Life-course socioeconomic position and obesity in African American Women: the Pitt County Study

OBJECTIVES: We studied obesity in African American women in relationship to their socioeconomic position (SEP) in childhood and adulthood. METHODS: On the basis of parents' occupation, we classified 679 women in the Pitt County (North Carolina) Study into low and high childhood SEP. Women's education, occupation, employment status, and home ownership were used to classify them into low and high adulthood SEP. Four life-course SEP categories resulted: low childhood/low adulthood, low childhood/high adulthood, high childhood/low adulthood, and high childhood/high adulthood. RESULTS: The odds of obesity were twice as high among women from low versus high childhood SEP backgrounds, and 25% higher among women of low versus high adulthood SEP. Compared to that in women of high SEP in both childhood and adulthood, the odds of obesity doubled for low/low SEP women, were 55% higher for low/high SEP women, and were comparable for high/low SEP women. CONCLUSIONS: Socioeconomic deprivation in childhood was a strong predictor of adulthood obesity in this community sample of African American women. Findings are consistent with both critical period and cumulative burden models of life-course socioeconomic deprivation and long-term risk for obesity in African American women.     

Socioeconomic trajectories across the life course and health outcomes in midlife: evidence for the accumulation hypothesis?

BACKGROUND: Recent research in social epidemiology has established the importance of considering the accumulation of advantage and disadvantage across the life course when examining adult health outcomes. This paper examines (1) accumulation across trichotomous categories of socioeconomic position (SEP), and (2) accumulation in analysis stratified by adult SEP. METHODS: Data are from the Whitehall II study. Each participant was categorized as having high (0), intermediate (1), or low (2) SEP at three time points in the life course, leading to 27 socioeconomic trajectories. These trajectories were summarized to yield a scale ranging from 0 (high SEP at all three time points) to 6 (low SEP at all three time points). Logistic regression was used to examine odds of incident coronary heart disease (CHD), poor mental and physical functioning, and minor psychiatric disorder. RESULTS: There was a graded linear relationship between accumulation of socioeconomic exposure and health. Men with a score of 6 had increased odds of CHD (2.53, 95% CI: 1.3, 5.1), poor physical functioning (2.19, 95% CI: 1.4, 4.1), and poor mental functioning (2.60, 95% CI: 1.4, 4.9) compared with men with a score of 0. In women there was an accumulation effect for CHD and physical functioning. No cumulative effect of SEP on minor psychiatric disorder was observed. The effects of accumulation were weaker in analyses stratified by adult SEP, with early deprivation followed by high adult SEP particularly detrimental for CHD. CONCLUSIONS: The health effects of socioeconomic disadvantage accumulate over the life course. In addition to accumulation effects, analysis stratified by adult SEP also provided support for the critical period and the pathway model.     

Association of regional socioeconomic deprivation and rurality with global developmental delay in early childhood: Data from mandatory school entry examinations in Germany

BackgroundFrom birth to young adulthood, health and development of young people are strongly linked to their living situation, including their family’s socioeconomic position (SEP) and living environment. The impact of regional characteristics on development in early childhood beyond family SEP has been rarely investigated. This study aimed to identify regional predictors of global developmental delay at school entry taking family SEP into consideration.MethodWe used representative, population-based data from mandatory school entry examinations of the German federal state of Brandenburg in 2018/2019 with n=22,801 preschool children. By applying binary multilevel models, we hierarchically analyzed the effect of regional deprivation defined by the German Index of Socioeconomic Deprivation (GISD) and rurality operationalized as inverted population density of the children’s school district on global developmental delay (GDD) while adjusting for family SEP (low, medium and high).ResultsFamily SEP was significantly and strongly linked to GDD. Children with the highest family SEP showed a lower odds for GDD compared to a medium SEP (female: OR=4.26, male: OR=3.46) and low SEP (female: OR=16.58, male: OR=12.79). Furthermore, we discovered a smaller, but additional and independent effect of regional socioeconomic deprivation on GDD, with a higher odds for children from a more deprived school district (female: OR=1.35, male: OR=1.20). However, rurality did not show a significant link to GDD in preschool children beyond family SEP and regional deprivation.ConclusionFamily SEP and regional deprivation are risk factors for child development and of particular interest to promote health of children in early childhood and over the life course.     

Life-course socioeconomic position and type 2 diabetes mellitus: The Framingham Offspring Study

Evidence is lacking on whether the duration and timing of low socioeconomic position (SEP) across a person's life course may be associated with incidence of type 2 diabetes mellitus (T2D). The authors' objectives were to investigate associations between cumulative SEP and the incidence of T2D in the Framingham Offspring Study (n = 1,893; 52% women; mean baseline age = 34 years). Pooled logistic regression analyses demonstrated that age-adjusted cumulative SEP was associated with T2D in women (for low vs. high cumulative SEP, odds ratio (OR) = 1.92, 95% confidence interval (CI): 1.08, 3.42). Age-adjusted analyses for young-adulthood SEP (7.85 for ≤12 vs. >16 years of education, OR = 2.84, 95% CI: 1.03), active professional life SEP (for laborer vs. professional/executive/supervisory/technical occupations, OR = 2.40, 95% CI: 1.05, 5.47), and social-mobility frameworks (for declining life-course SEP, OR = 2.99, 95% CI: 1.39, 6.44; for stable low vs. stable high life-course SEP, OR = 1.85, 95% CI: 1.02, 3.35) all demonstrated associations between low SEP and T2D incidence in women. No association was observed between childhood SEP and T2D in women for father's education (some high school or less vs. any postsecondary education, OR = 1.26, 95% CI: 0.72, 2.22). In men, there was little evidence of associations between life-course SEP and T2D incidence. These findings suggest that cumulative SEP is inversely associated with incidence of T2D in women, and that this association may be primarily due to the women's educational levels and occupations.     

Socioeconomic deprivation, coronary heart disease prevalence and quality of care: a practice-level analysis in Rotherham using data from the new UK general practitioner Quality and Outcomes Framework

BACKGROUND: The provision of coronary heart disease (CHD) health care has been shown to be inequitous, with those most in need having the least access to high-quality care. The new UK general practitioner (GP) Quality and Outcomes Framework (QOF) contract offers substantial financial rewards to general practices that combine maximal CHD case finding with high-quality CHD care. OBJECTIVE: To examine whether GP practice-level CHD prevalence and the measures of quality of care derived from the new QOF data are associated with area-level socioeconomic deprivation. METHODS: An ecological study of 38 GP practices contracting with Rotherham Primary Care Trust, United Kingdom, was carried out. We calculated Spearman rank correlation coefficients for practice-level age-sex-standardized QOF CHD prevalence against area deprivation score and for 11 QOF CHD indicator achievements against area deprivation score. RESULTS: Practice-level CHD prevalence showed a positive correlation with deprivation (r=0.64, p<0.001), as did one of the 11 quality-of-care indicators (recording of smoking status, r=0.34, p=0.04). The remaining 10 quality-of-care indicators showed no significant correlation with deprivation. CONCLUSION: Practice-level CHD prevalence is associated with deprivation, but we found no evidence of socioeconomic inequality in CHD care. This finding is in contrast to that from previous studies and the widely reported inverse care law.     

Neighbourhood and individual socioeconomic inequalities in smoking: the role of physical neighbourhood stressors

OBJECTIVE: To explore the association between physical neighbourhood stressors and smoking, and the contribution of these stressors to neighbourhood and individual socioeconomic inequalities in smoking. METHODS: Data were analysed of participants of the baseline measurement of the Dutch GLOBE study (1991), aged 20 years and older, who lived in 79 neighbourhoods of the city of Eindhoven (n = 9062). The neighbourhood socioeconomic environment was assessed from aggregated self reported information of participants' education and occupation level, and employment status. Neighbourhood stressors included were the physical quality (decay), required police attention, noise pollution from traffic, and population density in neighbourhoods. Current smokers were distinguished from previous and never smokers. RESULTS: Compared with those living in the most advantaged neighbourhoods, residents living in the socioeconomically most disadvantaged neighbourhoods were more likely to smoke (adjusted for age, sex, education, occupation, and employment status) (OR = 1.24, 95% CI 1.05 to 1.46). An increase in a summary neighbourhood stressor score was associated with smoking, independently of the neighbourhood socioeconomic environment (OR = 1.57, 95% CI 1.11 to 2.21, in the neighbourhoods with the highest stress score). Adjustment for the score substantially reduced the odds ratio for living in the socioeconomic most disadvantaged neighbourhoods (OR = 1.03, 95% CI 0.84 to 1.28, for those in the most disadvantaged neighbourhoods). Neighbourhood stressors contributed 10% to the increased probability of smoking in the lowest educated persons. CONCLUSIONS: Physical neighbourhood stressors are related to smoking and contribute substantially to neighbourhood inequalities in smoking over and above individual level characteristics.     

Race/ethnicity, life-course socioeconomic position, and body weight trajectories over 34 years: the Alameda County Study

OBJECTIVES: We investigated whether race differences in weight gain over 34 years were because of socioeconomic position (SEP) and psychosocial and behavioral factors (physical activity, cigarette smoking, alcohol consumption, depression, marital status, number of children). We used a life-course approach to SEP with 4 measures of SEP (childhood SEP, education, occupation, income) and a cumulative measure of SEP. METHODS: We used mixed models and data collected from the Alameda County Study to examine the association between race and weight change slopes and baseline weight in men (n=1186) and women (n=1375) aged 17 to 40 years at baseline (in 1965). RESULTS: All subjects gained weight over time. African American women weighed 4.96 kg (P < .001) more at baseline and gained 0.10 kg/year (P = .043) more weight than White women. Black men weighed 2.41 kg (P = .006) more at baseline but did not gain more weight than White men. The association of race with weight gain in women was largely because of cumulative SEP score. CONCLUSIONS: Interventions to prevent overweight and obesity should begin early in life and target the socioeconomically disadvantaged.     

Socioeconomic position and the metabolic syndrome in early, middle, and late life: evidence from NHANES 1999-2002

PURPOSE: To evaluate whether there is an association between socioeconomic position (SEP) and the metabolic syndrome at various ages, including adolescent, middle-aged and older participants in gender-specific analyses. METHODS: Participants were from the 1999-2002 National Health and Nutrition Examination Survey. SEP was measured by income and years of education. Metabolic syndrome was measured in adults using the American Heart Association guidelines and in adolescents using methods based on national reference data. Cross-sectional multivariable-adjusted logistic regression analyses were performed. RESULTS: In women aged 25 to 45 and 46 to 65 years, income below the poverty line (poverty income ratio [PIR] less than one) was associated with higher odds of metabolic syndrome compared with PIR greater than 3 (odds ratio [OR] = 4.90; 95% confidence interval (CI) = 2.24, 10.71, and OR = 2.54; CI = 1.38, 4.67, for the respective age groups) after adjustment for age, race/ethnicity, and menopause. Similar findings were observed for educational attainment. In adolescents, older adults (aged >65 years), and males, income and education were not related to the metabolic syndrome. CONCLUSIONS: This report demonstrates that SEP is associated with the metabolic syndrome in females aged 25 to 65 years and is less strongly associated in males, adolescents, or older participants. These findings provide physiologic mechanistic evidence linking SEP to risk for coronary heart disease.     

Socioeconomic position and hormone replacement therapy use: explaining the discrepancy in evidence from observational and randomized controlled trials

OBJECTIVES: We assessed the association between life-course socioeconomic status or position (SEP) and hormone replacement therapy (HRT). METHODS: We conducted a cross-sectional analysis of 4286 women aged 60 to 79 years. RESULTS: Women experiencing adverse socioeconomic circumstances across the life course were less likely to have used HRT. The associations of childhood socioeconomic measures with HRT use were independent of adult SEP, behavioral risk factors, and physiological risk factors for heart disease. CONCLUSIONS: SEP from across the life course is associated with HRT use. Because the association between early life SEP and HRT is not fully explained by adult risk factors, residual confounding (which is not captured by adjustment for adult variables only) may explain some of the disparity between observational studies and randomized controlled trials in this area.     

Life-course socioeconomic position and hypertension in African American men: the Pitt County Study

OBJECTIVES: We investigated the odds of hypertension for Black men in relationship to their socioeconomic position (SEP) in both childhood and adulthood. METHODS: On the basis of their parents' occupation, we classified 379 men in the Pitt County (North Carolina) Study into low and high childhood SEP. The men's own education, occupation, employment status, and home ownership status were used to classify them into low and high adulthood SEP. Four life-course SEP categories resulted: low childhood/low adulthood, low childhood/high adulthood, high childhood/low adulthood, and high childhood/high adulthood. RESULTS: Low childhood SEP was associated with a 60% greater odds of hypertension, and low adulthood SEP was associated with a 2-fold greater odds of hypertension. Compared with men of high SEP in both childhood and adulthood, the odds of hypertension were 7 times greater for low/low SEP men, 4 times greater for low/high SEP men, and 6 times greater for high/low SEP men. CONCLUSIONS: Greater access to material resources in both childhood and adulthood was protective against premature hypertension in this cohort of Black men. Though some parameter estimates were imprecise, study findings are consistent with both pathway and cumulative burden models of hypertension.     

Area deprivation, social class, and quality of life among people aged 75 years and over in Britain

BACKGROUND: There is a shortage of research studies that assess how selected characteristics of neighbourhood and personal social circumstances contribute towards health-related quality of life (QoL) among older people. METHODS: Analysis of baseline data for 5581 people aged > or =75 years and over from the Trial of Assessment and Management of Older People in the Community. The scores for four dimensions from the UK version of the Sickness Impact Profile and for the Philadelphia Geriatric Morale Scale were analysed in relation to individual social class and the Carstairs score of socioeconomic deprivation for the enumeration district of residence. RESULTS: In age and sex adjusted analyses, the proportion of participants of social class IV/V living in the most deprived areas who were in the quintile with worst QoL scores was more than double that among those from social class I/II living in the least deprived areas. Individual social class and area deprivation score contributed roughly equally to this doubling for home management, self-care and social interaction, whereas social class appeared a stronger determinant for mobility. Adjustment for living circumstances, health symptoms, and health behaviours substantially reduced the excess risk associated with social class and area deprivation. Being in a rural area was associated with lower risk of poor morale. CONCLUSION: Poor socioeconomic characteristics of both the area and the individual are associated with worse functioning (QoL) of older people in the community. This is not fully explained by health status. Policy should consider community-level interventions as well as those directed at individuals.     

Life-course socioeconomic position and incidence of dementia and cognitive impairment without dementia in older Mexican Americans: results from the Sacramento area Latino study on aging

There have been few investigations of the link between changes in life-course socioeconomic position (SEP) and cognitive decline or incidence of dementia. The authors examined the impact of changes in life-course SEP on incidence of dementia and cognitive impairment but not dementia (CIND) over a decade of follow-up. Participants of Mexican origin (n = 1,789) were members of the Sacramento Area Latino Study on Aging cohort. Incidence of dementia/CIND was ascertained by using standard diagnostic criteria. SEP indicators at 3 life stages (childhood, adulthood, and midlife) were used to derive a measure of cumulative SEP (range, 0 to 8) and SEP mobility. Nearly 24% of the sample maintained a low SEP throughout life. Hazard ratios and 95% confidence intervals were computed from Cox proportional hazards regression models. In fully adjusted models, participants with a continuously high SEP had lower hazard ratios for dementia/CIND compared with those with a continuously low SEP at all 3 life stages (hazard ratio = 0.49, 95% confidence interval: 0.24, 0.98; P = 0.04). In age-adjusted models, participants experienced a 16% greater hazard of dementia/CIND with every 1-unit increase in cumulative SEP disadvantage across the life course (hazard ratio = 1.16, 95% confidence interval: 1.01, 1.33; P = 0.04). Early exposures to social disadvantage may increase the risk of late-life dementia.     

Neighbourhood level and individual level SES effects on child problem behaviour: a multilevel analysis

OBJECTIVE: This study examined whether neighbourhood level socioeconomic variables have an independent effect on reported child behaviour problems over and above the effect of individual level measures of socioeconomic status. DESIGN AND SETTING: Multilevel analysis of cross sectional survey data relating individual level child behavioural problems and parental measures of socioeconomic status with neighbourhood level measures of socioeconomic deprivation in the city of Maastricht, the Netherlands. PARTICIPANTS: Children born in the years 1990-1991 attending the second grade of normal kindergarten schools in the city of Maastricht, the Netherlands. Out of 1417 eligible 5-7 year olds, the parents of 734 children (51.8%) agreed to participate. MAIN RESULTS: Child behaviour problems were more frequent in families of low parental occupation and education (F=14.51, df 3, 721, p<0.001; F=12.20, df 3, 721, p<0.001, respectively) and in families living in deprived neighbourhoods (F=13.26, df 2, 722, p<0.001). Multilevel random effects regression analysis showed that the effect of neighbourhood level deprivation remained after adjustment for individual level socioeconomic status (B over three levels of deprivation: 1.36; 95%CI=0.28, 2.45). CONCLUSIONS: Living in a more deprived neighbourhood is associated with higher levels of child problem behaviour, irrespective of individual level socioeconomic status. The additional effect of the neighbourhood may be attributable to contextual variables such as the level of social cohesion among residents.     

Social disadvantages in childhood and risk of all-cause death and cardiovascular disease in later life: a comparison of historical and retrospective childhood information

BACKGROUND: Childhood socioeconomic circumstances have been shown to contribute to adult mortality. The purpose of this study was to compare the association between objective historical records and recalled questionnaire-based information on childhood socioeconomic position (SEP) with regard to cardiovascular and all-cause mortality. METHODS: We examined the association between a socially disadvantaged childhood and all-cause mortality, cardiovascular disease (CVD) mortality, coronary heart disease (CHD) mortality, and acute coronary events among male participants in the Kuopio Ischemic Heart Disease (KIHD) Risk Factor Study, a population-based cohort study in eastern Finland with follow-up until 2002. The historical data on childhood factors were collected from school health records (n = 698), mainly from the 1930s to the 1950s. Recall data on socioeconomic conditions in childhood were obtained from the baseline examinations of the KIHD cohort (n = 2,682) in 1984-89. RESULTS: According to original school health records the men who were socially disadvantaged in childhood had a 1.41-fold (95% confidence interval 1.01-1.97) age-adjusted and examination-year-adjusted risk of all-cause death, a 1.32-fold (0.83-2.11) risk of CVD death, a 1.48-fold (0.85-2.57) risk of CHD death, and a 1.50-fold (1.02-2.20) risk of acute coronary events. After adjustment for biological and behavioural risk factors and for the SEP in adulthood the association was attenuated in all-cause death but did not change in CVD death, CHD death, and acute coronary events. On the contrary, the questionnaire-based recalled childhood data on childhood SEP showed no associations with mortality or acute coronary events. CONCLUSIONS: With regard to adult mortality, the use of historical records concerning hygiene and living conditions collected in childhood may either provide more accurate measures of early-life socioeconomic conditions or capture more relevant aspects of childhood socioeconomic disadvantage than retrospective recall data.     

Protective and harmful effects of neighborhood-level deprivation on individual-level health knowledge, behavior changes, and risk of coronary heart disease

The authors examined associations between neighborhood-level deprivation and cardiovascular disease-related health knowledge and behavior changes, as well as the estimated 12-year probability of experiencing a coronary heart disease event. Primary analyses included multilevel regression models among 8,197 women and men living in 82 neighborhoods in four northern California cities who were interviewed in one of five surveys conducted between 1979 and 1990. After controlling for age, gender, marital status, race/ethnicity, city, and time, the authors found that adults living in high-deprivation neighborhoods had significantly lower health knowledge and a higher probability of no positive behavior changes than did adults in moderately deprived neighborhoods (i.e., harmful effects). Conversely, those living in low-deprivation neighborhoods had significantly higher health knowledge and lower probabilities of no positive behavior changes and estimated risk of coronary heart disease (i.e., protective effects). The association between high neighborhood deprivation and no positive behavior changes remained statistically significant after additional adjustment for a composite measure of individual-level socioeconomic status. Associations with neighborhood deprivation did not vary by individual-level socioeconomic status. These results suggest that focusing exclusively on changing individuals' behaviors will have a limited effect unless contextual influences at the neighborhood level are also addressed.     

Neighbourhood deprivation and incidence of coronary heart disease: a multilevel study of 2.6 million women and men in Sweden

STUDY OBJECTIVE: To examine whether neighbourhood deprivation predicts incidence rates of coronary heart disease, beyond age and individual income. DESIGN: Follow up study from 31 December 1995 to 31 December 1999. Women and men were analysed separately with respect to incidence rates of coronary heart disease. Multilevel logistic regression was used in the analysis with individual level characteristics (age, individual income) at the first level and level of neighbourhood deprivation at the second level. Neighbourhood deprivation was measured at small area market statistics level by the use of Care Need Index. SETTING: Sweden. PARTICIPANTS: All women and men aged 40-64 in the Swedish population, in total 2.6 million people. MAIN RESULTS: There was a strong relation between level of neighbourhood deprivation and incidence rates of coronary heart disease for both women and men. In the full model, which took account of individual income, the risk of developing coronary heart disease was 87% higher for women and 42% higher for men in the most deprived neighbourhoods than in the most affluent neighbourhoods. For both women and men the variance at neighbourhood level was over twice the standard error, indicating significant differences in coronary heart disease risk between neighbourhoods. CONCLUSIONS: High levels of neighbourhood deprivation independently predict coronary heart disease for both women and men. Both individual and neighbourhood level approaches are important in health care policies.     

Examining Life-Course Socioeconomic Position,Contextualized Stress,and Depression among Well-Educated African-American Pregnant Women

PurposeThis article explores how childhood and adulthood socioeconomic position (SEP) and socioeconomic mobility, as indicators of life-course experiences, impact the relationship between contextualized stress and depression among well-educated, pregnant African-American women.MethodsThe Jackson, Hogue, Phillips Contextualized Stress Measure and the Beck Depression Inventory were administered to 101 well-educated, pregnant African-American women during their first and second trimesters. Bivariate associations and regression analysis were conducted to assess life-course SEP, mobility, and contextualized stress as predictors of depression. Based on the demographic data for childhood and adult SES, the SEP and mobility variables were created.ResultsResults from χ² analysis revealed that high contextual stress was significantly associated with no change in mobility, that is, staying the same. Results from regression models found that contextualized stress was the only predictor for depression. Additionally, life-course SEP and mobility did not moderate the relationship between contextualized stress and depression.ConclusionsOur findings illuminated the persistence of racial and gendered stress as risk factors for depression among well-educated, pregnant African-American women, regardless of life-course SEP. We offer an explanation as to why African-American women who possess the material and social resources thought to mediate psychosocial and pregnancy risks remain in jeopardy.     

Socioeconomic status and multimorbidity: a systematic review and meta‐analysis

Objectives: We performed a systematic review to identify, critically appraise and synthesise the existing literature on the association between SEP and multimorbidity occurrence. Methods: We searched Medline and Embase from inception to December 2014. Where possible we performed meta‐analysis to obtain summary odds ratios (ORs), exploring heterogeneity between studies through sub‐group analysis. Results: We identified 24 cross‐sectional studies that largely reported on education, deprivation or income in relation to multimorbidity occurrence. Differences in analysis methods allowed pooling of results for education only. Low versus high education level was associated with a 64% increased odds of multimorbidity (summary OR: 1.64, 95% CI 1.41 to 1.91), with substantial heterogeneity between studies partly explained by method of multimorbidity ascertainment. Increasing deprivation was consistently associated with increasing risk of multimorbidity, whereas the evidence on income was mixed. Few studies reported on interaction with age or sex. Conclusions: More methodologically robust studies that address these gaps and investigate alternate measures of social circumstances and environment may advance our understanding of how SEP affects multimorbidity risk. Implications for public health: A deeper understanding of the socioeconomic and demographic patterning of multimorbidity will help identify sub‐populations at greatest risk of becoming multimorbid.     

Socioeconomic disparities in metabolic syndrome differ by gender: evidence from NHANES III

PURPOSE: The aim of the study is to examine whether socioeconomic position (SEP) is associated with metabolic syndrome and whether the association differs by gender and race/ethnicity. METHODS: Study participants were from the Third National Health and Nutrition Examination Survey. SEP was measured by using education and poverty income ratio (PIR). Metabolic syndrome was measured according to the National Institutes of Health guidelines. Multivariable-adjusted logistic regression analyses were performed. RESULTS: Low education (<12 years) was associated with metabolic syndrome in women (odds ratio [OR], 1.77; 95% confidence interval [CI], 1.39-2.24) and less so in men (OR, 1.27; 95% CI, 0.97-1.66) versus more than 12 years of education. For income, low PIR (相似文献