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