Title: THE ROLE OF LIFESTYLE FACTORS IN THE ASSOCIATION BETWEEN
EDUCATION AND SELF-REPORTED FIBROMYALGIA: A MEDIATION ANALYSIS
Version: 1 Date: 12 Jan 2024
Reviewer's report:
This is analysis on "The role of lifestyle factors in the association between adult socioeconomic
position and self-reported fibromyalgia: A mediation analysis" investigates an interesting
research question on the association education and fibromyalgia. The methods are well
described, but the Discussion section needs major revision as it is too long and repetitive.
Major revision; Discussion section:
1) Overall, the discussion section is too long (6 pages including limitations) and is difficult
to follow. Try to focus on the main findings which you mention in the first paragraph and
discuss only these. For example, the second paragraph could be deleted because it discusses
the association between education and fibromyalgia without taking mediation of other lifestyle
factors into account, which is the main focus of the current analysis. The first paragraph should
start directly mentioning the results. I would have dropped the sentence starting with"Our results
showed a significant ...as I think this sentence is redundant.
2) For every paragraph the authors mention the results twice. It is enough to keep the numbers
and not the interpretation("This implies..."
Minor revisions Discussion section:
3) I think the use of index study is a bit confusing. Can you use "current" in stead?
4) 2nd paragraph: In stead of "comparable to" could you use "consistent with?"
5) 2nd paragraph: Rephrase "Years of education a significant predictor" to "education was
positively  associated with chronic widespread..."
6) Rephrase ""low sosioeconomic status ..with increased prevalence" . Please, drop prevalence
and just write "Chronic widespread pain.."
7) When you refer to Choi et al. the authors mention ..."after adjusting for other factors". Please
mention all the confounders as it is important when interpreting the results
8)What is social epidemiologic findings? Please drop this and just say "the observed
association ..consistent with other studies reporting an inverse association between sosieco...and
health"
9)"Better knowledge"?.  You mean more knowledge? Please, rephrase "Skills" ? Better skills
to healthy behavior? Please drop skills.
10) 3rd paragraph. Please rephrase "This could imply that there is varying exposure to lifestyle
to "Lifestyle factors could have different effect on the different levels of education".
11) Drop the the two sentences starting with "For clarity.." and "Although the logic.." to shorten
the discussion section  and it does not have any added value.
12) 5th paragraph; what does the "FMS" stand for?
13)6th paragraph; be accurate and concise and use  life style factors in stead of environmental
factors.
14) Strengths and limitations;
2nd paragraph; I do not understand the sentences on selection bias. It cannot be selection bias if
they are non-participants? Are they included? Please explain!
Minor revisions other than the Discussion section;
15) Figure 2; there is missing an "A" in "PA".
16)Figure 3; the heading lacks the outcome. Please add "Fibromyalgia" after education.
17) Figure 4; the heading lacks the outcome. Please add "Fibromyalgia" after education.
18) the heading: Is it not "education" you are looking at in the analyses? Why have you used
sosieconomic position in the heading? Please add education as it is more precise in describing
your analyses.