Socioeconomic Status, Dietary Patterns, and Cardiovascular Risk Factors in an Aging Population

Abstract

As the leading cause of death in the United States (U.S.), cardiovascular disease (CVD) is responsible for 17% of national health expenditures. The health and economic burden of CVD is especially high in older adults. As a consequence of population aging, it has been projected by the American Heart Association that by 2030, 40.5% of the U.S. population will have some form of CVD, assuming no change to current prevention strategies. In order to address this rising public health issue with more effective prevention strategies, a better understanding of CVD risk factors and their interrelationship is needed.

Obesity, type 2 diabetes (T2D), and hypertension (HTN) are each a leading and proximal CVD risk factor. In addition, they tend to coexist with each other and form multimorbidities, which are associated with substantially further elevated CVD risk. Using a life course approach, this dissertation examined the complex interrelationship among childhood socioeconomic status (SES), adulthood SES, adulthood dietary patterns, and the health outcomes of obesity, T2D, and HTN, individually and in the form of multimorbidities. Each of the three aims in this dissertation used a cross-sectional study design and was based on data from the Health and Retirement Study (HRS), a large nationally representative longitudinal study of U.S. adults aged over 50. Indicators of childhood SES included paternal education, maternal education and childhood financial strain. Indicators of adulthood SES included education and wealth. Two dietary patterns, prudent and Western, were initially identified using principal component analysis (PCA).

The first aim examined the associations of childhood SES with adulthood dietary patterns using linear regression models. Results of this aim showed that, in selected sociodemographic groups, higher paternal education is associated with healthier dietary habits in adulthood, independent of adulthood SES. The second aim examined the associations of adulthood dietary patterns with obesity, T2D, and HTN, separately, accounting for potential confounding by childhood and adulthood SES and using logistic regression models. Under the potential influence of reverse causation and survival bias, results of this aim showed positive associations of both the prudent and Western dietary patterns with the health outcomes. SES, whether in childhood or in adulthood, did not appear to be a strong confounder to these associations. The third aim used multinomial logistic regression models to explore the associations of childhood SES, adulthood SES, and adulthood dietary patterns with the multimorbidity of obesity, T2D, and HTN. Results of this aim showed that the multimorbidity of obesity, T2D, and HTN is highly prevalent among older U.S. adults, and under the potential influence of reverse causation and survival bias, it is independently associated with lower paternal education, lower participant’s education and wealth, and greater adherence to the prudent and Western dietary patterns.

Overall, this dissertation provides further evidence that childhood environment and conditions may underlie adulthood dietary habits and proximal CVD risk factors (e.g. obesity, T2D, and HTN), individually and in the form of multimorbidity. More studies, especially prospective studies, are needed to further evaluate the potential impact of paternal education on later life CVD risk, as well as whether dietary behavior is an underlying pathway linking childhood SES to later life CVD risk.