Life-course Socioeconomic Status Research Articles

Abstract MP01: Life-Course Socioeconomic Status and the Gut Microbiome in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL)

Introduction: Socioeconomic status (SES) in childhood and beyond may influence the gut microbiome (GMB), with implications for disease risk. Studies evaluating the relationship between life-course SES and the gut microbiome (GMB) are sparse, particularly among Hispanic/Latino individuals, who have a high prevalence of low SES. Hypothesis: Low life-course SES indicators are associated with less diversity and overall composition of the gut microbiome in United States (U.S.) Hispanic/Latino adults. Methods: The Hispanic Community Health Study/Study of Latinos (HCHS/SOL) is a multi-site population-based cohort study conducted in the U.S. Childhood sanitation conditions (plumbing, sewer/septic tank), childhood SES (parental education and childhood hardship), adulthood neighborhood SES, and adulthood SES (education, income, and economic hardship) were used as life-course SES indicators. Shotgun sequencing was performed on stool samples (n=1057). Alpha-diversity was measured by the Shannon diversity index. Permutational multivariate analysis of variance was used to assess the association of SES indicators with overall microbiome composition, as measured using the Jensen-Shannon Divergence distance. Analysis of Compositions of Microbiomes was used to identify associations of life-course SES indicators with GMB species, adjusting for age, sex, BMI, U.S. or foreign-born, study center, Hispanic/Latino background, type of stool, diet quality, smoking, alcohol consumption, depressive and anxiety symptoms, diabetes, hypertension, cardiovascular disease, dyslipidemia, and antibiotic use. Results: Low sanitation and low SES during childhood were reported by 32% (342 of 1053) and 37% (330 of 884) of participants, respectively. In adulthood, 56% (585 of 1053) lived in a low SES neighborhood and 45% (447 of 1002) had low SES. Life-course SES indicators were not associated with GMB diversity. However, overall microbiome composition differed significantly according to childhood SES (R2 =0.28%, P = 0.04). Low childhood sanitation was associated with higher abundance of Ruminococcus torques and Clostridium lactatifermentans , and depleted abundance of Prevotella species. Low childhood SES was associated with higher abundance of species from genus Streptococcus (S. salivarius, S. parasanguinis, and S. infantis), Veillonella parvula, Prevotella stercorea, and Roseburia intestinalis. Low adulthood SES was associated with depleted abundance of species from Bacteroides, and living in a low adulthood neighborhood SES was associated with depleted abundance of species from Rikenella . Conclusion: Low childhood SES was associated with an altered GMB composition in U.S. Hispanic/Latino adults. Early-life SES may have long-term effects on GMB composition, underscoring another biological mechanism linking early childhood factors to adulthood disease.

Life-course socioeconomic status and obesity: a scoping review protocol

ObjectiveWe aim to explore the literature that studies the links between life-course socioeconomic status and weight status and characterize the life-course approach used.IntroductionObesogenic environments are increasing rapidly in deprived environments,...

Associations of current and childhood socioeconomic status and health outcomes amongst patients with knee or hip osteoarthritis in a Mexico City family-practice setting

ObjectivesTo examine the association of current and childhood socioeconomic status (SES) with patient-reported functional status, quality of life and disability in patients with knee or hip osteoarthritis (OA).MethodsCross-sectional study amongst individuals seeking care for any medical reason in a primary care family-practice clinic in Mexico City. We included individuals with self-reported doctor-diagnosed arthritis, recruited through waiting-room posters and invitations by treating family physicians. We administered a survey using validated Spanish language versions of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), the Osteoarthritis of Lower Limbs and Quality of Life (AMICAL), and the Stanford Health Assessment Questionnaire-Disability Index (HAQ-DI). To estimate current and childhood SES, we collected data on education level and occupation type for both the patient and their parents, as well as using a validated tool to estimate income quintile.ResultsWe recruited 154 patients and excluded 8 patients. There was a high correlation between outcome scores. Estimated income and education levels were correlated with WOMAC, AMICAL and HAQ-DI scores, and significant differences were found in all scores by occupation type. The associations for current SES variables and outcome scores remained significant independently of age, sex, BMI, and presence of diabetes or hypertension, and were largely explained by current income in mutually adjusted models. Childhood SES – in particular as measured through maternal education – was best correlated with AMICAL scores, though its effect seemed largely mediated by its association with current SES.ConclusionsCurrent Socioeconomic Status impacts functional status, quality of life and disability amongst OA patients in Mexico City. The WOMAC, AMICAL and HAQ-DI scores correlate with each other and are all potentially useful markers of disease severity. More research is needed to elucidate the relationships between childhood SES and OA outcomes. Awareness of life-course SES may be useful in identifying patients at risk for worse outcomes.

Life-course socioeconomic status and its impact on functional health of Portuguese older adults

Abstract Background Functional health is arguably one of the most important health indicators for older adults, because it assesses physical, cognitive, and social functions in combination. However, life-course circumstances may impact this multidimensional construct. The aim of the present study was to assess the relationship between life-course socioeconomic status (SES) and different dimensions of functional health in older adults. Methods Data on 821 Portuguese adults aged 50 and over in 2013-2015 were analyzed. Life-course SES was computed using participants’ paternal occupation (non-manual (nm); manual (m)) and own occupation (nm; m), resulting in four patterns: stable high (nm+nm), upward (m+nm), downward (nm+m), stable low (m+m). Functional health included physical and mental functioning, cognitive function, handgrip strength, and walking speed. Linear (beta coefficients) and logistic regressions (odds ratios) were used to estimate the association between life-course SES and functional health. Results Overall, those who accumulated social disadvantage during life-course presented worse functional health than those with stable high SES (stable low - SF-36 physical functioning: β=−9.75; 95%CI: -14.34;-5.15; SF-36 mental health: β=−7.33; 95%CI: -11.55;-3.11; handgrip strength: β=−1.60; 95%CI: -2.86;-0.35; walking time, highest tertile: OR = 5.28; 95%CI: 3.07;9.09). Those with an upward SES were not statistically different from those in the stable high SES for most of the health outcomes however, those with an upward SES trajectory tended to have higher odds of cognitive impairment (OR = 1.75; 95%CI: 0.96;3.19). A downward SES trajectory increased the odds of slower walking speed (OR = 4.62; 95%CI: 1.78;11.95). Conclusions A disadvantaged life-course SES impacts older adults’ physical and mental functioning. For some outcomes, this was attenuated by a favourable adulthood SES but those with a stable low SES consistently presented worse functional health. Key messages • Overall, stable high SES leads to better functional health, but for mental health functioning, handgrip strength and walking speed, it is possible to overcome the initial social disadvantage. • These results reinforce that even though health disparities may start early in life, they are mutable and capable of changing through the improvement of socioeconomic conditions.

Determinants of functional disability trajectories: An assessment of the disablement model and life-course perspective.

Functional disability is a widespread challenge faced by the older population in China, where those with functional disabilities demand greater healthcare and geriatric services. This study performs a longitudinal analysis examining the effects of physiological conditions, intra-, and extra-individual factors, and life-course socioeconomic status risk factors on the disability levels and change rates of functional disability trajectories in old age. Data for this study came from the four waves of the China Health and Retirement Longitudinal Survey. A latent growth model was used to analyze the functional disability of 5044 older adults aged 60 and over in 2011 who survived to 2018. Pathologies are closely associated with functional disability trajectories, and higher numbers of comorbidities relate to more disabilities. Risk factors and intra- and extra-individual factors affect functional disability trajectories and work through independent and shared mechanisms. The effects of risk factors can be traced to childhood conditions, and higher childhood and adulthood socioeconomic status is related to fewer functional disabilities. Functional disability trajectories are dynamic processes related to pathologies, intra-, and extra-individual factors, and life-course risk factors, and thus prevention and control measures should focus on both childhood and adulthood. Promoting working in later life and improving childhood socioeconomic statusdeserve prompt attention. Geriatr Gerontol Int 2023; 23: 817-829.

Life-course socio-economic status and its impact on functional health of Portuguese older adults.

Functional health is arguably one of the most important health indicators for older adults, because it assesses physical, cognitive and social functions in combination. However, life-course circumstances may impact this multidimensional construct. The aim of the present study was to assess the relationship between life-course socio-economic status (SES) and different dimensions of functional health in older adults. Data on 821 Portuguese adults aged 50 years and over in 2013-2015 were analysed. Life-course SES was computed using participants' paternal occupation (non-manual (nm); manual (m)) and own occupation (nm; m), resulting in four patterns: stable high (nm + nm), upward (m + nm), downward (nm + m) and stable low (m + m). Functional health included physical and mental functioning, cognitive function, handgrip strength, and walking speed. Linear (beta coefficients) and logistic regressions (odds ratios) were used to estimate the association between life-course SES and functional health.Overall, those who accumulated social disadvantage during life-course presented worse functional health than those with stable high SES (stable low - SF-36 physical functioning: β = -9.75; 95% CI: -14.34; -5.15; SF-36 mental health: β = -7.33; 95% CI: -11.55; -3.11; handgrip strength: β = -1.60; 95% CI: -2.86; -0.35; walking time, highest tertile: OR = 5.28; 95% CI: 3.07; 9.09). Those with an upward SES were not statistically different from those in the stable high SES for most of the health outcomes; however, those with an upward SES trajectory tended to have higher odds of cognitive impairment (OR = 1.75; 95% CI: 0.96; 3.19). A downward SES trajectory increased the odds of slower walking speed (OR = 4.62; 95% CI: 1.78; 11.95). A disadvantaged life-course SES impacts older adults' physical and mental functioning. For some outcomes, this was attenuated by a favourable adulthood SES but those with a stable low SES consistently presented worse functional health.

Socioeconomic differences in older adults' unplanned hospital admissions: the role of health status and social network.

the socioeconomic distribution of unplanned hospital admissions in older adults is poorly understood. We compared associations of two life-course measures of socioeconomic status (SES) with unplanned hospital admissions while comprehensively accounting for health, and examined the role of social network in this association. in 2,862 community-dwelling adults aged 60+ in Sweden, we derived (i) an aggregate life-course SES measure grouping individuals into Low, Middle or High SES based on a summative score, and (ii) a latent class measure that additionally identified a Mixed SES group, characterised by financial difficulties in childhood and old age. The health assessment combined measures of morbidity and functioning. The social network measure included social connections and support components. Negative binomial models estimated the change in hospital admissions over 4years in relation to SES. Stratification and statistical interaction assessed effect modification by social network. adjusting for health and social network, unplanned hospitalisation rates were higher for the latent Low SES and Mixed SES group (incidence rate ratio [IRR] = 1.38, 95% confidence interval [CI]: 1.12-1.69, P = 0.002; IRR = 2.06, 95% CI: 1.44-2.94, P < 0.001; respectively; ref: High SES). Mixed SES was at a substantially greater risk of unplanned hospital admissions among those with poor (and not rich) social network (IRR: 2.43, 95% CI: 1.44-4.07; ref: High SES), but the statistical interaction test was non-significant (P = 0.493). socioeconomic distributions of older adults' unplanned hospitalisations were largely driven by health, although considering SES dynamics across life can reveal at-risk sub-populations. Financially disadvantaged older adults might benefit from interventions aimed at improving their social network.

Direct Effect of Life-Course Socioeconomic Status on Late-Life Cognition and Cognitive Decline in the Rush Memory and Aging Project.

The role of socioeconomic status (SES) across the life course in late-life cognition is unclear. We tested the hypotheses that: 1) High SES in childhood, young adulthood, midlife, and late life have independent causal effects on higher cognition level and slower cognitive decline; 2) Compared with stable low SES (referent), stable high SES has the largest estimated effect for higher cognition level and slower decline among life-course SES combinations. The Rush Memory and Aging Project enrolled 1,940 dementia-free older adults in northeastern Illinois (1997-2018). We used inverse probability-weighted marginal structural models to estimate the joint and independent effect of each life-course SES on global and domain-specific cognition. A total of 1,746 participants had, on average, 6 years of follow-up. High SES at each life-course stage starting in young adulthood had a protective estimated effect on global and domain-specific cognition intercepts. Compared with consistently low SES, consistently high SES (β= 0.64, 95% confidence interval: 0.48, 0.93) and high SES beyond childhood (β= 0.64, 95% confidence interval: 0.47, 0.83) had the largest benefit for global cognition intercepts. None of the life-course SES measures influenced rate of global or domain-specific decline. Additional understanding of life-course SES components influencing cognitive level is warranted.

EDUCATION AND COGNITIVE ABILITY: EXPLORING DIRECT AND INDIRECT EFFECTS IN THE UNITED STATES AND MEXICO

Abstract Education positively relates with cognition, which may be explained by enhanced cognitive reserve. However, education may also impact cognition indirectly by improving health, health behaviors, and life-course socioeconomic status (SES). This analysis explores the associations between education and cognition in the US and Mexico and quantifies the extent to which associations are direct versus indirect through health and SES. We use data from two studies: the MexCog in Mexico (n=2,042) and US Harmonized Cognitive Assessment Protocol (HCAP, n=3,267). Cognitive domains included Memory, Executive Function, Language, Visuospatial, and Orientation. Karlson-Holm-Breen (KHB) methods were used in linear regression models to quantify how much of the associations between years of education and cognitive domains were direct versus indirect through chronic conditions, income, wealth, smoking, and exercise. In regression models, years of education related positively with all cognitive domains in both studies, even when controlling for health and SES. KHB mediation analyses suggested that most of the education-cognition association was direct. In MexCog, estimates of the percent of the education-cognition association that was indirect through health and SES ranged from 4.17% (Memory) to 5.15% (Executive Function). In HCAP, indirect effects ranged from 8.95% (Orientation) to 12.15% (Language). Education was associated with better cognitive abilities in the US and Mexico regardless of cognitive domain or adjustment for late-life health and SES. Results suggested that education primarily related with cognition directly and that effects of education on cognitive abilities are not eliminated by reducing educational disparities in the late-life health and SES factors we analyzed.

VIGILANCE, STRESS COPING, AND DISPARITIES IN METABOLIC HEALTH OVER THE LIFE COURSE

Abstract Recent investigations of the mechanisms through which stress may impact cardiometabolic health point to the potential importance of cognitive tendencies (e.g., vigilance, coping strategies) in this relationship. This study examined the associations between vigilance and stress coping with metabolic risk, and whether these associations varied by race and life course socioeconomic status (SES). Data come from the Healthy Aging in Neighborhoods of Diversity across the Life Span (HANDLS) study, a cohort of urban adults (n=3720, baseline age 30-64 years; balanced by race, sex, age and household income). Vigilance was measured by the MacArthur Reactive Responding subscale; stress coping was measured by the Brief Cope scale. Metabolic risk was operationalized by metabolic syndrome z-scores (MetS-Z). Linear mixed models were used to examine longitudinal associations between cognitive tendencies and MetS-Z; interaction terms were used to examine effect modification by race and life course SES. Black participants reported higher adaptive coping; participants experiencing persistent poverty or downward mobility reported higher vigilance and avoidant coping and lower adaptive coping. Overall, vigilance was not associated with metabolic risk. Avoidant and adaptive coping were inversely associated with baseline MetS-Z and further varied by sociodemographic factors. Higher adaptive coping was associated with lower MetS-Z among White adults, while higher avoidant coping was associated with lower MetS-Z among Black adults. Lower stress coping were associated with higher MetS-Z among White participants with low lifecourse SES or downward socioeconomic mobility. In sum, stress coping may modulate the stress-health relationship, but these associations must be interpreted within the intersection of contextual factors.

Effects of multilingualism on cognition among older Indian adults in the nationally representative LASI‐DAD study

AbstractBackgroundMultilingualism is hypothesized to protect late life cognition such that older multilinguals demonstrate better cognitive functioning compared to monolinguals. However, several studies have failed to find evidence of a multilingual advantage among aging populations. Methodological differences such as inconsistent accounting of critical environmental and sociocultural factors (e.g., educational experiences, lifecourse socioeconomic status, residential urbanicity) associated with multilingualism may explain these inconsistent findings. Furthermore, the lack of research conducted in low‐ and middle‐income countries limit the generalizability of these findings. India offers a unique opportunity to study the role of multilingualism in cognitive aging, given its rich linguistic and sociocultural diversity.MethodThe current study utilizes a national representative sample of older Indian adults from the Harmonized Diagnostic Assessment of Dementia for the Longitudinal Study in India (LASI‐DAD). Respondents included 4,088 adults aged 60 and over, speaking over 40 different languages and dialects (73.6% monolingual, 26.4% report speaking ≥2 languages). We evaluated the association of multilingualism with global cognitive functioning after accounting for critical demographic and health factors such as age, sex, urbanicity, total consumption, diabetes, and hearing loss, among others. We also assessed whether this association differed by region and education.ResultOverall, multilingualism was associated with better global cognition after controlling for demographic and health confounds. There was an interaction between region and multilingualism such that there was a greater benefit of multilingualism on cognition in South India compared to North India. The effect of multilingualism on cognition also differed by level of education, with the greatest benefit among multilinguals with higher levels of education. However, stratified models demonstrated that multilingualism was positively associated with cognition, regardless of education, in South India, whereas this association was only observed among those with higher educational attainment in North India.ConclusionIn India, multilingualism was associated with better cognition, but this association differed by region and educational attainment. Future research should investigate regional variations in lifecourse factors that may explain the differences in the multilingual advantage observed across North and South India. Furthermore, future studies should deconstruct multilingualism (e.g., age of acquisition, proficiency) in order to evaluate their association with cognition cross‐sectionally and longitudinally.

Is childhood or midlife socioeconomic status more predictive of brain health across race/ethnicity?

AbstractBackgroundLower lifecourse socioeconomic status (SES) is associated with worse cognition and greater risk for Alzheimer’s disease (AD). Parental level of educational attainment is one indicator of childhood SES, which predicts myriad health outcomes throughout the lifespan. It is unclear whether midlife SES moderates the impact of childhood SES on midlife outcomes, like brain health. Subgroup differences are important for future risk reduction efforts; therefore, we tested whether midlife SES modifies the influence of childhood SES similarly in White, Black, and Latinx middle‐aged adults.MethodParticipants were 569 middle‐aged older adults drawn from the Offspring study of Racial/Ethnic Disparities in AD (adult children of WHICAP participants), who received MRI (mean age = 54.5 (SD = 10.6) years; 46 non‐Latinx White, 131 non‐Latinx Black, 392 Latinx; 66% women). We used general linear models to examine the relationship of childhood SES (e.g., parental education) with MRI markers of cerebrovascular disease (e.g., white matter hyperintensity volume; WMH) and whether MSES (e.g., educational attainment) moderated this relationship, controlling for sex/gender and age.ResultWhite participants were more likely to have higher childhood SES (F(2,568) = 199.3, p&lt;.001) and MSES (F(2,568) = 36.1, p&lt;.001), followed by Black, then Latinx participants. In the full sample, childhood SES was not associated with WMH volume. Race/ethnicity stratified models revealed that greater childhood SES was associated with lower WMH volume, but only in White participants (B = ‐0.60, CI = ‐0.109,‐0.010). Midlife SES was not associated with WMH volume in the full sample or within each race/ethnicity group. Among White participants, midlife SES did not modify the effect of childhood SES on WMH volume. Midlife SES was unrelated to WMH volume in Black and Latinx participants.ConclusionWe found that childhood SES predicts brain health in middle aged White people. We found racial and ethnic subgroup differences in the relationship of socioeconomic indicators to brain health. However, future studies aim to further understand mechanisms of brain health disparities by considering other SES indicators than parental and offspring education, larger subgroup sample sizes, absolute versus relative SES mobility, other lived experiences, and cognitive outcomes.

Mediators of Life-Course and Late-Life Financial Strain on Late-Life Health in Japan: Based on a Cross-Sectional Survey

PurposeFew studies have examined together the psychosocial mediators of how life-course and late-life socioeconomic status (SES) influence late-life health. This study explored psychosocial mediators of influences of not only life-course but also late-life financial strain on late-life health in Japan, using a cross-sectional survey. It was hypothesized that: 1) both life-course and late-life financial strain will influence late-life health through common mediators, and 2) such mediating influences will be large on health indicators strongly related to psychosocial resources, such as depressive tendencies and self-rated health.MethodsThe participants (N = 739) were aged 65 years and older and lived in metropolitan Tokyo, Japan. Life-course financial strain was measured retrospectively by the number of financially strenuous experiences over the participants’ life-courses. Possible mediators included stressors (life-course and late-life major traumatic life events) and psychosocial resources (self-esteem, sense of control, health literacy, social networks, and social support). Health indicators included multimorbidity, disabled activities of daily living (ADL), depressive tendency, and poorer self-rated health.ResultsHaving a sense of control mediated the significant influences of both life-course and late-life financial strain on disabled ADL. Furthermore, self-esteem significantly mediated the influences of both life-course and late-life financial strain on depressive tendencies and poorer self-rated health. All such mediating influences were significant at p < 0.05. Psychosocial resources did not mediate significant influences of life-course and financial strain on multimorbidity.ConclusionThe results support our hypotheses and make three main contributions on the mechanism through which SES influences late-life health: 1) psychosocial resources mediate the effect of life-course SES on late-life health; 2) the influence differs depending on health type; and 3) these results can generalize to older adults in not only Japan but also Western countries.

Life-Course Neighborhood Socioeconomic Status and Cardiovascular Events in Black and White Adults in the Atherosclerosis Risk in Communities Study.

It has been reported that residents of low-socioeconomic-status (SES) neighborhoods have a higher risk of developing cardiovascular disease (CVD). However, most of the previous studies focused on 1-time measurement of neighborhood SES in middle-to-older adulthood and lacked demographic diversity to allow for comparisons across different race/ethnicity and sex groups. We examined neighborhood SES in childhood and young, middle, and older adulthood in association with CVD risk among Black and White men and women in the Atherosclerosis Risk in Communities Study (1996-2019). We found that lower neighborhood SES in young, middle, and older adulthood, but not in childhood, was associated with a higher risk of CVD later in life. When compared with the highest quartile, the lowest quartile of neighborhood SES in young, middle, and older adulthood was associated with 18% (hazard ratio (HR) = 1.18, 95% confidence interval (CI): 1.02, 1.36), 21% (HR = 1.21, 95% CI: 1.04, 1.39), and 12% (HR = 1.12, 95% CI: 0.99, 1.26) increases in the hazard of total CVD, respectively. The association between lower neighborhood SES in older adulthood and higher CVD hazard was particularly strong among Black women. Our study findings support the role of neighborhood SES in cardiovascular health in both Black and White adults.

Association of life‐course socioeconomic status with allostatic load inChinese middle‐aged and older adults

To examine the association of life-course socioeconomic status (SES) and mobility with allostatic load (AL) in a large cohort of Chinese middle-aged and older adults. Drawing on data from 17 552 middle-aged and older adults from three waves of a longitudinal study conducted in China in 2011-2015, generalized estimating equation (GEE) models were used for the overall sample and subsample to examine the association between life-course SES and AL. On the whole, those who were literate had lower AL (β=-0.034, 95% CI=-0.065, -0.004), while those with a non-agricultural occupation (β=0.093, 95% CI=0.065, 0.120) and better financial status in childhood (β=0.037, 95% CI=0.012, 0.063) or adulthood (β=0.033, 95% CI=0.009, 0.058) had higher AL. In terms of SES mobility, a stable high education was associated with lower AL (β=-0.041, 95% CI=-0.078, -0.004). Upward (β=0.090, 95% CI=0.061, 0.120) or stable high (β=0.075, 95% CI=0.025, 0.125) occupation was related to higher AL. Downward (β=0.034, 95% CI=0.003, 0.064) or stable high (β=0.072, 95% CI=0.037, 0.107) financial status was associated with higher AL. Education manifested no associations with AL for the rural and men samples. Financial status showed no relationship with AL for the urban sample. Our findings demonstrate the importance of applying life-course models for gaining an understanding of SES and AL. Efforts to lower AL among Chinese middle-aged and older adults should consider childhood and current SES status, as well as different subgroups. Geriatr Gerontol Int 2022; 22: 425-432.

Contributions of social determinants of health to systolic blood pressure in United States adult immigrants: Use of path analysis to validate a conceptual framework.

Validate a conceptual framework and identify pathways between antecedent (life-course socioeconomic status (L-SES)), predisposing (age, sex, married, homeless as a child), enabling (health literacy, acculturation), and need (disability) social determinants of health (SDoH) and systolic blood pressure (SBP) in US immigrants. 181 immigrants were enrolled in the study. Path analysis was used to identify paths by which SDoH influence SBP and to determine if antecedents, predisposing, enabling, and need factors have direct and indirect relationships with SBP. The final model(chi2(5)=14.88, p = 0.011, RMSEA = 0.070, pclose = 0.17, CFI = 0.96) showed L-SES was directly associated with age (0.12, p = 0.019) and disability(0.17, p = 0.001); and indirectly associated with disability (0.29, p < 0.001) and SBP (0.31, p < 0.001). Age (0.31, p < 0.001) and sex(0.25, p < 0.001) were directly associated with SBP, and age was directly associated with disability (0.29, p < 0.001) and indirectly associated with SBP(0.14, p = 0.018). Other predisposing factors such as being married (-0.32, p < 0.001) and being homeless as a child alone (0.16, p < 0.001) were directly associated with disability and indirectly associated (0.14, p = 0.018) with SBP. Enabling factor of health literacy (0.16, p = 0.001) was directly associated with disability and indirectly associated (0.14, p = 0.018) with SBP. Need factor of disability (0.14, p = 0.018) was directly associated with SBP. This study provides the first validation of a conceptual model for the relationship between SDoH and SBP among immigrants and identifies potential targets for focused interventions.

Life Course Socioeconomic Status and Risk of Hospitalization for Heart Failure or Atrial Fibrillation in The Moli-Sani Study Cohort.

We investigated the association of cumulative socioeconomic disadvantage (CSD) and socioeconomic (SES) trajectories across life course with the risk of first hospitalization for heart failure (HF) or atrial fibrillation (AF) and tested some biological mechanisms in explaining such associations. Longitudinal analysis on 21,756 HF- and AF-free subjects recruited in the Moli-sani Study (2005-2010; Italy) and followed up for 8.2 years. CSD was computed using childhood SES, education and adulthood SES indicators, and the same were used to define overall trajectories. High disadvantage across life course (CSD≥8) posed subjects at increased risk of HF (Hazard ratio [HR]=2.58; 95%CI 1.78, 3.74) or AF (HR=1.57;1.05,2.33), as compared to low CSD. All explanatory factors accounted for 18.5% and 24% of the excess of HF and AF risks, respectively, associated with CSD. For subjects with low childhood SES, advancements in education lowered risk of HF (HR=0.70;0.48, 1.02) or AF (HR=0.50;0.28, 0.89), whereas achievements of adulthood SES were unlikely to contribute to disease reduction. In conclusion, a life-course disadvantaged SES is an important predictor of first hospitalization for HF and AF; known risk factors partially explained the SES-disease gradient. Upwardly mobile groups are likely to mitigate the effect of poor childhood circumstances especially through educational advancement.

Quantifying direct effects of social determinants of health on systolic blood pressure in United States adult immigrants.

Identify the pathway by which social determinants of health (SDoH) variables impact systolic blood pressure (SBP) in immigrants. Latent variables were used to assess the relationship between SDoH and SBP. Latent variables were identified using confirmatory factor analysis (CFA) for (1) global socioeconomic status (SES) (education, income, number of hours worked per week), (2) stressors of immigration (life-course SES, immigration stress, immigration demand), (3) adaptation to immigration (perceived discrimination, perceived stress, health literacy), and (4) burden of disease (disability, comorbidities, chronic pain). Structural equation modeling (SEM) was used to investigate the relationship between immigrant specific latent variables and SBP. The study included 181 adult immigrants. The initial model (chi2 (77, n = 181) = 302.40, p < 0.001, RMSEA = 0.086, CFI = 0.84, TLI = 0.78, CD = 0.91) showed that stressors of immigration had a direct relationship with SBP (-0.35, p = 0.033); global (SES) had a direct relationship with burden of disease (-0.70, p = 0.007) and an indirect relationship with SBP by way of burden of disease (0.24, p = 0.015). The final model (chi2 (69, n = 181) = 149.98, p < 0.001, RMSEA = 0.054, CFI = 0.94, TLI = 0.91, CD = 0.96) maintained that global SES had a direct relationship with burden of disease (-0.40, p < 0.001) and an indirect relationship with SBP by way burden of disease (0.34, p < 0.001). This study suggests a direct relationship between burden of disease and SBP, and an indirect relationship between SES and SBP. Development of interventions should take burden of disease into account as a direct driver of blood pressure in immigrants, and address factors related to SES.

Life Course Socioeconomic Status and Late-Life Cognition and Cognitive Decline in the Rush Memory and Aging Project

The relationships among life course socioeconomic status (SES) measures with later life cognition and cognitive decline are unclear. We test the hypothesis that life-course SES is associated with late life level of cognition and rate of cognitive decline. The Rush Memory and Aging Project enrolled 1,864 dementia-free people aged ≥65 years between 1994 – 2018. Participants reported early life (parental education, number of siblings, and childhood financial need), mid-life (income at 40 years), and late life (baseline income) SES. Global cognitive function is a composite of 19 neuropsychological tests, administered annually. We utilized marginal structural models to assess the effect of SES (dichotomized at the median) at three life-course stages on late life global cognitive function and decline. We calculated inverse probability weights to adjust for socio-demographic confounders at each life-course stage. A total 1,063 participants had all relevant variables. Average follow-up was 4.4 years, and mean baseline age was 80.4 years. Most respondents were non-Hispanic white (89.7%) and female (74.1%). In the fully adjusted model, high childhood SES (coefficient 0.10; 95% CI 0.01, 0.20) and high late-life SES were associated with higher cognition intercept (coefficient 0.21; 95% CI 0.09, 0.32). High mid-life SES was associated with slower rate of cognitive decline (coefficient 0.02; 95% CI 0.001, 0.05). Childhood and late-life SES measures were not related to cognitive decline. Childhood and adult SES may reflect processes in building cognitive capacity, while midlife SES may reflect cognition maintenance. Interventions relating to SES across the life-course may benefit later life cognition.

Gender Difference in the Association Between Subjective Socioeconomic Mobility Across Life Course and Mortality at Older Ages: Results From the JAGES Longitudinal Study.

BackgroundSocioeconomic mobility affects health throughout the life course. However, it is not known whether there are gender differences in the association between life-course subjective socioeconomic status (SSS) mobility and mortality at older ages.MethodsParticipants were 16,690 community-dwelling adults aged 65–100 years in the Japan Gerontological Evaluation Study (JAGES). Baseline information including demographic characteristics, depression, and lifestyle factors were collected in 2010. Participants’ vital status was confirmed in 2013 via linkage to death records. We categorized life-course socioeconomic mobility into the following categories: ‘persistently high’, ‘downward mobility’, ‘upward mobility’, and ‘persistently low’. Cox proportional hazard modeling was used to estimate hazard ratios (HR) for all-cause mortality.ResultsMortality HRs for the ‘downward’ group were 1.37 (95% confidence interval [CI], 1.08–1.74) among men and 1.27 (95% CI, 0.94–1.71) among women in comparison with the ‘persistently high’ group. Compared to the ‘persistently low’ group, the HRs for the ‘upward’ group were 0.54 (95% CI, 0.35–0.83) among women and 0.91 (95% CI, 0.73–1.24) among men. Associations were not changed after adjusting for objective socioeconomic status but were attenuated by depression.Conclusions‘Downward’ mobility was associated with mortality among men, but not among women. Depression appeared to mediate the association. A protective effect of upward mobility was observed among women but not among men.