Neighbourhood socioeconomic deprivation and allostatic load: a multi-cohort study

Abstract

Living in deprived neighbourhoods may have biological consequences, but few studies have assessed this empirically. We examined the association between neighbourhood deprivation and allostatic load, a biological marker of wear and tear, taking into account individual’s socioeconomic position. We analysed data from three cohort studies (CoLaus-Switzerland; EPIPorto-Portugal; Whitehall II-UK) comprising 16,364 participants. We defined allostatic load using ten biomarkers of dysregulated metabolic, cardiovascular, and inflammatory systems (body mass index; waist circumference; total, high and low density lipoprotein cholesterol; triglycerides; glucose; systolic and diastolic blood pressure; C-reactive protein). Mixed Poisson regression models were fitted to examine associations with neighbourhood deprivation (in quintiles, Q1-least deprived as reference). After adjustment for confounding variables, participants living in the most deprived quintile had 1.13 times higher allostatic load than those living in the least deprived quintile (Relative Risk, RR, for Q2 RR = 1.06, 95% CI 1.03-1.09; Q3 = 1.06, 1.03–1.10; Q4 = 1.09, 1.06–1.12; Q5 = 1.13, 1.09–1.16). This association was partially modified by individual’s socioeconomic position, such that the relative risk was higher in participants with low socioeconomic position (Q5 vs Q1 1.16, 1.11–1.22) than those with high socioeconomic position (Q5 vs Q1 1.07, 1.01–1.13). Neighbourhood deprivation is associated with biological wear and tear, suggesting that neighbourhood-level interventions may yield health gains.

Decomposing the educational gradient in allostatic load across European populations. What matters the most: differentials in exposure or in susceptibility?

“…Sensitivity analyses suggest that our estimates for the DE component are sensitive to unmeasured confounding, with strength and direction of bias depending on the correlations of the unmeasured confounder with smoking/alcohol and with AL (online supplemental figure S2). Conversely, the DS component is less sensitive to unmeasured confounding: confounders with the same characteristics as neighbourhood socioeconomic deprivation 23 and age would have biased our estimates by about 1% (online supplemental figure S3).…”

“…Finally, the most salient pathway through which accumulation occurs under a DS mechanism is the metabolic one, including glucose, lipids and body weight. The social gradient in AL depends on a number of non-behavioural factors including neighbourhood deprivation, 23 social disadvantage in early life, 34 material disadvantage 13 and workplace stress and occupational toxic exposures. 35 To mitigate the disproportionate AL accumulation among people in the lower educational groups, a joint action is required to intervene both upstream on the psychosocial factors leading to AL accumulation in lower social strata ,13 23 34 35 and downstream with policies on healthy diet and physical activity specifically targeting lower social classes, in a collaborative effort across different sectors.…”

Social and spatial inequalities in allostatic load among adults in China: a multilevel longitudinal study

“…Instead, it was found that people tend to have higher AL on average and with all other things being equal if they had lower personal educational attainment, which aligns with a wealth of research showing a socioeconomic gradient in health 27. But also higher AL was found among people who lived in a county with higher mean years of education, which is the opposite to that found in other countries (eg, Portugal, Switzerland and the UK) 16. Furthermore, the difference in AL among persons with more compared with less personal educational attainment appeared to be amplified when living in counties with higher mean years of education.…”

“…In such a scenario, were that person able to move to a more affluent area, perhaps the impact of their personal socioeconomic disadvantage might be lessened (the ‘pull up/pull down’ hypothesis) 18. The aforementioned recent study16 found evidence for these hypotheses in a multicohort study wherein AL was higher among residents of socioeconomically disadvantaged areas and, especially, for those with low person-level socioeconomic circumstances.…”

“…Some studies have already documented association between allostatic load and person-level indicators of socioeconomic circumstances 15. Scant attention, until very recently,16 has been paid to investigating potential interactions between person and area-level indicators of socioeconomic circumstances on AL. On one hand, it might be hypothesised that the impact of low personal socioeconomic circumstances on the development of AL might be compounded by living in a socioeconomically disadvantaged area (the ‘deprivation amplification’ hypothesis) 17.…”