Systematic Review of the Influence of Childhood Socioeconomic Circumstances on Risk for Cardiovascular Disease in Adulthood
Received 28 January 2005; accepted 8 June 2005. published online 02 November 2005.
Purpose
Adverse socioeconomic circumstances in childhood may confer a greater risk for adult cardiovascular disease (CVD). The purpose of this review is to systematically evaluate evidence for an association between socioeconomic circumstances during childhood and specific CVD subtypes, independent of adult socioeconomic conditions.
Methods
We systematically retrieved individual-level studies of morbidity and mortality from CVD and specific CVD subtypes linked to early life influences, including coronary heart disease (CHD), ischemic and hemorrhagic stroke, peripheral vascular disease, markers of atherosclerosis (carotid intima-media thickness and stenosis), and rheumatic heart disease. Indicators of socioeconomic position in childhood varied, although most studies relied on father's occupation.
Results
We located 40 studies (24 prospective, 11 case–control, and 5 cross-sectional) reported in 50 publications. Thirty-one studies (19 prospective, 7 case–control, and all 5 cross-sectional) found a robust inverse association between childhood circumstances and CVD risk, although findings sometimes varied among specific outcomes, socioeconomic measures, and sex. Case–control studies reported mixed results. The association was stronger for stroke and, in particular, hemorrhagic stroke, than for CHD. Childhood socioeconomic conditions remained important predictors of CVD, even in younger cohorts.
Conclusion
Childhood and adulthood socioeconomic circumstances are important determinants of CVD risk. The specific contribution of childhood and adulthood characteristics varies across different CVD subtypes. Disease-specific mechanisms are likely to explain the childhood origins of these adult health inequalities.
From the Department of Social Medicine, University of Bristol, Bristol, UK (B.G., G.D.S.); and Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada (J.W.L.)
Address correspondence to: Bruna Galobardes, MBBChir, Department of Social Medicine, Canynge Hall, Whiteladies Road, Bristol, BS8 2PR, UK. Tel.: (+44) 117-928-7249; fax: (+44) 117-928-7325.
J.W.L. and G.D.S. were supported in part by a Robert Wood Johnson Foundation Investigators Award in Health Policy Research. Funds from this award also partly supported B.G.
The views expressed in this review are those of the authors and not necessarily any funding bodies.
ABSTRACT