Lifecourse Socioeconomic Position and Cardiovascular Health.

Abstract

Background: A major limitation of past work on the social patterning of cardiovascular disease has been the reliance of measures of socioeconomic position (SEP) assessed at a single point in time in adulthood. The purpose of this dissertation research was to move beyond this limitation to explore how individuals, neighborhoods of residence, and health interact with each other over time. Methods: Chapter 2 utilized the Multi-Ethnic Study of Atherosclerosis (MESA) to examine the relation between childhood SEP [CSEP], adult SEP [ASEP], and 20-year average exposure to neighborhood poverty [NSEP] with the prevalence of subclinical atherosclerosis, as assessed by common carotid intimal-medial thickness (IMT). Chapter 3, using MESA also, used latent trajectory class modeling to determine patterns of neighborhood poverty over a 20-year period and then examined how these patterns were related to the amount of IMT, and associated risk factors. Chapter 4 used the Alameda County Study to examine if health-related indicators were associated with socioeconomic changes in residential mobility. Results: After adjustment for age, CSEP and ASEP were both inversely and independently associated with IMT, with slightly stronger associations in women than men. NSEP was only associated with IMT in women. There was evidence of heterogeneity in ASEP- and NSEP by race/ethnicity. Distinctive clusters of neighborhood poverty were found over the 20-year period; 5 out of 6 stable and one upwardly mobile. Generally, and mostly in women, higher stable neighborhood poverty (SNP) was associated with worse cardiovascular outcomes than lower SNP. All medical conditions showed non-significant decreased odds of moving to a ‘better’ neighborhood and a ‘worse’ neighborhood (based on changes in census tract median family income between study waves). BMI was the only health indicator to be associated with both increased odds of moving to a better neighborhood and decreased odds of moving to a worse neighborhood. Conclusion: Lower SEP at multiple points in the lifecourse and higher neighborhood poverty over 20 years was related to worse cardiovascular health. If health selection is occurring, it is most likely to be an indirect result of the socioeconomic consequences of extreme weight or a general increased mobility of healthy individuals.