Abstract
BackgroundA relatively consistent body of research supports an inverse graded relationship between socioeconomic status (SES) and cardiovascular disease (CVD). More recently, researchers have proposed various life course SES hypotheses, which posit that the combination, accumulation, and/or interactions of different environments and experiences throughout life can affect adult risk of CVD. Different life course designs have been utilized to examine the impact of SES throughout the life course. This systematic review describes the four most common life course hypotheses, categorizes the studies that have examined the associations between life course SES and CVD according to their life course design, discusses the strengths and weaknesses of the different designs, and summarizes the studies' findings.MethodsThis research reviewed 49 observational studies in the biomedical literature that included socioeconomic measures at a time other than adulthood as independent variables, and assessed subclinical CHD, incident CVD morbidity and/or mortality, and/or the prevalence of traditional CVD risk factors as their outcomes. Studies were categorized into four groups based upon life course design and analytic approach. The study authors' conclusions and statistical tests were considered in summarizing study results.ResultsStudy results suggest that low SES throughout the life course modestly impacts CVD risk factors and CVD risk. Specifically, studies reviewed provided moderate support for the role of low early-life SES and elevated levels of CVD risk factors and CVD morbidity and mortality, little support for a unique influence of social mobility on CVD, and consistent support for the detrimental impact of the accumulation of negative SES experiences/conditions across the life course on CVD risk.ConclusionsWhile the basic life course SES study designs have various methodologic and conceptual limitations, they provide an important approach from which to examine the influence of social factors on CVD development. Some limitations may be addressed through the analysis of study cohorts followed from childhood, the evaluation of CVD risk factors in early and middle adulthood, and the use of multiple SES measures and multiple life course analysis approaches in each life course study.
Highlights
A relatively consistent body of research supports an inverse graded relationship between socioeconomic status (SES) and cardiovascular disease (CVD)
This review describes the major groups of conceptual life course SES models, and categorizes and summarizes studies that examine the associations between life course SES and CVD risk
Early SES → outcome life course studies: overview. These studies examined the effect of childhood and/or adolescent SES on risk of adult CVD (e.g., incident myocardial infarction (MI), CVD death, incident/fatal stroke) [37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54,55,56] and typically tested the latent effects hypothesis. They commonly measured the independent effect of childhood SES by statistically adjusting for later-life SES and CVD risk factors in regression models
Summary
A relatively consistent body of research supports an inverse graded relationship between socioeconomic status (SES) and cardiovascular disease (CVD). The adult behavioral lifestyle theory of cardiovascular disease (CVD) describes an adult's lifestyle choices and levels of physiologic risk factors as the primary predictors of CVD risk [1,2,3] This approach is supported by a relatively consistent literature demonstrating an inverse, graded relationship between SES and CVD [4,5,6,7,8,9,10,11,12]. A force behind the interest in the impact of early-life conditions on adult health is the fetal origins (Barker) hypothesis This hypothesis, which has been met with considerable support and criticism, posits that poor nutrition during fetal and early infant development ("critical periods") can increase risks for adult disease. While the dominance of the adult lifestyle model of chronic disease development may not be threatened by evidence for the fetal origins hypothesis, a reconsideration of the primary importance of adult behaviors and risk factors is underway
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