:00Z","timestamp":1780963200000},"content-version":"unspecified","delay-in-days":69,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100005416","name":"Norwegian Research Council","doi-asserted-by":"crossref","award":["319705"],"award-info":[{"award-number":["319705"]}],"id":[{"id":"10.13039\/501100005416","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["bmjph"],"accepted":{"date-parts":[[2026,5,21]]},"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Well-known non-communicable disease (NCD) risk factors tend to cluster, forming groups with similar \u2018risk factor phenotypes\u2019. However, the characterisation of such clusters and the role of socioeconomic position (SEP) in modifying their associations with NCDs still remain unclear.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We utilised data on smoking, physical activity, alcohol consumption, body mass index, blood pressure, cholesterol and triglyceride from health examination surveys conducted in Norwegian adults from 1974 to 2019 (n=5\u200976\u2009299; age 20\u201365 years; 64% participation; 52%\u2009women) linked to registry data on education, income and mortality (follow-up through 2020). We identified risk factor clusters using latent profile analyses and used flexible parametric survival models to estimate differences in mean age at NCD death across sex, different birth years and SEP (education and income levels).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>We identified four distinct clusters containing 44% (\u2018healthy\u2019), 45% (\u2018suboptimal\u2019), 4% (\u2018dyslipidaemics\u2019) and 7% (\u2018hypertensives\u2019) of the study sample, respectively. During a mean follow-up of 26 years, 61 241 died from an NCD.<\/jats:p>\n                    <jats:p>Compared with the cluster with the healthiest profile, other clusters had markedly shorter survival across sex and different birth cohorts. However, differences were also substantially modified by SEP: we estimated that individuals with primary education or low income died several years earlier than individuals with tertiary education or high income within each of the four risk factor clusters.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Our findings show how NCD risk factors cluster and how SEP modifies the association between this clustering and NCD mortality. The substantial influence of SEP highlights the need for public health strategies that focus not only on changing behavioural and metabolic risk factors but also on addressing socioeconomic disparities to effectively reduce the burden of NCDs.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjph-2025-004101","type":"journal-article","created":{"date-parts":[[2026,6,9]],"date-time":"2026-06-09T11:55:43Z","timestamp":1781006143000},"page":"e004101","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Joint association of risk factor clustering and socioeconomic position with non-communicable disease mortality risk: a prospective cohort study of 576 299 Norwegian men and women in the NCDNOR project"],"prefix":"10.1136","volume":"4","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4401-301X","authenticated-orcid":false,"given":"Knut Eirik","family":"Dalene","sequence":"first","affiliation":[{"name":"Department of Chronic Diseases, Norwegian Institute of Public Health, Oslo, Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simon","family":"Lergenmuller","sequence":"additional","affiliation":[{"name":"Department of Registration, Cancer Registry of Norway, Norwegian Institute of Public Health, Oslo, Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hein","family":"Stigum","sequence":"additional","affiliation":[{"name":"Department of Chronic Diseases, Norwegian Institute of Public Health, Oslo, Norway"},{"name":"Department of Community Medicine and Global Health, University of Oslo, Oslo, Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haakon Eduard","family":"Meyer","sequence":"additional","affiliation":[{"name":"Department of Chronic Diseases, Norwegian Institute of Public Health, Oslo, Norway"},{"name":"Department of Community Medicine and Global Health, University of Oslo, Oslo, Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wenche","family":"Nystad","sequence":"additional","affiliation":[{"name":"Department of Chronic Diseases, Norwegian Institute of Public Health, Oslo, Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Inger K","family":"Larsen","sequence":"additional","affiliation":[{"name":"Department of Registration, Cancer Registry of Norway, Norwegian Institute of Public Health, Oslo, Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0736-5139","authenticated-orcid":false,"given":"Erik Reidar","family":"Sund","sequence":"additional","affiliation":[{"name":"Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Tr\u00f8ndelag, Norway"},{"name":"Levanger Hospital, Levanger, Nord-Trondelag, Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steinar","family":"Krokstad","sequence":"additional","affiliation":[{"name":"Levanger Hospital, Levanger, Nord-Trondelag, Norway"},{"name":"Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laila A","family":"Hopstock","sequence":"additional","affiliation":[{"name":"The Department of Health and Care Sciences, UiT The Arctic University of Norway, Troms\u00f8, Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ulf","family":"Ekelund","sequence":"additional","affiliation":[{"name":"Department of Chronic Diseases, Norwegian Institute of Public Health, Oslo, Oslo, Norway"},{"name":"Department of Sports Medicine, Norwegian School of Sports Sciences, Oslo, Oslo, Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lars","family":"J\u00f8ran Kjerpeseth","sequence":"additional","affiliation":[{"name":"Department of Chronic Diseases, Norwegian Institute of Public Health, Oslo, Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Inger","family":"Ariansen","sequence":"additional","affiliation":[{"name":"Department of Chronic Diseases, Norwegian Institute of Public Health, Oslo, Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,6,9]]},"reference":[{"key":"2026060904551674000_4.2.e004101.1","unstructured":"The World Health Organization . 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