Skip to main content
NCBI home page
Journal of Epidemiology and Community Health logoLink to Journal of Epidemiology and Community Health
. 1995 Feb;49(1):10–15. doi: 10.1136/jech.49.1.10

Childhood socioeconomic status and risk of cardiovascular disease in middle aged US women: a prospective study.

M D Gliksman 1, I Kawachi 1, D Hunter 1, G A Colditz 1, J E Manson 1, M J Stampfer 1, F E Speizer 1, W C Willett 1, C H Hennekens 1
PMCID: PMC1060067  PMID: 7706992

Abstract

OBJECTIVE--To examine prospectively the relationship of childhood socioeconomic status and risk of cardiovascular disease in middle aged women. DESIGN--A prospective cohort of women with 14 years follow up data (1976-90). SUBJECTS--A total of 117,006 registered female nurses aged 30 to 55 years in 1976 and free of diagnosed coronary heart disease, stroke, and cancer at baseline. MAIN OUTCOME MEASURES--Incident fatal coronary heart disease, non-fatal myocardial infarction, and stroke (fatal and non-fatal). RESULTS--Low socioeconomic status in childhood was associated with a modestly increased risk of incident non-fatal myocardial infarction and total cardiovascular disease in adulthood. Compared with middle aged women from white collar childhood backgrounds, the age adjusted risk of total cardiovascular disease for women from blue collar backgrounds was 1.13 (95% CI 1.02, 1.24) and that of non-fatal myocardial infarction was 1.23 (95% CI 1.06, 1.42). No significant increase in risk was observed for stroke or fatal coronary heart disease. Adjustment for differences in family and personal past medical history, medication use, exercise, alcohol intake, diet, birth weight, being breastfed in infancy, and adult socioeconomic circumstance somewhat attenuated the increased risks observed for women from blue collar childhood socioeconomic backgrounds. In multivariate analysis, women whose fathers had been manual labourers had the highest relative risk of total coronary heart disease (RR = 1.53; 95% CI 1.09, 2.16) and non-fatal myocardial infarction (RR = 1.67; 95% CI 1.11, 2.53) when compared with women whose fathers had been employed in the professions. CONCLUSION--In this group lower childhood socioeconomic status was associated with a small but significant increase in the risk of total coronary heart disease as well as non-fatal myocardial infarction. For women from the most socioeconomically disadvantaged childhood backgrounds, the association is not explained by differences in a large number of cardiovascular risk factors, by differences in adult socioeconomic status, or by differences in indices of nutrition during gestation or infancy.

Full text

PDF
10

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Ariouat J. F., Barker D. J. The diet of girls and young women at the beginning of the century. Nutr Health. 1993;9(1):15–23. doi: 10.1177/026010609300900102. [DOI] [PubMed] [Google Scholar]
  2. Baker I. A., Sweetnam P. M., Yarnell J. W., Bainton D., Elwood P. C. Haemostatic and other risk factors for ischaemic heart disease and social class: evidence from the Caerphilly and Speedwell studies. Int J Epidemiol. 1988 Dec;17(4):759–765. doi: 10.1093/ije/17.4.759. [DOI] [PubMed] [Google Scholar]
  3. Barker D. J., Gluckman P. D., Godfrey K. M., Harding J. E., Owens J. A., Robinson J. S. Fetal nutrition and cardiovascular disease in adult life. Lancet. 1993 Apr 10;341(8850):938–941. doi: 10.1016/0140-6736(93)91224-a. [DOI] [PubMed] [Google Scholar]
  4. Carstairs V., Morris R. Deprivation: explaining differences in mortality between Scotland and England and Wales. BMJ. 1989 Oct 7;299(6704):886–889. doi: 10.1136/bmj.299.6704.886. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Colditz G. A., Bonita R., Stampfer M. J., Willett W. C., Rosner B., Speizer F. E., Hennekens C. H. Cigarette smoking and risk of stroke in middle-aged women. N Engl J Med. 1988 Apr 14;318(15):937–941. doi: 10.1056/NEJM198804143181501. [DOI] [PubMed] [Google Scholar]
  6. Colditz G. A., Willett W. C., Stampfer M. J., Sampson L., Rosner B., Hennekens C. H., Speizer F. E. The influence of age, relative weight, smoking, and alcohol intake on the reproducibility of a dietary questionnaire. Int J Epidemiol. 1987 Sep;16(3):392–398. doi: 10.1093/ije/16.3.392. [DOI] [PubMed] [Google Scholar]
  7. Elford J., Whincup P., Shaper A. G. Early life experience and adult cardiovascular disease: longitudinal and case-control studies. Int J Epidemiol. 1991 Dec;20(4):833–844. doi: 10.1093/ije/20.4.833. [DOI] [PubMed] [Google Scholar]
  8. Fall C. H., Barker D. J., Osmond C., Winter P. D., Clark P. M., Hales C. N. Relation of infant feeding to adult serum cholesterol concentration and death from ischaemic heart disease. BMJ. 1992 Mar 28;304(6830):801–805. doi: 10.1136/bmj.304.6830.801. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Giovannucci E., Colditz G., Stampfer M. J., Rimm E. B., Litin L., Sampson L., Willett W. C. The assessment of alcohol consumption by a simple self-administered questionnaire. Am J Epidemiol. 1991 Apr 15;133(8):810–817. doi: 10.1093/oxfordjournals.aje.a115960. [DOI] [PubMed] [Google Scholar]
  10. Gliksman M. D., Dwyer T., Wlodarczyk J. Differences in modifiable cardiovascular disease risk factors in Australian schoolchildren: the results of a nationwide survey. Prev Med. 1990 May;19(3):291–304. doi: 10.1016/0091-7435(90)90029-j. [DOI] [PubMed] [Google Scholar]
  11. Gliksman M. D., Lazarus R., Wilson A. Differences in serum lipids in Australian children: is diet responsible? Int J Epidemiol. 1993 Apr;22(2):247–254. doi: 10.1093/ije/22.2.247. [DOI] [PubMed] [Google Scholar]
  12. HILL A. B. THE ENVIRONMENT AND DISEASE: ASSOCIATION OR CAUSATION? Proc R Soc Med. 1965 May;58:295–300. doi: 10.1177/003591576505800503. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Hebert P. R., Buring J. E., O'Connor G. T., Rosner B., Hennekens C. H. Occupation and risk of nonfatal myocardial infarction. Arch Intern Med. 1992 Nov;152(11):2253–2257. [PubMed] [Google Scholar]
  14. Kaplan G. A., Salonen J. T. Socioeconomic conditions in childhood and ischaemic heart disease during middle age. BMJ. 1990 Nov 17;301(6761):1121–1123. doi: 10.1136/bmj.301.6761.1121. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Kawachi I., Marshall S., Pearce N. Social class inequalities in the decline of coronary heart disease among New Zealand men, 1975-1977 to 1985-1987. Int J Epidemiol. 1991 Jun;20(2):393–398. doi: 10.1093/ije/20.2.393. [DOI] [PubMed] [Google Scholar]
  16. Liberatos P., Link B. G., Kelsey J. L. The measurement of social class in epidemiology. Epidemiol Rev. 1988;10:87–121. doi: 10.1093/oxfordjournals.epirev.a036030. [DOI] [PubMed] [Google Scholar]
  17. Manson J. E., Rimm E. B., Stampfer M. J., Colditz G. A., Willett W. C., Krolewski A. S., Rosner B., Hennekens C. H., Speizer F. E. Physical activity and incidence of non-insulin-dependent diabetes mellitus in women. Lancet. 1991 Sep 28;338(8770):774–778. doi: 10.1016/0140-6736(91)90664-b. [DOI] [PubMed] [Google Scholar]
  18. Manson J. E., Stampfer M. J., Colditz G. A., Willett W. C., Rosner B., Speizer F. E., Hennekens C. H. A prospective study of aspirin use and primary prevention of cardiovascular disease in women. JAMA. 1991 Jul 24;266(4):521–527. [PubMed] [Google Scholar]
  19. Marmot M. G., Shipley M. J., Rose G. Inequalities in death--specific explanations of a general pattern? Lancet. 1984 May 5;1(8384):1003–1006. doi: 10.1016/s0140-6736(84)92337-7. [DOI] [PubMed] [Google Scholar]
  20. Marmot M. Socioeconomic determinants of CHD mortality. Int J Epidemiol. 1989;18(3 Suppl 1):S196–S202. [PubMed] [Google Scholar]
  21. Paffenbarger R. S., Jr, Blair S. N., Lee I. M., Hyde R. T. Measurement of physical activity to assess health effects in free-living populations. Med Sci Sports Exerc. 1993 Jan;25(1):60–70. doi: 10.1249/00005768-199301000-00010. [DOI] [PubMed] [Google Scholar]
  22. Peck A. M., Vågerö D. H. Adult body height, self perceived health and mortality in the Swedish population. J Epidemiol Community Health. 1989 Dec;43(4):380–384. doi: 10.1136/jech.43.4.380. [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. Reed D. M. The paradox of high risk of stroke in populations with low risk of coronary heart disease. Am J Epidemiol. 1990 Apr;131(4):579–588. doi: 10.1093/oxfordjournals.aje.a115542. [DOI] [PubMed] [Google Scholar]
  24. Rose G. Mass prevention: population-directed approach. Acta Cardiol Suppl. 1988;29:131–139. [PubMed] [Google Scholar]
  25. Shaper A. G., Phillips A. N., Pocock S. J., Walker M., Macfarlane P. W. Risk factors for stroke in middle aged British men. BMJ. 1991 May 11;302(6785):1111–1115. doi: 10.1136/bmj.302.6785.1111. [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. Stamler R., Shipley M., Elliott P., Dyer A., Sans S., Stamler J. Higher blood pressure in adults with less education. Some explanations from INTERSALT. Hypertension. 1992 Mar;19(3):237–241. doi: 10.1161/01.hyp.19.3.237. [DOI] [PubMed] [Google Scholar]
  27. Stampfer M. J., Colditz G. A., Willett W. C., Manson J. E., Rosner B., Speizer F. E., Hennekens C. H. Postmenopausal estrogen therapy and cardiovascular disease. Ten-year follow-up from the nurses' health study. N Engl J Med. 1991 Sep 12;325(11):756–762. doi: 10.1056/NEJM199109123251102. [DOI] [PubMed] [Google Scholar]
  28. Stampfer M. J., Colditz G. A., Willett W. C., Speizer F. E., Hennekens C. H. A prospective study of moderate alcohol consumption and the risk of coronary disease and stroke in women. N Engl J Med. 1988 Aug 4;319(5):267–273. doi: 10.1056/NEJM198808043190503. [DOI] [PubMed] [Google Scholar]
  29. Stampfer M. J., Hennekens C. H., Manson J. E., Colditz G. A., Rosner B., Willett W. C. Vitamin E consumption and the risk of coronary disease in women. N Engl J Med. 1993 May 20;328(20):1444–1449. doi: 10.1056/NEJM199305203282003. [DOI] [PubMed] [Google Scholar]
  30. Walker M., Shaper A. G., Phillips A. N., Cook D. G. Short stature, lung function and risk of a heart attack. Int J Epidemiol. 1989 Sep;18(3):602–606. doi: 10.1093/ije/18.3.602. [DOI] [PubMed] [Google Scholar]
  31. Washburn R. A., Adams L. L., Haile G. T. Physical activity assessment for epidemiologic research: the utility of two simplified approaches. Prev Med. 1987 Sep;16(5):636–646. doi: 10.1016/0091-7435(87)90047-8. [DOI] [PubMed] [Google Scholar]
  32. Washburn R. A., Goldfield S. R., Smith K. W., McKinlay J. B. The validity of self-reported exercise-induced sweating as a measure of physical activity. Am J Epidemiol. 1990 Jul;132(1):107–113. doi: 10.1093/oxfordjournals.aje.a115622. [DOI] [PubMed] [Google Scholar]
  33. Willett W. C., Green A., Stampfer M. J., Speizer F. E., Colditz G. A., Rosner B., Monson R. R., Stason W., Hennekens C. H. Relative and absolute excess risks of coronary heart disease among women who smoke cigarettes. N Engl J Med. 1987 Nov 19;317(21):1303–1309. doi: 10.1056/NEJM198711193172102. [DOI] [PubMed] [Google Scholar]
  34. Willett W. C., Sampson L., Browne M. L., Stampfer M. J., Rosner B., Hennekens C. H., Speizer F. E. The use of a self-administered questionnaire to assess diet four years in the past. Am J Epidemiol. 1988 Jan;127(1):188–199. doi: 10.1093/oxfordjournals.aje.a114780. [DOI] [PubMed] [Google Scholar]
  35. Willett W. C., Stampfer M. J., Manson J. E., Colditz G. A., Speizer F. E., Rosner B. A., Sampson L. A., Hennekens C. H. Intake of trans fatty acids and risk of coronary heart disease among women. Lancet. 1993 Mar 6;341(8845):581–585. doi: 10.1016/0140-6736(93)90350-p. [DOI] [PubMed] [Google Scholar]
  36. Willett W., Stampfer M. J., Bain C., Lipnick R., Speizer F. E., Rosner B., Cramer D., Hennekens C. H. Cigarette smoking, relative weight, and menopause. Am J Epidemiol. 1983 Jun;117(6):651–658. doi: 10.1093/oxfordjournals.aje.a113598. [DOI] [PubMed] [Google Scholar]
  37. Williams F. L., Lloyd O. L. Cerebrovascular disease in Scotland during 1959 to 1983: its geographical distribution and associations. Community Med. 1989 Nov;11(4):306–315. [PubMed] [Google Scholar]
  38. Winkleby M. A., Jatulis D. E., Frank E., Fortmann S. P. Socioeconomic status and health: how education, income, and occupation contribute to risk factors for cardiovascular disease. Am J Public Health. 1992 Jun;82(6):816–820. doi: 10.2105/ajph.82.6.816. [DOI] [PMC free article] [PubMed] [Google Scholar]
  39. Yarnell J. W., Limb E. S., Layzell J. M., Baker I. A. Height: a risk marker for ischaemic heart disease: prospective results from the Caerphilly and Speedwell Heart Disease Studies. Eur Heart J. 1992 Dec;13(12):1602–1605. doi: 10.1093/oxfordjournals.eurheartj.a060111. [DOI] [PubMed] [Google Scholar]

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

RESOURCES