Life Course Models of Socioeconomic Position and Cardiovascular Risk Factors: 1946 Birth Cohort

Abstract

Purpose To identify the life course model that best describes the association between life course socioeconomic position (SEP) and cardiovascular (CVD) risk factors [body mass index (BMI), systolic and diastolic blood pressure, total cholesterol, low-density lipoprotein, high-density lipoprotein, triglycerides, glycated haemoglobin] and explore BMI across the life course as mediators of the relationship. Methods The Medical Research Council (MRC) National Survey of Health and Development was used to compare partial F-tests of simpler nested life course SEP models corresponding to critical period, accumulation, and social mobility modes with a saturated model. Then, the chosen life course model for each CVD risk factor was adjusted for BMI at age 53 and lifetime BMI (ages 4, 26, 43, and 53 years). Results Among women, SEP was generally associated with CVD risk factors in a cumulative manner; while childhood critical period was the prominent model for men. Using the best fitting SEP models, adjustment for BMI at age 53 reduced associations for all outcomes in both genders. Further adjustment for lifetime BMI (4, 26, 43 and 53 years) did not substantially alter most associations (except for triglycerides). Conclusion SEP at different points across life influences CVD risk factors differently in men and women.

A Life Course Perspective on Body Size and Cardio-metabolic Health

“…Early childhood and adolescence in particular are emerging as important periods for the establishment of obesity and programming of cardio-metabolic risk. It has recently been shown in the MRC National Survey of Health and Development that socioeconomic disadvantage in early childhood, more so than at any other age, is associated with cardio-metabolic risk factors at age 53 years, for example (Murray et al 2011). In the same cohort, exposure to obesity emerges during adolescence as being associated with greater carotid-intima media thickness at 60-64 years of age in men ).…”

Life Course Socioeconomic Position and Subclinical Disease: The Jackson Heart Study

“…1,12,13 Childhood and adult SEP independently and jointly contribute to an increased prevalence of CVD risk factors, subclinical disease, and CVD disparities. [14][15][16][17][18][19][20][21] Prior work has also shown that lower cumulative life course SEP was associated with increased prevalence of subclinical CVD 17,[22][23][24] among relatively smaller or non-African American samples.…”

“…25 Studies of mostly White populations have shown that early exposure to CVD risk factors may contribute to the development of subclinical CVD as an adolescent, young adult, and adult. [19][20][21]23,24,26 However, it remains uncertain whether the childhood social and economic circumstances of African American adults are related to greater prevalence of subclinical CVD.…”

Family structure and socio-emotional wellbeing in the early years: a life course approach

“…Any life course model which offers a model fit as good as the saturated model is then considered further. Since its proposal, the structured life course approach has been applied in several studies exploring the influence of social circumstances on health across the life course (Birnie, et al 2011;Cooper, Mishra & Kuh, 2011;Gustafsson, Persson & Hammarstrom, 2011;Murray et al, 2011;West et al, 2012 ;Wills, Hardy, Black & Kuh, 2010) and throughout childhood (Evans & Kohli, 1997;Giles et al, 2011;Lin, Leung, Hui, Lam and Schooling, 2011).…”