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American Journal of Epidemiology Advance Access originally published online on January 29, 2009
American Journal of Epidemiology 2009 169(7):829-836; doi:10.1093/aje/kwn403
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American Journal of Epidemiology © The Author 2009. Published by the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oxfordjournals.org.

ORIGINAL CONTRIBUTIONS

Life-Course Socioeconomic Position and Incidence of Coronary Heart Disease

The Framingham Offspring Study

Eric B. Loucks, John W. Lynch, Louise Pilote, Rebecca Fuhrer, Nisha D. Almeida, Hugues Richard, Golareh Agha, Joanne M. Murabito and Emelia J. Benjamin

Correspondence to Dr. Eric B. Loucks, Douglas Mental Health Institute, McGill University, 6875 LaSalle Blvd., Montreal, QC, Canada H4H 1R3 (e-mail: eric.loucks{at}mcgill.ca).

Received for publication June 30, 2008. Accepted for publication December 5, 2008.

Cumulative exposure to socioeconomic disadvantage across the life course may be inversely associated with coronary heart disease (CHD); the mechanisms are not fully clear. An objective of this study was to determine whether cumulative life-course socioeconomic position (SEP) is associated with CHD incidence in a well-characterized US cohort that had directly assessed childhood and adulthood measures of SEP and prospectively measured CHD incidence. Furthermore, analyses aimed to evaluate whether adjustment for CHD risk factors reduces the association between cumulative life-course SEP and CHD. The authors examined 1,835 subjects who participated in the Framingham Heart Study Offspring Cohort from 1971 through 2003 (mean age, 35.0 years; 52.4% women). Childhood SEP was measured as father's education; adulthood SEP was assessed as own education and occupation. CHD incidence included myocardial infarction, coronary insufficiency, and coronary death. Cox proportional hazards analyses indicated that cumulative SEP was associated with incident CHD after adjustment for age and sex (hazard ratio = 1.82, 95% confidence interval: 1.17, 2.85 for low vs. high cumulative SEP score). Adjustment for CHD risk factors reduced that magnitude of association (hazard ratio = 1.29, 95% confidence interval: 0.78, 2.13). These findings underscore the potential importance of CHD prevention and treatment efforts for those whose backgrounds include low SEP throughout life.

cohort studies; coronary disease; myocardial ischemia; social class; socioeconomic factors

Abbreviations: CHD, coronary heart disease; CI, confidence interval; HDL, high density lipoprotein; HR, hazard ratio; SEP, socioeconomic position


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