The effect of lifetime socioeconomic status on cardiovascular health among adults 50-years and older
Allegra, Joseph Carmen
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The relationship between wealth and health continues to have important implications for public health policy as well as for individual behavior. As a result, economists, sociologists, and epidemiologists, among other disciplines, persist in pursuing a plausible working model linking wealth and health. Previous research indicates that childhood socioeconomic status (SES) plays a significant role in late-life health outcomes, however the mechanism by which this effect occurs remains unclear. Four competing models have been developed to explain this association: the critical-period model, the accumulation of risks model, and the pathway model, and the social-mobility model. Using data from the Health and Retirement Study, we conducted three observational investigations in order to 1) establish the prevalence of cardiovascular diseases (CVD) during the baseline year of 2006, 2) determine if social-mobility best explains the relationship between total net worth and incident CVD during the study period 2006-2012, and 3) provide an alternative hypothesis to the social-mobility model. Key findings from our analyses showed an inverse association between total net worth quintiles and prevalent CVD. The odds of any CVD diagnosis were 32% and 38% less among respondents in the two highest quintiles compared to the bottom quintile. Respondents in the top quintile also had lower odds of CHF (OR=0.57; 0.40-0.81, p=0.002) and angina (OR=0.58; 0.43-0.79, p<0.0001). In terms of economic mobility, respondents born into affluence who subsequently fell to the lowest tertile of net worth still had 0.69 times the risk of incident CVD compared to lifetime economically poor respondents. Maintaining middle class status from childhood to adulthood yielded an incidence rate ratio of 0.53 (0.37-0.78, p = 0.001). In addition to social mobility, we investigated the critical-period model. Results from this analysis suggested an association between respondents who identified their childhood socioeconomic status as "about average" and incident CVD (RR=0.73; 0.57-0.93, p=0.01) compared to respondents who identified their childhood SES as "poor". Our results add to a growing body of research concerning the timing of SES circumstance and its effect on health later in life. Accurate early-life SES information will be needed in order to determine the appropriate model driving this association.