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Early adulthood socioeconomic trajectories contribute to inequalities in adult cardiovascular health, independently of childhood and adulthood socioeconomic position.

Accepted version
Peer-reviewed

Type

Article

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Authors

Winpenny, Eleanor M  ORCID logo  https://orcid.org/0000-0003-1933-0168
Howe, Laura D 
van Sluijs, Esther MF 
Hardy, Rebecca 
Tilling, Kate 

Abstract

BACKGROUND: Cardiovascular health shows significant socioeconomic inequalities, however there is little understanding of the role of early adulthood in generation of these inequalities. We assessed the contribution of socioeconomic trajectories during early adulthood (16-24 years) to cardiovascular health in mid-adulthood (46 years). METHODS: Participants from the 1970 British Cohort Study with socioeconomic data available in early adulthood were included (n=12 423). Longitudinal latent class analysis identified socioeconomic trajectories, based on patterns of economic activity throughout early adulthood. Cardiometabolic risk factors (46 years) were regressed on socioeconomic trajectory class (16-24 years), testing mediation by adult socioeconomic position (46 years). Models were stratified by sex and adjusted for childhood socioeconomic position (SEP) and adolescent health. RESULTS: Six early adulthood socioeconomic trajectories were identified: (1) Continued Education (20.2%), (2) Managerial Employment (16.0%), (3) Skilled Non-manual Employment (20.9%), (4) Skilled Manual Employment (18.9%), (5) Partly Skilled Employment (15.8%) and (6) Economically Inactive (8.1%). The 'Continued Education' trajectory class showed the best cardiovascular health at age 46 years, with the lowest levels of cardiometabolic risk factors. For example, systolic blood pressure was 128.9 mm Hg (95% CI 127.8 to 130.0) among men in the 'Continued Education' class, compared with 131.3 mm Hg (95% CI 130.4 to 132.2) among men in the 'Skilled Manual' class. Patterns across classes 2-6 differed by risk factor and sex. The observed associations were largely not mediated by SEP at age 46 years. CONCLUSION: Findings suggest an independent contribution of early adulthood socioeconomic trajectories to development of later life cardiovascular inequalities. Further work is needed to understand mediators of this relationship and potential for interventions to mitigate these pathways.

Description

Keywords

blood pressure, cardiovascular diseases, inequalities, life course epidemiology, social epidemiology, Adolescent, Adult, Blood Pressure, Cohort Studies, Employment, Humans, Male, Middle Aged, Risk Factors, Social Class, Socioeconomic Factors

Journal Title

J Epidemiol Community Health

Conference Name

Journal ISSN

0143-005X
1470-2738

Volume Title

Publisher

BMJ

Rights

All rights reserved
Sponsorship
Medical Research Council (MR/K023187/1)
MRC (MC_UU_00006/5)
Medical Research Council (MC_UU_12015/7)
MRC (MR/T010576/1)
Economic and Social Research Council (ES/K000357/1)
This work was supported by the UK Medical Research Council [grant number MC_UU_12015/7, MC_UU_00006/5 to EvS], and the Centre for Diet and Activity Research (CEDAR) [MR/K023187/1], where funding from Cancer Research UK, the British Heart Foundation, the Economic and Social Research Council, the Medical Research Council, the National Institute for Health Research, and the Wellcome Trust, under the auspices of the UK Clinical Research Collaboration, is gratefully acknowledged. EW is funded by a Career Development Award from the UK Medical Research Council [MR/T010576/1]. LDH is funded by a Career Development Award from the UK Medical Research Council [MR/M020894/1]. LDH and KT work in the Integrative Epidemiology Unit which receives funding from the U.K. Medical Research Council and the University of Bristol (MC_UU_00011/3).