Logo of jepicomhJournal of Epidemiology and Community HealthVisit this articleSubmit a manuscriptReceive email alertsContact usBMJ
J Epidemiol Community Health. 1999 Dec; 53(12): 757–764.
PMCID: PMC1756821

When does cardiovascular risk start? Past and present socioeconomic circumstances and risk factors in adulthood

Abstract

STUDY OBJECTIVES: To compare associations of childhood and adult socioeconomic position with cardiovascular risk factors measured in adulthood. To estimate the effects of adult socioeconomic position after adjustment for childhood circumstances. DESIGN: Cross sectional survey, using the relative index of inequality method to compare socioeconomic differences at different life stages. SETTING: The Whitehall II longitudinal study of men and women employed in London offices of the Civil Service at study baseline in 1985-88. PARTICIPANTS: 4774 men and 2206 women born in the period 1930-53 who were administered questions on early socioeconomic circumstances. MAIN RESULTS: Adult occupational position (employment grade) was inversely associated (high status-low risk) with current smoking and leisure time physical inactivity, with waist/height, and with metabolic risk factors HDL cholesterol, triglycerides, post-load glucose and fibrinogen. Associations of these variables with childhood socioeconomic position (father's Registrar General Social Class) were weaker or absent, with the exception of smoking in women. Childhood social position was associated with adult weight in both sexes and with current smoking, waist/height, HDL cholesterol and fibrinogen in women. Height, a measure of health capital or constitution, was weakly linked with father's social class and more strongly linked with own employment grade. The combination of childhood disadvantage (low father's class) together with a low status clerical occupation in men was particularly associated with higher body mass index as an adult (interaction test p < 0.001). Adjustment for earlier socioeconomic position--using father's class and own education level simultaneously--did not weaken the effects of adult socioeconomic position, except in the case of smoking in women, when the grade effect was reduced by 59 per cent. CONCLUSIONS: Cardiovascular risk factors in adulthood were in general more strongly related to adult than to childhood socioeconomic position. Among women but not men there was a strong but unexplained link between father's class and adult smoking habit. In both sexes degree of obesity was associated with both childhood and adulthood social position. These findings suggest that the socially patterned accumulation of health capital and cardiovascular risk begins in childhood and continues, according to socioeconomic position, during adulthood.

 

Full Text

The Full Text of this article is available as a PDF (108K).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Barker DJ. Fetal origins of coronary heart disease. BMJ. 1995 Jul 15;311(6998):171–174. [PMC free article] [PubMed]
  • Gliksman MD, Kawachi I, Hunter D, Colditz GA, Manson JE, Stampfer MJ, Speizer FE, Willett WC, Hennekens CH. Childhood socioeconomic status and risk of cardiovascular disease in middle aged US women: a prospective study. J Epidemiol Community Health. 1995 Feb;49(1):10–15. [PMC free article] [PubMed]
  • Burr ML, Sweetnam PM. Family size and paternal unemployment in relation to myocardial infarction. J Epidemiol Community Health. 1980 Jun;34(2):93–95. [PMC free article] [PubMed]
  • Vågerö D, Leon D. Effect of social class in childhood and adulthood on adult mortality. Lancet. 1994 May 14;343(8907):1224–1225. [PubMed]
  • Notkola V, Punsar S, Karvonen MJ, Haapakoski J. Socio-economic conditions in childhood and mortality and morbidity caused by coronary heart disease in adulthood in rural Finland. Soc Sci Med. 1985;21(5):517–523. [PubMed]
  • Wannamethee SG, Whincup PH, Shaper G, Walker M. Influence of fathers' social class on cardiovascular disease in middle-aged men. Lancet. 1996 Nov 9;348(9037):1259–1263. [PubMed]
  • Smith GD, Hart C, Blane D, Gillis C, Hawthorne V. Lifetime socioeconomic position and mortality: prospective observational study. BMJ. 1997 Feb 22;314(7080):547–552. [PMC free article] [PubMed]
  • Lynch JW, Kaplan GA, Cohen RD, Kauhanen J, Wilson TW, Smith NL, Salonen JT. Childhood and adult socioeconomic status as predictors of mortality in Finland. Lancet. 1994 Feb 26;343(8896):524–527. [PubMed]
  • Blane D, Hart CL, Smith GD, Gillis CR, Hole DJ, Hawthorne VM. Association of cardiovascular disease risk factors with socioeconomic position during childhood and during adulthood. BMJ. 1996 Dec 7;313(7070):1434–1438. [PMC free article] [PubMed]
  • Brunner E, Davey Smith G, Marmot M, Canner R, Beksinska M, O'Brien J. Childhood social circumstances and psychosocial and behavioural factors as determinants of plasma fibrinogen. Lancet. 1996 Apr 13;347(9007):1008–1013. [PubMed]
  • Marmot MG, Smith GD, Stansfeld S, Patel C, North F, Head J, White I, Brunner E, Feeney A. Health inequalities among British civil servants: the Whitehall II study. Lancet. 1991 Jun 8;337(8754):1387–1393. [PubMed]
  • Brunner EJ, Marmot MG, White IR, O'Brien JR, Etherington MD, Slavin BM, Kearney EM, Smith GD. Gender and employment grade differences in blood cholesterol, apolipoproteins and haemostatic factors in the Whitehall II study. Atherosclerosis. 1993 Sep;102(2):195–207. [PubMed]
  • Brunner EJ, Marmot MG, Nanchahal K, Shipley MJ, Stansfeld SA, Juneja M, Alberti KG. Social inequality in coronary risk: central obesity and the metabolic syndrome. Evidence from the Whitehall II study. Diabetologia. 1997 Nov;40(11):1341–1349. [PubMed]
  • Wagstaff A, Paci P, van Doorslaer E. On the measurement of inequalities in health. Soc Sci Med. 1991;33(5):545–557. [PubMed]
  • Roberts R, Brunner E, White I, Marmot M. Gender differences in occupational mobility and structure of employment in the British Civil Service. Soc Sci Med. 1993 Dec;37(12):1415–1425. [PubMed]
  • Marmot MG, Rose G, Shipley M, Hamilton PJ. Employment grade and coronary heart disease in British civil servants. J Epidemiol Community Health. 1978 Dec;32(4):244–249. [PMC free article] [PubMed]
  • Marmot MG, Bosma H, Hemingway H, Brunner E, Stansfeld S. Contribution of job control and other risk factors to social variations in coronary heart disease incidence. Lancet. 1997 Jul 26;350(9073):235–239. [PubMed]
  • Hart CL, Smith GD, Blane D. Social mobility and 21 year mortality in a cohort of Scottish men. Soc Sci Med. 1998 Oct;47(8):1121–1130. [PubMed]
  • Wilson TW, Kaplan GA, Kauhanen J, Cohen RD, Wu M, Salonen R, Salonen JT. Association between plasma fibrinogen concentration and five socioeconomic indices in the Kuopio Ischemic Heart Disease Risk Factor Study. Am J Epidemiol. 1993 Feb 1;137(3):292–300. [PubMed]
  • Forsdahl A. Living conditions in childhood and subsequent development of risk factors for arteriosclerotic heart disease. The cardiovascular survey in Finnmark 1974-75. J Epidemiol Community Health. 1978 Mar;32(1):34–37. [PMC free article] [PubMed]
  • Smith GD, Hart C, Blane D, Hole D. Adverse socioeconomic conditions in childhood and cause specific adult mortality: prospective observational study. BMJ. 1998 May 30;316(7145):1631–1635. [PMC free article] [PubMed]
  • Bosma H, Marmot MG, Hemingway H, Nicholson AC, Brunner E, Stansfeld SA. Low job control and risk of coronary heart disease in Whitehall II (prospective cohort) study. BMJ. 1997 Feb 22;314(7080):558–565. [PMC free article] [PubMed]
  • Braddon FE, Rodgers B, Wadsworth ME, Davies JM. Onset of obesity in a 36 year birth cohort study. Br Med J (Clin Res Ed) 1986 Aug 2;293(6542):299–303. [PMC free article] [PubMed]
  • Power C, Moynihan C. Social class and changes in weight-for-height between childhood and early adulthood. Int J Obes. 1988;12(5):445–453. [PubMed]
  • Bao W, Srinivasan SR, Berenson GS. Persistent elevation of plasma insulin levels is associated with increased cardiovascular risk in children and young adults. The Bogalusa Heart Study. Circulation. 1996 Jan 1;93(1):54–59. [PubMed]
  • Davey Smith G, Hart C. Insulin resistance syndrome and childhood social conditions. Lancet. 1997 Jan 25;349(9047):284–285. [PubMed]
  • Rona RJ. Genetic and environmental factors in the control of growth in childhood. Br Med Bull. 1981 Sep;37(3):265–272. [PubMed]
  • Peck MN, Lundberg O. Short stature as an effect of economic and social conditions in childhood. Soc Sci Med. 1995 Sep;41(5):733–738. [PubMed]
  • Montgomery SM, Bartley MJ, Wilkinson RG. Family conflict and slow growth. Arch Dis Child. 1997 Oct;77(4):326–330. [PMC free article] [PubMed]
  • Pocock SJ, Shaper AG, Cook DG, Phillips AN, Walker M. Social class differences in ischaemic heart disease in British men. Lancet. 1987 Jul 25;2(8552):197–201. [PubMed]
  • Colhoun HM, Hemingway H, Poulter NR. Socio-economic status and blood pressure: an overview analysis. J Hum Hypertens. 1998 Feb;12(2):91–110. [PubMed]

Articles from Journal of Epidemiology and Community Health are provided here courtesy of BMJ Group

Formats:

Related citations in PubMed

See reviews...See all...

Cited by other articles in PMC

See all...

Links

  • PubMed
    PubMed
    PubMed citations for these articles

Recent Activity

Your browsing activity is empty.

Activity recording is turned off.

Turn recording back on

See more...