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Association of Childhood Socioeconomic Status With Subsequent Coronary Heart Disease in Physicians
Michelle M. Kittleson, MD, PhD;
Lucy A. Meoni, ScM;
Nae-Yuh Wang, PhD;
Audrey Y. Chu, BS;
Daniel E. Ford, MD, MPH;
Michael J. Klag, MD, MPH
Arch Intern Med. 2006;166:2356-2361.
Background Adult socioeconomic status (SES) is an independent risk factor for the development of coronary heart disease (CHD), but whether low childhood SES has an effect in adults who have achieved high SES is unknown.
Methods We examined the risk of CHD and mortality associated with low childhood SES in 1131 male medical students from The Johns Hopkins Precursors Study, a prospective cohort of graduates of The Johns Hopkins University School of Medicine from 1948 to 1964 with a median follow-up of 40 years.
Results Of 1131 subjects, 216 (19.1%) were from low-SES families. Medical students from low-SES families were slightly older at graduation (26.8 vs 26.2 years; P = .004) and gained more weight over time (P = .01). Low childhood SES conferred a 2.40-fold increased hazard of developing CHD on or before age 50 years (95% confidence interval, 1.21-4.74) but not at older ages. The impact of low SES on early CHD was not reduced by adjusting for other CHD risk factors, including body mass index, cholesterol level, amount of exercise, depression, coffee drinking, smoking, hypertension, diabetes mellitus, and parental CHD history. Low childhood SES did not confer an increased risk of all-cause mortality.
Conclusions Low childhood SES is associated with an increased incidence of CHD before age 50 years among men with high adulthood SES. This risk is not mediated by traditional risk factors for CHD. These findings highlight the importance of childhood events on the development of CHD early in adulthood and the persistent effects of low SES.
Author Affiliations: Divisions of Cardiology (Dr Kittleson) and General Internal Medicine (Ms Meoni and Drs Wang, Ford, and Klag), Department of Medicine, The Johns Hopkins School of Medicine, and Departments of Epidemiology (Ms Chu and Drs Ford and Klag), Biostatistics (Ms Meoni), and Health Policy and Management (Drs Ford and Klag), Johns Hopkins Bloomberg School of Public Health, The Johns Hopkins University, Baltimore, Md. Dr Kittleson is now with the Division of Cardiology, David Geffen School of Medicine at UCLA, Los Angles, Calif.
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