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May 13, 2008Journal of Epidemiology & Community Health135 citationsOpen Access

Cumulative life course and adult socioeconomic status and markers of inflammation in adulthood

RPRicardo A. PollittUniversity of North Carolina at Chapel Hill JKJay S. KaufmanBoston University KRK. M. RoseCentre Hospitalier Régional Universitaire de Brest

Structured PICO

Does cumulative life course and adult low socioeconomic status increase adult levels of inflammatory risk markers in a biracial cohort?

Population

12,681 white and African-American participants in the Atherosclerosis Risk in Communities (ARIC) study and two ancillary studies

Intervention

Cumulative life course and adult exposure to low socioeconomic status (SES), including low education, social class, and neighborhood SES

Comparator

Higher socioeconomic status (graded comparison)

Outcome

Adult levels of inflammatory risk markers (fibrinogen, white blood cell count (WBC), C-reactive protein (CRP), von Willebrand factor (vWF) and an overall inflammatory score)surrogate

Cumulative exposure to adverse socioeconomic conditions across the life course is associated with an elevated systemic inflammatory burden in adulthood, potentially serving as a pathway linking low SES to elevated cardiovascular disease risk.

Abstract

OBJECTIVE: To examine the association between cumulative life course and adult socioeconomic status (SES) and adult levels of inflammatory risk markers (fibrinogen, white blood cell count (WBC), C-reactive protein (CRP), von Willebrand factor (vWF) and an overall inflammatory score). DESIGN: Retrospective cohort study. SETTING: 12,681 white and African-American participants in the Atherosclerosis Risk in Communities (ARIC) study and two ancillary studies. METHODS: Participants provided information on SES and place of residence in childhood and young (30-40 years) and mature (45+) adulthood. Residences were linked to census data for neighbourhood SES information. Multiple imputation (MI) was used for missing data. Linear regression and adjusted geometric means were used to estimate the effects of SES on inflammatory risk marker levels. RESULTS: Graded, statistically significant associations were observed between greater cumulative life-course exposure to low education and social class and elevated levels of fibrinogen and WBC among white participants. Stronger graded, statistically significant associations were observed between low adult education, social class and neighbourhood SES and elevated inflammatory levels. Associations were weaker and less consistent in African-Americans. Covariate adjustment attenuated results but many associations remained strong. CONCLUSIONS: Our results suggest that cumulative exposure to adverse SES conditions across the life course and low adult SES are associated with an elevated systemic inflammatory burden in adulthood. Chronic systemic inflammation may be one pathway linking low life-course SES and elevated cardiovascular disease risk.

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