Associations of socioeconomic position in childhood and young adulthood with cardiometabolic risk factors: the Jerusalem Perinatal Family Follow-Up Study

Correspondence to Dr B Savitsky, The Braun School of Public Health, The Hebrew University-Hadassah Medical Center, P.O. Box 12272, Jerusalem 91120, Israe l; [email protected]

Introduction

Cardiometabolic disease is currently a prominent and growing public health concern.¹ There is substantial evidence that socioeconomic position (SEP) is associated with cardiometabolic disease development directly and through physical and behavioural risk factors such as hypertension, obesity, lipids, diabetes, smoking, sedentary lifestyle and unhealthy diet patterns.^2–4

A life-course approach to chronic disease development proposes that accumulation, and interaction of social environment and biological factors experienced throughout the life course impact current and future health conditions and thus ultimately impact adult health.^5–7 Several life-course models of socioeconomic impact on adult health have been proposed. The critical period model, emphasising timing of exposure (particularly early life), proposes that early-life events and environmental exposures impact health risk factors later in life. Alternatively, the accumulation model, emphasising duration of exposures, proposes that experiences and environments during early and later life accumulate to influence adult disease risk. The social mobility model, on the other hand, focuses on mobility or change across the life course as the primary impact on adult health.^{8 9} Along these lines, Gluckman's match–mismatch hypothesis^{10 11} claims that the early environment can induce long-term cardiovascular effects if there is a ‘mismatch’ between the early developmental environment and the subsequent environment in later life.

Previous studies have demonstrated inverse associations between SEP in different life periods and cardiometabolic risk factors (CMRs), with some differences in findings.^{6 12–15} For example, Power et al⁶ demonstrated that occupation-based social class in childhood and adulthood are both independently associated with blood pressure (BP), body mass index (BMI), glycated haemoglobin (HbA1c), high-density lipoprotein cholesterol (HDL-C) and triglycerides (TG). Results from the Framingham Heart Study showed that cumulative effect of lower SEP throughout the life course is associated with higher coronary heart disease (CHD) incidence.¹⁵ Furthermore, several recent studies provide support for the importance of social mobility on levels of CMRs. These studies conducted in Brazil,¹⁶ the USA,^{17 18} Poland¹⁹ and Sweden²⁰ generally suggest that upward mobility in SEP decreases risks for cardiometabolic-related outcomes, while downward mobility has adverse health effects. Of relevance here, a study...