Socioeconomic Position, Race/Ethnicity, and Inflammation in the Multi-Ethnic Study of Atherosclerosis

Abstract

Background-Low socioeconomic position is known to be associated with cardiovascular events and atherosclerosis.Reasons for these associations remain a topic of research. Inflammation could be an important mediating mechanism linking socioeconomic position to cardiovascular risk. Methods and Results-This cross-sectional study used data from the baseline examination of the Multi-Ethnic Study of Atherosclerosis (MESA), a study of 6814 men and women 45 to 84 years of age. Race-and ethnicity-stratified regression analyses were used to estimate associations of household income and education with C-reactive protein and interleukin-6 before and after adjustment for infection and medication use, psychosocial factors, behaviors, adiposity, and diabetes mellitus. Low income was associated with higher concentrations of interleukin-6 in all race/ethnic groups. Percent differences associated with 1-SD-lower income were 9% (95% confidence interval [CI], 7 to 11), 6% (95% CI, 1 to 10), 8% (95% CI, 4 to 11), and 8% (95% CI, 3 to 13) for whites, Chinese, blacks, and Hispanics. Low levels of education were associated with higher levels of interleukin-6 only among whites and blacks (percent difference in interleukin-6 associated with 1-SD-lower education: 9% [95% CI, 6 to 12] among Whites, and 7% [95% CI, 3 to 10] among blacks). Similar patterns were observed for C-reactive protein. Adiposity was the single most important factor explaining socioeconomic position associations, especially among blacks and whites. A smaller effect was seen for psychosocial factors and behaviors in all race groups. Conclusions-Both household income and education are associated with inflammation, but associations vary across race/ethnic groups. Associations likely result from socioeconomic position patterning of adiposity and other factors.

Ethnic Differences in C-Reactive Protein Concentrations

“…We confirmed this finding within the SWAN cohort, where we found educational level to be the most informative SES predictor of CRP concentrations. The impact of ethnicity and SES on CRP concentrations was also examined in the MESA cohort (35 ), where educational level was found to be a strong predictor of CRP. Yet in MESA, further examination in multivariate models found that the relationship between CRP and SES persisted only in whites, with substantial confounding by metabolic factors, adiposity, and behaviors.…”

Demographic Differences in Systemic Inflammatory Response Syndrome Score After Trauma

“…Critical care research 16,17 (nonspecific to trauma) has shown that African Americans and persons of low socioeconomic status have nearly twice the rates of sepsis, organ dysfunction, and sepsis-related mortality as do whites. Low socioeconomic status has been associated with high levels of baseline inflammation, 18 a finding related to early organ dysfunction. 19,20 Few data on these outcomes specific to trauma are available.…”

Information about secondary prevention in coronary patients: a comparison between Italian and Brazilian Application of MICRO-Q Questionnaire

“…Much of this socioeconomic status relationship can be attributed to CVD and the combined effects of disparities in health-related behaviours, environmental conditions, social structures, and the contact and delivery of health care. Because these factors change in developed and developing countries and because they are modifiable, it is important to compare countries to find ways to reach people with different ways of life [21][22][23][24].…”