Life-course socioeconomic positions and subclinical atherosclerosis in the multi-ethnic study of atherosclerosis

Abstract

A major limitation of past work on the social patterning of atherosclerosis has been the reliance on measures of neighborhood or individual-level socioeconomic position (SEP) assessed at a single point in time in adulthood. Risk of chronic disease is thought to accumulate throughout the life-course, so the use of a measure for a single point in time may result in inaccurate estimates of the social patterning of subclinical disease. Using data from the US Multi-Ethnic Study of Atherosclerosis (MESA), we examined the relation between childhood SEP [CSEP] (father or caretaker’s education), adulthood SEP [ASEP] (a summary score of income, education, and wealth), and 20-year average exposure to neighborhood poverty [NSEP] (residential addresses geocoded and linked to census data) and the prevalence of subclinical atherosclerosis, as assessed by common carotid intimal–medial thickness (IMT) in mid to late adulthood. Participants were 45–84 years of age at baseline and were sampled from six study sites in the United States. After adjustment for age, CSEP and ASEP were both inversely and independently associated with IMT in men. All three indicators CSEP, ASEP, and NSEP were inversely and independently associated with IMT in women. Associations were somewhat reduced after adjustment for cardiovascular risk factors, suggesting that these factors may play a mediating role. There was evidence of heterogeneity in effects of NSEP by gender, and in the effects of ASEP and NSEP by race/ethnicity. Our results contribute to the growing body of work that shows that SEP at multiple points in the life-course, and at the individual and neighborhood level, contributes to the development of atherosclerosis.

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

“…However, many of these studies used limited SEP measures, subclinical markers, or relatively smaller or nonAfrican American sample. 2,17,[22][23][24]32 Adult family income also significantly predicted LVH and PAD after adjustment for age and sex. In another recently published study, investigators found that prevalent diabetes was significantly higher in lower vs high SEP African Americans with associations persisting after risk factor adjustment, which is similar to the relationships between LVH with income and PAD with education.…”

“…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.…”

Social Determinants of Risk and Outcomes for Cardiovascular Disease

“…This scarring can result in thickening and stiffening of the vascular wall, with consequent narrowing of the vascular lumen. 296 The consequences of these changes include increased blood pressure (especially diastolic pressure) and reduced blood flow, as well as an increased risk of thrombosis.…”

Heterogeneity in chronic disease outcomes among women and men in midlife: examining the role of stability and change in childhood economic hardship

“…Further, childhood disadvantage has been treated as static, rather than as a dynamic process involving stability and change over time (e.g. Lemelin et al, 2009;Pudrovska & Anikputa, 2013;Walsemann, Ailshire, Bell & Frongillo, 2012), and its effects rarely compared across health outcomes.…”