Comparison of three lifecourse models of poverty in predicting cardiovascular disease risk in youth

Poverty over the early life course and young adult cardio-metabolic risk

OBJECTIVES

There is little known about whether exposure to family poverty at specific periods of the early life course independently contributes to coronary heart disease risk beyond the contribution of concurrent poverty.

METHODS

Children were recruited in early pregnancy and additional survey data obtained during the pregnancy and at the 5-, 14- and 30-year follow-ups. Fasting blood samples were also obtained at the 30-year follow-up. Analyses are multinominal logistic regressions stratified by gender and with adjustments for confounding.

RESULTS

For male offspring, family poverty at different stages of the early life course was not associated with measures of cardio-metabolic risk. For females early life course, poverty predicted obesity, homeostatic model assessment of insulin resistance (HOMA-IR) and total cholesterol/high-density lipoprotein cholesterol (TC/HDL-C), as well as concurrent family poverty associated with obesity, HOMA-IR, TC/HDL-C, HDL-C and increased systolic and diastolic blood pressure.

CONCLUSIONS

Family poverty in the early life course independently predicts increased levels of cardio-metabolic risk of females. The primary finding, however, is that concurrent poverty is independently and strongly associated with increased cardio-metabolic risk levels in young adulthood.

Could nature help children rise out of poverty? Green space and future earnings from a cohort in ten U.S. cities

BACKGROUND

Growing up in poverty is associated with poor health, and the American Dream of upward mobility is becoming an illusion for many low-income children. But nearby green space can support academic achievement, creativity, and emotional regulation, and these traits might help children rise out of poverty.

OBJECTIVES

To examine the relationship between recent incomes of children born into poverty in the ten largest U.S. cities and densities of residential green space during childhood.

METHODS

We calculate park proximity, park acreage, new park development, and NDVI greenness for 1980-1990 from Landsat and Trust for Public Land data. We obtain the 2014 income for children born between 1978 and 1982 into families in poverty from The Opportunity Atlas cohort, aggregated at the tract level (n = 5849).

RESULTS

Conditional autoregressive (CAR) models of tracts show statistically significant associations between income rank and above-average levels of greenness but not between income rank and park measures, adjusting for individual and neighborhood confounders and spatial autocorrelation. We estimate that, over a 30-year career, children growing up in tracts with the most vegetative cover will earn cumulatively $28,000 more than children growing up in tracts with the least cover, on average. Tracts with lower than average levels of precipitation, higher disadvantage, higher population density, or higher annual temperatures do not show beneficial effects of green space.

CONCLUSIONS

Greenness may be weakly associated with children rising out of poverty in wetter, cooler, less-dense, more advantaged census tracts.

Socioeconomic status and risk of cardiovascular disease in 20 low-income, middle-income, and high-income countries: the Prospective Urban Rural Epidemiologic (PURE) study

BACKGROUND

Socioeconomic status is associated with differences in risk factors for cardiovascular disease incidence and outcomes, including mortality. However, it is unclear whether the associations between cardiovascular disease and common measures of socioeconomic status-wealth and education-differ among high-income, middle-income, and low-income countries, and, if so, why these differences exist. We explored the association between education and household wealth and cardiovascular disease and mortality to assess which marker is the stronger predictor of outcomes, and examined whether any differences in cardiovascular disease by socioeconomic status parallel differences in risk factor levels or differences in management.

METHODS

In this large-scale prospective cohort study, we recruited adults aged between 35 years and 70 years from 367 urban and 302 rural communities in 20 countries. We collected data on families and households in two questionnaires, and data on cardiovascular risk factors in a third questionnaire, which was supplemented with physical examination. We assessed socioeconomic status using education and a household wealth index. Education was categorised as no or primary school education only, secondary school education, or higher education, defined as completion of trade school, college, or university. Household wealth, calculated at the household level and with household data, was defined by an index on the basis of ownership of assets and housing characteristics. Primary outcomes were major cardiovascular disease (a composite of cardiovascular deaths, strokes, myocardial infarction, and heart failure), cardiovascular mortality, and all-cause mortality. Information on specific events was obtained from participants or their family.

FINDINGS

Recruitment to the study began on Jan 12, 2001, with most participants enrolled between Jan 6, 2005, and Dec 4, 2014. 160 299 (87·9%) of 182 375 participants with baseline data had available follow-up event data and were eligible for inclusion. After exclusion of 6130 (3·8%) participants without complete baseline or follow-up data, 154 169 individuals remained for analysis, from five low-income, 11 middle-income, and four high-income countries. Participants were followed-up for a mean of 7·5 years. Major cardiovascular events were more common among those with low levels of education in all types of country studied, but much more so in low-income countries. After adjustment for wealth and other factors, the HR (low level of education vs high level of education) was 1·23 (95% CI 0·96-1·58) for high-income countries, 1·59 (1·42-1·78) in middle-income countries, and 2·23 (1·79-2·77) in low-income countries (p_interaction<0·0001). We observed similar results for all-cause mortality, with HRs of 1·50 (1·14-1·98) for high-income countries, 1·80 (1·58-2·06) in middle-income countries, and 2·76 (2·29-3·31) in low-income countries (p_interaction<0·0001). By contrast, we found no or weak associations between wealth and these two outcomes. Differences in outcomes between educational groups were not explained by differences in risk factors, which decreased as the level of education increased in high-income countries, but increased as the level of education increased in low-income countries (p_interaction<0·0001). Medical care (eg, management of hypertension, diabetes, and secondary prevention) seemed to play an important part in adverse cardiovascular disease outcomes because such care is likely to be poorer in people with the lowest levels of education compared to those with higher levels of education in low-income countries; however, we observed less marked differences in care based on level of education in middle-income countries and no or minor differences in high-income countries.

INTERPRETATION

Although people with a lower level of education in low-income and middle-income countries have higher incidence of and mortality from cardiovascular disease, they have better overall risk factor profiles. However, these individuals have markedly poorer health care. Policies to reduce health inequities globally must include strategies to overcome barriers to care, especially for those with lower levels of education.

FUNDING

Full funding sources are listed at the end of the paper (see Acknowledgments).

The Association Between Physical Activity and General Life Satisfaction in Lower Secondary School Students: The Role of Individual and Family Factors

The objective of the paper was to investigate the association between PA and general life satisfaction in adolescents, taking into account family affluence and selected psychological, family and school factors. The survey (2015) involved 4085 Polish lower-secondary school students. Life satisfaction was measured with the abridged Students' Life Satisfaction Scale (SLSS). Vigorous Physical Activity, self-esteem, family affluence, family relations and the perception of the school environment were considered as independent variables. Hierarchical and path models were applied. The mean SLSS score was M = 4.66 (SD = 2.23), and 36.9% of its variability was explained-mainly by self-esteem. The impact of PA on self-esteem became stronger when family affluence decreased, which led to the conclusion that material status may modify the impact of behavioural factors on the SLSS scores' variability in adolescence.

Model Selection of the Effect of Binary Exposures over the Life Course

Supplemental Digital Content is available in the text.

Epidemiologists are often interested in examining the effect on a later-life outcome of an exposure measured repeatedly over the life course. When different hypotheses for this effect are proposed by competing theories, it is important to identify those most supported by observed data as a first step toward estimating causal associations. One method is to compare goodness-of-fit of hypothesized models with a saturated model, but it is unclear how to judge the “best” out of two hypothesized models that both pass criteria for a good fit. We developed a new method using the least absolute shrinkage and selection operator to identify which of a small set of hypothesized models explains most of the observed outcome variation. We analyzed a cohort study with repeated measures of socioeconomic position (exposure) through childhood, early- and mid-adulthood, and body mass index (outcome) measured in mid-adulthood. We confirmed previous findings regarding support or lack of support for the following hypotheses: accumulation (number of times exposed), three critical periods (only exposure in childhood, early- or mid-adulthood), and social mobility (transition from low to high socioeconomic position). Simulations showed that our least absolute shrinkage and selection operator approach identified the most suitable hypothesized model with high probability in moderately sized samples, but with lower probability for hypotheses involving change in exposure or highly correlated exposures. Identifying a single, simple hypothesis that represents the specified knowledge of the life course association allows more precise definition of the causal effect of interest.

Status of cardiovascular disease and stroke in Hispanics/Latinos in the United States: a science advisory from the American Heart Association

BACKGROUND AND PURPOSE

This American Heart Association (AHA) scientific statement provides a comprehensive overview of current evidence on the burden cardiovascular disease (CVD) among Hispanics in the United States. Hispanics are the largest minority ethnic group in the United States, and their health is vital to the public health of the nation and to achieving the AHA's 2020 goals. This statement describes the CVD epidemiology and related personal beliefs and the social and health issues of US Hispanics, and it identifies potential prevention and treatment opportunities. The intended audience for this statement includes healthcare professionals, researchers, and policy makers.

METHODS

Writing group members were nominated by the AHA's Manuscript Oversight Committee and represent a broad range of expertise in relation to Hispanic individuals and CVD. The writers used a general framework outlined by the committee chair to produce a comprehensive literature review that summarizes existing evidence, indicate gaps in current knowledge, and formulate recommendations. Only English-language studies were reviewed, with PubMed/MEDLINE as our primary resource, as well as the Cochrane Library Reviews, Centers for Disease Control and Prevention, and the US Census data as secondary resources. Inductive methods and descriptive studies that focused on CVD outcomes incidence, prevalence, treatment response, and risks were included. Because of the wide scope of these topics, members of the writing committee were responsible for drafting individual sections selected by the chair of the writing committee, and the group chair assembled the complete statement. The conclusions of this statement are the views of the authors and do not necessarily represent the official view of the AHA. All members of the writing group had the opportunity to comment on the initial drafts and approved the final version of this document. The manuscript underwent extensive AHA internal peer review before consideration and approval by the AHA Science Advisory and Coordinating Committee.

RESULTS

This statement documents the status of knowledge regarding CVD among Hispanics and the sociocultural issues that impact all subgroups of Hispanics with regard to cardiovascular health. In this review, whenever possible, we identify the specific Hispanic subgroups examined to avoid generalizations. We identify specific areas for which current evidence was less robust, as well as inconsistencies and evidence gaps that inform the need for further rigorous and interdisciplinary approaches to increase our understanding of the US Hispanic population and its potential impact on the public health and cardiovascular health of the total US population. We provide recommendations specific to the 9 domains outlined by the chair to support the development of these culturally tailored and targeted approaches.

CONCLUSIONS

Healthcare professionals and researchers need to consider the impact of culture and ethnicity on health behavior and ultimately health outcomes. There is a need to tailor and develop culturally relevant strategies to engage Hispanics in cardiovascular health promotion and cultivate a larger workforce of healthcare providers, researchers, and allies with the focused goal of improving cardiovascular health and reducing CVD among the US Hispanic population.

The Hispanic Community Children's Health Study/Study of Latino Youth (SOL Youth): design, objectives, and procedures

PURPOSE

This article describes the design and methodology of the Study of Latino Youth (SOL Youth) study, a multicenter study of Hispanic/Latino children living in the United States.

METHODS

Participants are children aged 8-16 years whose parents/legal guardians participated in the Hispanic Community Health Study/Study of Latinos, a large community-based cohort study of Hispanic/Latino adults living in the United States.

RESULTS

Between 2012 and 2014, 1600 children recruited from four field centers (Bronx, Chicago, Miami, and San Diego) will undergo a 3.5-hour examination to collect biospecimens, obtain anthropometric measures, blood pressure, fitness level, dietary intake, and physical activity. Psychosocial and environmental characteristics are assessed by questionnaire. Primary study aims are to examine associations of youth's lifestyle behaviors and cardiometabolic risk factors with (1) youth's acculturation and parent-child differences in acculturation; (2) parenting strategies, family behaviors, and parental health behaviors; and (3) youth's psychosocial functioning.

CONCLUSIONS

SOL Youth will determine the prevalence and distribution of obesity-promoting lifestyle behaviors, cardiometabolic risk profiles, and novel biomarkers associated with obesity and insulin resistance. This article describes the study methodology and considers advantages and limitations of embedding a cohort of children within a well-characterized cohort of adults.