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

Eleanor M Winpenny*, Laura D Howe, Kate M Tilling

*Corresponding author for this work

Research output: Contribution to journalArticle (Academic Journal)peer-review

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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 (16-24y) to cardiovascular health in mid-adulthood (46y).
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 across early adulthood. Cardiometabolic risk factors (46y) were regressed on socioeconomic trajectory class (16-24y), testing mediation by adult socioeconomic position (46y). Models were stratified by sex and adjusted for childhood 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 46y, with the lowest levels of cardiometabolic risk factors. For example, systolic blood pressure was 128.9mmHg (95%CI 127.8, 130.0) among men in the ‘Continued Education’ class, compared to 131.3mmHg (95%CI 130.4, 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 46y.
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.
Original languageEnglish
Article number1172–1180
Pages (from-to)1172-1180
Number of pages9
JournalJournal of Epidemiology and Community Health
Volume75
Issue number12
Early online date6 Aug 2021
DOIs
Publication statusE-pub ahead of print - 6 Aug 2021

Bibliographical note

Funding Information:
Funding 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. EMW is funded by a Career Development Award from the UK Medical Research Council (MR/T010576/1). LH is funded by a Career Development Award from the UK Medical Research Council (MR/M020894/1). LH and KT work in the Integrative Epidemiology Unit which receives funding from the UK Medical Research Council and the University of Bristol (MC_UU_00011/3).

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