Elsevier

The Lancet

Volume 348, Issue 9037, 9 November 1996, Pages 1259-1263
The Lancet

Articles
Influence of fathers' social class on cardiovascular disease in middle-aged men

https://doi.org/10.1016/S0140-6736(96)02465-8Get rights and content

Summary

Background

The independent effect of early life circumstances on adult cardiovascular risk is still unresolved. We assessed the associations of father's social class with cardiovascular risk factors and with risk of ischaemic heart disease and stroke in adult life.

Methods

We did a longitudinal study of cardiovasular disease in 5934 men aged 40–59 years at enrolment. A cross-sectional measurement survey was done between 1978 and 1980 and a follow-up questionnaire was completed in 1992. The main endpoints were non-fatal myocardial infarction and stroke based on general practitioners' reports obtained between screening and 1992 and on recall of physician-diagnosed ischaemic heart disease in the 1992 questionnaire.

Findings

Father's social class was strongly associated with social class in adulthood (fathers' occupation was manual for 41·3% of professionals [I] vs 89·1% for unskilled manual workers [V]) and was significantly related to height (non-manual vs manual 175·4 cm [SE 0·2] vs 172·9 cm [0·1], p<0·0001) and obesity (213 [14·1%] vs 804 [20·1%], p<0·0001) irrespective of adult social class; no association was found with blood glucose (log, 1·69 [0·005] vs 1·70 [0·003], p=0·22) or cholesterol (6·34 [0·03] vs 6·29 mmol/L [0·02], p=0·16. Men whose fathers' social class was manual had significantly higher rates of non-fatal myocardial infarction (342/4006 vs 92/1510) and self-reported physician-diagnosed ischaemic heart disease (686/4006 vs 192/1510) than men whose fathers' social class was non-manual, even after adjustment for adult social class and other established risk factors (relative odds 1·3 [95% CI 1·0–1·7], p<0·05 and 1·3 [1·1–1·6], p<0·01, respectively). The influence of father's social class on non-fatal myocardial infarction and ischaemic heart disease was only seen in men whose adult social class was non-manual. No association was seen between father's social class and non-fatal stroke.

Interpretation

Father's social class is strongly associated with adult social class. The higher risk of non-fatal myocardial infarction and self-reported physician-diagnosed ischaemic heart disease seen in men whose father's social class was manual suggests that socioeconomic status early in life has some persisting influence on ischaemic heart disease risk in adult life.

Introduction

The possibility that cardiovascular disease originates in childhood, if not earlier, has been recognised for many years. Ecological studies that used infant mortality as an indicator of the early environment have reported geographic associations with ischaemic heart disease2, 3 and with blood lipid concentrations in adult life.4 Barker and colleagues have reported that size at birth is a predictor of cardiovascular disease5, 6 and of specific adult cardiovascular risk factors.7, 8, 9 Other studies have examined the influence of childhood social circumstances on adult cardiovascular risk factors or outcomes,10, 11, 12 but the extent to which these studies have been able to allow for the confounding effect of adult social circumstances has been questioned,13 and the independent effect of early life circumstances on adult cardiovascular risk is still to be resolved.14 We have examined the associations of father's social class, as a marker of social circumstances in early life, with adult cardiovascular risk factors at screening and with the prevalence of ischaemic heart disease and stroke 12–14 years later. By taking adult social class and adult cardiovascular risk factors into account in the analyses, we have tried to establish whether childhood socioeconomic status is an independent risk factor for cardiovascular disease.

Section snippets

Methods

The British Regional Heart Study is a prospective study of cardiovascular disease which involved 7735 men aged 40–59 years, selected from the age-sex registers of one general practice in each of 24 towns in England, Wales, and Scotland and who were screened between 1978 and 1980.15 We selected practices that reflected the social class distribution of the town.16 Research nurses administered to each man a standard questionnaire (Q1), which included questions on smoking habits, alcohol intake,

Father's social class and adult social class

Father's social class was strongly associated with adult social class (table 1). The proportion of men reporting their fathers' occupation as manual was 41·3% in professionals (I) compared with 89·1% in unskilled manual workers (V). The family amenity score in childhood was strongly associated with father's social class (table 2). Adult social class was also strongly related to family amenity score in childhood, presumably through its close association with father's social class.

Cardiovascular risk factors

Mean age was

Discussion

In this cohort of British men, low childhood socioeconomic status, as measured by father's social class, was associated with increased rates of non-fatal myocardial infarction and of self-reported recall of physician-diagnosed ischaemic heart disease in middle-age. Both findings were independent of adult social class in multivariate analysis. No association was seen with non-fatal stroke. Reporting of father's social class, validated by the correlations with childhood family amenity score and

References (29)

  • MD Gliksman et al.

    Childhood socioeconomic status and risk of cardiovascular disease in middle-aged US women: a prospective study

    J Epidemiol Community Health

    (1995)
  • E Arnesen et al.

    The Tromso Heart Study: coronary risk factors and their association with living conditions during childhood

    J Epidemiol Community Health

    (1985)
  • GA Kaplan et al.

    Socioeconomic conditions in childhood and ischaemic heart disease during middle-age

    BMJ

    (1990)
  • J Elford et al.

    Early life experience and adult cardiovascular disease: longitudinal and case-control studies

    Int J Epidemiol

    (1991)
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