Abstract
BackgroundChronic inflammation has been postulated to be one mediating mechanism explaining the association between low socioeconomic position (SEP) and cardiovascular disease (CVD). We sought to examine the association between life course SEP and C-reactive protein (CRP) levels in adulthood, and to evaluate the extent to which health-risk behaviors and metabolic alterations mediate this association. Additionally, we explored the possible modifying influence of gender.Methods and FindingsOur analytical sample comprised 13,371 participants from ELSA-Brasil baseline, a multicenter prospective cohort study of civil servants. SEP during childhood, young adulthood, and adulthood were considered. The potential mediators between life course SEP and CRP included clusters of health-risk behaviors (smoking, low leisure time physical activity, excessive alcohol consumption), and metabolic alterations (obesity, hypertension, low HDL, hypertriglyceridemia, and diabetes). Linear regression models were performed and structural equation modeling was used to evaluate mediation. Although lower childhood SEP was associated with higher levels of CRP in adult life, this association was not independent of adulthood SEP. However, CRP increased linearly with increasing number of unfavorable social circumstances during the life course (p trend <0.001). The metabolic alterations were the most important mediator between cumulative SEP and CRP. This mediation path accounted for 49.5% of the total effect of cumulative SEP on CRP among women, but only 20.2% among men. In consequence, the portion of the total effect of cumulative SEP on CRP that was mediated by risk behaviors and metabolic alterations was higher among women (55.4%) than among men (36.8%).ConclusionsCumulative SEP across life span was associated with elevated systemic inflammation in adulthood. Although health-risk behaviors and metabolic alterations were important mediators of this association, a sizable fraction of this association was not mediated by these factors, suggesting that other pathways might play a role, especially among men.
Highlights
The association between lower adulthood socioeconomic position (SEP) and increased risk of cardiovascular disease (CVD) is well-established [1]
Cumulative SEP across life span was associated with elevated systemic inflammation in adulthood
Health-risk behaviors and metabolic alterations were important mediators of this association, a sizable fraction of this association was not mediated by these factors, suggesting that other pathways might play a role, especially among men
Summary
The association between lower adulthood socioeconomic position (SEP) and increased risk of cardiovascular disease (CVD) is well-established [1]. A number of mechanisms have been put forward to account for the association between low life course SEP and cardiovascular risk, including higher prevalence of risk behaviors among disadvantaged individuals, such as smoking, excessive alcohol consumption, and sedentarism [3]. These behaviors may in turn lead to metabolic, endocrine and immune dysregulation, which could promote a pro-inflammatory and pro-thrombotic state [3,4].
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