Neighborhood, household, and individual socioeconomic position in early life and childhood cardiovascular health measures: an international cross-cohort study

  1. Kavindi Gamage
  2. Susanna Pätsi
  3. Tong Chen
  4. Kate Mooney
  5. Sylvain Sebert
  6. Naomi Priest
  7. Toby Mansell
  8. David Burgner
  9. Barwon Infant Study Investigator Group
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Abstract

Background

Cardiovascular disease (CVD) is socioeconomically patterned and risk accrues from early life. Evidence in younger populations is scarce. We investigated the extent to which early life socioeconomic position (SEP) affects cardiovascular health (CVH) in children and adolescents, and the extent of mediation by body mass index (BMI).

Methods and Results

We analysed 5 longitudinal cohorts: the Barwon Infant Study (BIS, Australia, mean age 4.1 years, n=708); Born in Bradford (United Kingdom, mean age 9.3 years, n=4576); the Longitudinal Study of Australian Children’s Child Health CheckPoint (LSAC-CP, Australia, mean 12.0 years, n=1874); the Northern Finland Birth Cohort 1986 (NFBC1986) (Finland, mean 16.0 years, n=9467); and the Avon Longitudinal Study of Parents and Children (ALSPAC, United Kingdom, mean 17.8 years, n=4875). Exposures were neighborhood disadvantage, household SEP, and maternal education (in pregnancy/at birth). Outcomes were carotid intima-media thickness, pulse wave velocity, blood pressure, and lipids (in childhood/adolescence). From 12 years, those with lower SEP had worse CVH, adjusted for age, sex, and ethnicity. For example, LSAC-CP 12-year-olds in the most disadvantaged neighborhoods had higher pulse wave velocity (β = 0.1 m/s; 95% CI, 0.03-0.2; P =0.003) than those in the most advantaged, and NFBC1986 16-year-olds whose mothers had the lowest education had higher triglycerides (β = 0.07 mmol/L; 95% CI, 0.0-0.1; P =0.04) than those whose mothers had the highest education. Hypothetical reductions in CVH differences by shifting BMI distributions varied by cohort and exposure.

Conclusions

The adverse effects of lower SEP on CVH are apparent from mid-childhood. Prevention should address intermediate mechanisms and upstream neighborhood, household, and maternal factors.

Clinical Perspective

What Is New?

  • This is the first and largest multicohort study to date to investigate the effects of multiple indicators SEP on CVH across multiple time points in childhood and adolescence, comprehensively assessed by vascular measures and lipids.

  • Effects of low SEP on adverse CVH were consistent across several high-income contexts from 12 years of age.

  • BMI was an important mediator in most relationships.

What Are the Clinical Implications?

  • The effects of socioeconomic conditions on CVH are likely established by mid-childhood.

  • Clinicians must advocate for policy efforts to provide equitable socioeconomic resources for neighborhoods, families and children.

  • Intervening on BMI may reduce socioeconomic inequalities in CVH in children and adolescents.

Article activity feed

  1. Version published to 10.1101/2025.11.16.25340203 on medRxiv