Does cytomegalovirus infection contribute to socioeconomic disparities in all-cause mortality?

Abstract

The social patterning of cytomegalovirus (CMV) and its implication in aging suggest that the virus may partially contribute to socioeconomic disparities in mortality. We used Cox regression and inverse odds ratio weighting to quantify the proportion of the association between socioeconomic status (SES) and all-cause mortality that was attributable to mediation by CMV seropositivity. Data were from the National Health and Nutrition Examination Survey (NHANES) III (1988–1994), with mortality follow-up through December 2011. SES was assessed as household income (income-to-poverty ratio ≤1.30; >1.30 to ≤1.85; >1.85 to ≤3.50; >3.50) and education (<high school; high school; >high school). We found strong associations between low SES and increased mortality: hazard ratio (HR) 1.80; 95% confidence interval (CI): 1.57, 2.06 comparing the lowest versus highest income groups and HR 1.29; 95% CI: 1.13, 1.48 comparing <high school versus >high school education. 65% of individuals were CMV seropositive, accounting for 6–15% of the SES-mortality associations. Age modified the associations between SES, CMV, and mortality, with CMV more strongly associated with mortality in older individuals. Our findings suggest that cytomegalovirus may partially contribute to persistent socioeconomic disparities in mortality, particularly among older individuals.

Cytomegalovirus (CMV) in cervical cancer screening tests: A series of 8 cases and review of the literature

“…One patient was pregnant, correlating with prior reports of CMV infection detected proximal to pregnancy . Four cases in our series had immune‐affecting conditions, such as tuberculosis exposure, diabetes and/or obesity . Nine papers reported detection of CMV in patient with competent immune systems, which was represented in three of our cases.…”

How does cytomegalovirus factor into diseases of aging and vaccine responses, and by what mechanisms?

“…More recently, using data from the Sacramento Area Latino study of Aging, Meier et al found that early-life socioeconomic status influences adult probability of CMV infection and that this association was mediated by measures of midlife socioeconomic status (Meier et al 2016). In addition, using data from NHANES, Feinstein et al observed that socioeconomic disparities in all-cause mortality in the US were associated with CMV infection and that this pathway was strongest among older individuals (Feinstein et al 2016). Further support for a role for CMV in socioeconomic differentials in immunity was demonstrated in a study by Aiello et al, where CMV was found to be a significant mediator of the impact of income on T cell markers of aging .…”

Correspondence Between Cytomegalovirus Immunoglobulin-G Levels Measured in Saliva and Serum

“…Geographic, socioeconomic (SES), and racial/ethnic disparities in HCMV infection rates and prevalence worldwide are well documented with low SES and racial/ethnic minority groups disproportionately affected ( 21 – 23 ). The marked sociodemographic disparities in HCMV infections parallel disparities in the rates of exposure to adversity, and HCMV’s stress-linked mechanism for viral shedding and reactivation, raises the possibility that monitoring HCMV antibody levels could benefit public health efforts to prevent and mitigate downstream risks associated with infection ( 24 ). Serum HCMV immunoglobulin-G (IgG) tests are currently used in clinical settings ( 25 ).…”