Skip to main content

Advertisement

Log in

Early-life and adult socioeconomic status and inflammatory risk markers in adulthood

  • Perinatal Epidemiology
  • Published:
European Journal of Epidemiology Aims and scope Submit manuscript

Abstract

Background: Associations between childhood and adult socioeconomic status (SES) and adult levels of inflammatory markers (C-reactive protein [CRP], fibrinogen, white blood cell count [WBC], and von Willebrand factor [vWF]) were examined in the Atherosclerosis Risk in Communities (ARIC) Study cohort. Methods: A total of 12,681 white and African-American participants provided information on SES (via education and social class) and place of residence in childhood and adulthood. Residences were linked to census data for neighborhood SES information. Multiple imputation was used to impute missing data. Hierarchical and linear regression were used to estimate the effects of SES and possible mediation by adult cardiovascular disease (CVD) risk factors. Findings: Low childhood social class and education were associated with elevated levels of CRP, fibrinogen, WBC, and vWF (increments of 17%, 2%, 4% and 3% for lowest versus highest education in childhood, respectively) among whites. Findings were less consistent among African-Americans. Adult SES was more strongly associated with inflammation than childhood SES. Individual-level SES measures were more consistently associated with inflammation than neighborhood-level measures. Fibrinogen and WBC showed the most consistent associations with SES; the largest changes in inflammation by SES were observed for CRP. Covariate adjustment strongly attenuated these associations. Mediation of the SES-inflammation associations by BMI, smoking and HDL cholesterol (HDL-C) are suggested by these data. Conclusion: Low individual- and neighborhood-level SES in childhood and adulthood are associated with modest increments in adult inflammatory burden. These associations may operate through the influence of low SES on traditional CVD risk factors, especially BMI, smoking and HDL-C.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Diez-Roux AV, Nieto FJ, Tyroler HA, Crum LD, Szklo M Social inequalities and atherosclerosis. The atherosclerosis risk in communities study. Am J Epidemiol 1995; 141(10): 960–72

    CAS  PubMed  Google Scholar 

  2. Kunst AE, Groenhof F, Andersen O et al. Occupational class and ischemic heart disease mortality in the United States and 11 European countries. Am J Public Health 1999; 89(1): 47–3

    CAS  PubMed  Google Scholar 

  3. Diez-Roux AV, Nieto FJ, Muntaner C et al. Neighborhood environments and coronary heart disease: a multilevel analysis. Am J Epidemiol 1997; 146(1): 48–3

    CAS  PubMed  Google Scholar 

  4. Armstrong D, Barnett E, Casper M, Wing S. Community occupational structure, medical and economic resources, and coronary mortality among U.S. blacks and whites, 1980–988. Ann Epidemiol 1998; 8(3): 184–91

    Article  CAS  PubMed  Google Scholar 

  5. Kaplan GA, Keil JE Socioeconomic factors and cardiovascular disease: a review of the literature. Circulation 1993; 88(4 Pt 1): 1973–998

    CAS  PubMed  Google Scholar 

  6. Kumari M, Marmot M, Brunner E. Social determinants of von willebrand factor: the Whitehall II study. Arterioscler Thromb Vasc Biol 2000; 20(7): 1842–847

    CAS  PubMed  Google Scholar 

  7. Owen N, Poulton T, Hay FC, Mohamed-Ali V, Steptoe A Socioeconomic status, C-reactive protein, immune factors, and responses to acute mental stress. Brain Behav Immun 2003; 17(4): 286–95

    Article  CAS  PubMed  Google Scholar 

  8. Panagiotakos DB, Pitsavos C, Manios Y, Polychronopoulos E, Chrysohoou CA, Stefanadis C. Socio-economic status in relation to risk factors associated with cardiovascular disease, in healthy individuals from the ATTICA study. Eur J Cardiovasc Prev Rehabil 2005; 12(1): 68–4

    Article  PubMed  Google Scholar 

  9. Myllykangas M, Pekkanen J, Rasi V, Haukkala A, Vahtera E, Salomaa V Haemostatic and other cardiovascular risk factors, and socioeconomic status among middle-aged Finnish men and women. Int J Epidemiol 1995; 24(6): 1110–116

    Article  CAS  PubMed  Google Scholar 

  10. Smith GD, Hart C, Blane D, Hole D Adverse socioeconomic conditions in childhood and cause specific adult mortality: prospective observational study. Br Med J 1998; 316(7145): 1631–635

    CAS  Google Scholar 

  11. Brunner E, Shipley MJ, Blane D, Smith GD, Marmot MG. When does cardiovascular risk start? Past and present socioeconomic circumstances and risk factors in adulthood. J Epidemiol Community Health 1999; 53(12): 757–64

    Article  CAS  PubMed  Google Scholar 

  12. Marmot M, Shipley M, Brunner E, Hemingway H. Relative contribution of early life and adult socioeconomic factors to adult morbidity in the Whitehall II study. J Epidemiol Community Health 2001; 55(5): 301–07

    Article  CAS  PubMed  Google Scholar 

  13. Smith GD, McCarron P, Okasha M, McEwen J. Social circumstances in childhood and cardiovascular disease mortality: prospective observational study of Glasgow University students. J Epidemiol Community Health 2001; 55(5): 340–41

    Article  CAS  PubMed  Google Scholar 

  14. Wamala SP, Lynch J, Kaplan GA. Women’s exposure to early and later life socioeconomic disadvantage and coronary heart disease risk: the Stockholm Female Coronary Risk Study. Int J Epidemiol 2001; 30(2): 275–84

    Article  CAS  PubMed  Google Scholar 

  15. Claussen B, Davey Smith G, Thelle D. Impact of childhood and adulthood socioeconomic position on cause specific mortality: the Oslo Mortality Study. J Epidemiol Community Health 2003; 57(1): 40–5

    Article  CAS  PubMed  Google Scholar 

  16. Osler M, Andersen A-MN, Due P, Lund R, Damsgaard MT, Holstein BE. Socioeconomic position in early life, birth weight, childhood cognitive function, and adult mortality. A longitudinal study of Danish men born in 1953. J Epidemiol Community Health 2003; 57: 681–86

    Article  CAS  PubMed  Google Scholar 

  17. Ebrahim S, Montaner D, Lawlor DA. Clustering of risk factors and social class in childhood and adulthood in British women’s heart and health study: cross sectional analysis. Br Med J 2004; 328(7444): 861

    Article  Google Scholar 

  18. Sallout B, Walker M. The fetal origin of adult diseases. J Obstet Gynaecol 2003; 23(5): 555–60

    Article  CAS  PubMed  Google Scholar 

  19. Kuh D, Ben-Shlomo Y. A Life Course Approach to Chronic Disease Epidemiology. Oxford: Oxford University Press; 1997

    Google Scholar 

  20. Hertzman C, Power C, Matthews S, Manor O Using an interactive framework of society and lifecourse to explain self-rated health in early adulthood. Soc Sci Med 2001; 53(12): 1575–585

    Article  CAS  PubMed  Google Scholar 

  21. Power C, Hertzman C Social and biological pathways linking early life and adult disease. Br Med Bull 1997; 53(1): 210–21

    CAS  PubMed  Google Scholar 

  22. Galobardes B, Lynch JW, Davey Smith G. Childhood socioeconomic circumstances and cause-specific mortality in adulthood: systematic review and interpretation. Epidemiol Rev 2004; 26: 7–1

    Article  PubMed  Google Scholar 

  23. Pollitt RA, Rose KM, Kaufman JS. Evaluating the evidence for models of life course socioeconomic factors and cardiovascular outcomes: a systematic review. BMC Public Health 2005; 5(1): 7

    Article  PubMed  Google Scholar 

  24. Pearson TA, Mensah GA, Alexander RW et al. Markers of inflammation and cardiovascular disease: application to clinical and public health practice: A statement for healthcare professionals from the Centers for Disease Control and Prevention and the American Heart Association. Circulation 2003; 107(3): 499–11

    Article  PubMed  Google Scholar 

  25. Ross R. Atherosclerosis — an inflammatory disease. N Engl J Med 1999; 340(2): 115–26

    Article  CAS  PubMed  Google Scholar 

  26. Huber SA, Sakkinen P, Conze D, Hardin N, Tracy R. Interleukin-6 exacerbates early atherosclerosis in mice. Arterioscler Thromb Vasc Biol 1999; 19(10): 2364–367

    CAS  PubMed  Google Scholar 

  27. Meade TW, Mellows S, Brozovic M et al. Haemostatic function and ischaemic heart disease: principal results of the Northwick Park Heart Study. Lancet 1986; 2(8506): 533–37

    Article  CAS  PubMed  Google Scholar 

  28. Kannel WB, Wolf PA, Castelli WP, D’Agostino RB Fibrinogen and risk of cardiovascular disease. The Framingham Study. JAMA 1987; 258(9): 1183–186

    Article  CAS  PubMed  Google Scholar 

  29. Yarnell JW, Baker IA, Sweetnam PM et al. Fibrinogen, viscosity, and white blood cell count are major risk factors for ischemic heart disease. The Caerphilly and Speedwell collaborative heart disease studies. Circulation 1991; 83(3): 836–44

    CAS  PubMed  Google Scholar 

  30. Danesh J, Collins R, Appleby P, Peto R Association of fibrinogen, C-reactive protein, albumin, or leukocyte count with coronary heart disease: meta-analyses of prospective studies. JAMA 1998; 279(18): 1477–482

    Article  CAS  PubMed  Google Scholar 

  31. de Ferranti S, Rifai N C-reactive protein and cardiovascular disease: a review of risk prediction and interventions. Clin Chim Acta 2002; 317(1–2): 1–5

    Article  PubMed  Google Scholar 

  32. Folsom AR, Wu KK, Rosamond WD, Sharrett AR, Chambless LE Prospective study of hemostatic factors and incidence of coronary heart disease: the Atherosclerosis Risk in Communities (ARIC) Study. Circulation 1997; 96(4): 1102–108

    CAS  PubMed  Google Scholar 

  33. Heslop P, Smith GD, Macleod J, Hart C. The socioeconomic position of employed women, risk factors and mortality. Soc Sci Med 2001; 53(4): 477–85

    Article  CAS  PubMed  Google Scholar 

  34. Tunstall-Pedoe H, Woodward M, Tavendale R, A’Brook R, McCluskey MK. Comparison of the prediction by 27 different factors of coronary heart disease and death in men and women of the Scottish Heart Health Study: cohort study. Br Med J 1997; 315(7110): 722–29

    CAS  Google Scholar 

  35. Festa A, D’Agostino R Jr., Howard G, Mykkanen L, Tracy RP, Haffner SM Chronic subclinical inflammation as part of the insulin resistance syndrome: the Insulin Resistance Atherosclerosis Study (IRAS). Circulation 2000; 102(1): 42–7

    CAS  PubMed  Google Scholar 

  36. Ziccardi P, Nappo F, Giugliano G et al. Reduction of inflammatory cytokine concentrations and improvement of endothelial functions in obese women after weight loss over one year. Circulation 2002; 105(7): 804–09

    Article  CAS  PubMed  Google Scholar 

  37. Brunner E, Davey Smith G, Marmot M, Canner R, Beksinska M, O’Brien J Childhood social circumstances and psychosocial and behavioural factors as determinants of plasma fibrinogen. Lancet 1996; 347(9007): 1008–013

    Article  CAS  PubMed  Google Scholar 

  38. Wilson TW, Kaplan GA, Kauhanen J et al. Association between plasma fibrinogen concentration and five socioeconomic indices in the Kuopio Ischemic Heart Disease Risk Factor Study. Am J Epidemiol 1993; 137(3): 292–00

    CAS  PubMed  Google Scholar 

  39. Jackson R, Chambless LE, Yang K et al. Differences between respondents and nonrespondents in a multicenter community-based study vary by gender ethnicity. The Atherosclerosis Risk in Communities (ARIC) Study Investigators. J Clin Epidemiol 1996; 49(12): 1441–446

    Article  CAS  PubMed  Google Scholar 

  40. The Atherosclerosis Risk in Communities (ARIC) Study: design and objectives. The ARIC investigators. Am J Epidemiol 1989; 129(4): 687–02

    Google Scholar 

  41. Life Course Socioeconomic Status, Social Context and Cardiovascular Disease (LC-SES) Study: Manual of Procedures. http://lifecourseepi.info/lifecourse2/forms/index.htm

  42. Rose KM, Wood JL, Knowles S et al. Historical measures of social context in life course studies: retrospective linkage of addresses to decennial censuses. Int J Health Geogr 2004; 3(1): 27

    Article  PubMed  Google Scholar 

  43. Wright EO. Class counts: comparative studies in class analysis/Erik Olin Wright.: Cambridge; New York: Cambridge University Press; Paris: Maison des sciences de l’homme, 1997; 1997

  44. Krieger N, Williams DR, Moss NE Measuring social class in US public health research: concepts, methodologies, and guidelines. Annu Rev Public Health 1997; 18: 341–78

    Article  CAS  PubMed  Google Scholar 

  45. Horton NJ, Lipsitz SR. Multiple imputation in practice: comparison of software packages for regression models with missing variables. Am Statist 2001; 55(3): 244–54

    Article  Google Scholar 

  46. Schafer JL. Multiple imputation: a primer. Stat Methods Med Res 1999; 8(1): 3–5

    Article  CAS  PubMed  Google Scholar 

  47. Schafer JL, Graham JW. Missing data: our view of the state of the art. Psychol Methods 2002; 7(2): 147–77

    Article  PubMed  Google Scholar 

  48. Collins LM, Schafer JL, Kam CM. A comparison of inclusive and restrictive strategies in modern missing data procedures. Psychol Methods 2001; 6(4): 330–51

    Article  CAS  PubMed  Google Scholar 

  49. Royston P. Multiple imputation of missing values. Stata J 2004; 4(3): 227–41

    Google Scholar 

  50. National Heart Lung and Blood Institute. Atherosclerosis Risk in Communities (ARIC) Study Protocol, Manual 9: Hemostasis Determinations. In University of North Carolina: School of Public Health; 1987

  51. Papp AC, Hatzakis H, Bracey A, Wu KK ARIC hemostasis study-I. Development of a blood collection and processing system suitable for multicenter hemostatic studies. Thromb Haemost 1989; 61(1): 15–9

    CAS  PubMed  Google Scholar 

  52. Clauss A Gerinnungsphysiologische Schnellmethode zur Bestimmung des Fibrinogens. Acta Haematol. 1957; 17: 237–46

    Article  CAS  PubMed  Google Scholar 

  53. Chambless LE, McMahon R, Wu K, Folsom A, Finch A, Shen YL Short-term intraindividual variability in hemostasis factors. The ARIC Study. Atherosclerosis Risk in Communities Intraindividual Variability Study. Ann Epidemiol 1992; 2(5): 723–33

    Article  CAS  PubMed  Google Scholar 

  54. Duncan BB, Schmidt MI, Chambless LE, Folsom AR, Carpenter M, Heiss G. Fibrinogen, other putative markers of inflammation, and weight gain in middle-aged adults — the ARIC study. Atherosclerosis Risk in Communities. Obes Res 2000; 8(4): 279–86

    Article  CAS  PubMed  Google Scholar 

  55. Beck JD, Elter JR, Heiss G, Couper D, Mauriello SM, Offenbacher S Relationship of periodontal disease to carotid artery intima-media wall thickness: The Atherosclerosis Risk in Communities (ARIC) Study. Arterioscler Thromb Vasc Biol 2001; 21(11): 1816–822

    Article  CAS  PubMed  Google Scholar 

  56. Slade GD, Ghezzi EM, Heiss G, Beck JD, Riche E, Offenbacher S Relationship between periodontal disease and C-reactive protein among adults in the Atherosclerosis Risk in Communities study. Arch Intern Med 2003; 163(10): 1172–179

    Article  PubMed  Google Scholar 

  57. Duncan BB, Schmidt MI, Pankow JS et al. Low-grade systemic inflammation and the development of type 2 diabetes: the atherosclerosis risk in communities study. Diabetes 2003; 52(7): 1799–805

    Article  CAS  PubMed  Google Scholar 

  58. Diez Roux AV A glossary for multilevel analysis. J Epidemiol Community Health 2002; 56(8): 588–94

    Article  CAS  PubMed  Google Scholar 

  59. Merlo J, Chaix B, Yang M, Lynch J, Rastam L A brief conceptual tutorial of multilevel analysis in social epidemiology: linking the statistical concept of clustering to the idea of contextual phenomenon. J Epidemiol Community Health 2005; 59(6): 443–49

    Article  PubMed  Google Scholar 

  60. Baecke J, Burema J, Frijters J A short questionnaire for the measurement of habitual physical activity in epidemiological studies. Am J Clin Nutr 1982; 36(5): 936–42

    CAS  PubMed  Google Scholar 

  61. Hoyle RH, Kenny DA. Sample size, reliability, and test of statistical mediation. In: Hoyle RH ed. Statistical Strategies for Small Sample Research. Thousand Oaks, CA: SAGE Publications; 1999 195–22

    Google Scholar 

  62. Baron RM, Kenny DA The moderator-mediator variable distinction in social psychological research: conceptual, strategic, and statistical considerations. J Pers Soc Psychol 1986; 51(6): 1173–182

    Article  CAS  PubMed  Google Scholar 

  63. Lynch JW, Kaplan GA, Salonen JT Why do poor people behave poorly? Variation in adult health behaviours and psychosocial characteristics by stages of the socioeconomic lifecourse. Soc Sci Med 1997; 44(6): 809–19

    Article  CAS  PubMed  Google Scholar 

  64. Borrell LN, Diez Roux AV, Rose K, Catellier D, Clark BL Neighbourhood characteristics and mortality in the Atherosclerosis Risk in Communities Study. Int J Epidemiol 2004; 33(2): 398–07

    Article  PubMed  Google Scholar 

  65. Bosma H, Dike van de Mheen H, Borsboom GJJM, Mackenbach JP. Neighborhood Socioeconomic Status and All-Cause Mortality. Am J Epidemiol 2001; 153(4): 363–71

    Article  CAS  PubMed  Google Scholar 

  66. Cole SR, Hernan MA Fallibility in estimating direct effects. Int J Epidemiol 2002; 31(1): 163–65

    Article  PubMed  Google Scholar 

  67. Poole C, Kaufman JS What does standard adjustment for downstream mediators tell us about social effect pathways? Am J Epidemiol 2000; 151: S52

    Google Scholar 

  68. McGill HC Jr., Herderick EE, McMahan CA et al. Atherosclerosis in youth. Minerva Pediatr 2002; 54(5): 437–47

    PubMed  Google Scholar 

  69. Zieske AW, Malcom GT, Strong JP. Natural history and risk factors of atherosclerosis in children and youth: the PDAY study. Pediatr Pathol Mol Med 2002; 21(2): 213–37

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

The Atherosclerosis Risk in Communities Study is carried out as a collaborative study supported by National Heart, Lung, and Blood Institute contracts N01-HC-55015, N01-HC-55016, N01-HC-55018, N01-HC-55019, N01-HC-55020, N01-HC-55021, and N01-HC-55022. The authors thank the staff and participants of the ARIC study for their important contributions.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Ricardo A. Pollitt.

Electronic Supplementary Material

Below is the link to the electronic Supplementary Material.

Additional Table 1

Relative differences in estimated levels of adult von Willebrand Factor (vWF) for lower social class versus Capitalist/Expert Manager social class, lower versus High education and lower versus High neighborhood SES in childhood and adulthood for white and African-American study participants.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Pollitt, R.A., Kaufman, J.S., Rose, K.M. et al. Early-life and adult socioeconomic status and inflammatory risk markers in adulthood. Eur J Epidemiol 22, 55–66 (2007). https://doi.org/10.1007/s10654-006-9082-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10654-006-9082-1

Keywords

Navigation