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标题：Life-Course Socioeconomic Position and Hypertension in African American Men: The Pitt County Study
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作者：Sherman A. James ; John Van Hoewyk ; Robert F. Belli 等
期刊名称：American journal of public health
印刷版ISSN：0090-0036
出版年度：2006
卷号：96
期号：5
页码：812-817
DOI：10.2105/AJPH.2005.076158
语种：English
出版社：American Public Health Association
摘要：Objectives. We investigated the odds of hypertension for Black men in relationship to their socioeconomic position (SEP) in both childhood and adulthood. Methods. On the basis of their parents’ occupation, we classified 379 men in the Pitt County (North Carolina) Study into low and high childhood SEP. The men’s own education, occupation, employment status, and home ownership status were used to classify them into low and high adulthood SEP. Four life-course SEP categories resulted: low childhood/low adulthood, low childhood/high adulthood, high childhood/low adulthood, and high childhood/high adulthood. Results. Low childhood SEP was associated with a 60% greater odds of hypertension, and low adulthood SEP was associated with a 2-fold greater odds of hypertension. Compared with men of high SEP in both childhood and adulthood, the odds of hypertension were 7 times greater for low/low SEP men, 4 times greater for low/high SEP men, and 6 times greater for high/low SEP men. Conclusions. Greater access to material resources in both childhood and adulthood was protective against premature hypertension in this cohort of Black men. Though some parameter estimates were imprecise, study findings are consistent with both pathway and cumulative burden models of hypertension. Studies documenting an association between low socioeconomic position (SEP) in childhood—or, alternatively, low SEP in both childhood and adulthood—and increased risk for morbidity and mortality from a variety of chronic diseases in adulthood are growing in number. 1 ^– 3 A recent review 4 focused specifically on life-course socioeconomic factors and risk for cardiovascular disease (CVD) concluded that studies provide moderate support for an independent contribution of low SEP in early life and increased CVD risk factors, CVD morbidity, and CVD mortality in adulthood. Though the review found little support for an independent association between CVD risk and social mobility (i.e., movement from one SEP level in childhood to another in adulthood), fairly consistent support was observed for a positive association between lifelong socioeconomic disadvantage and adverse CVD outcomes in adulthood. 4 Three major conceptual models have been advanced 5 ^, 6 to organize the literature on life-course SEP and early versus late emergence of CVD and other chronic diseases in adulthood. The first is the “latency effects” model, 5 also called the “biological chains of risk” model, 6 which posits that early-life SEP can influence adult health independent of intervening changes in SEP. The second is the “pathway” 5 or “social chains of risk” model, 6 which acknowledges the importance of early-life conditions for adult health, but stipulates that important intervening life events (like upward or downward social mobility) can alter health trajectories initiated in early childhood. Finally, the “cumulative burden” model, 5 also called the “accumulation of risk” model, 6 hypothesizes that health-damaging effects of socioeconomic deprivation in both childhood and adulthood aggregate over the life course to significantly undermine health by middle adulthood. Because of the more widespread availability of epidemiological data on childhood SEP (most commonly measured by father’s occupation) in western and northern Europe, the vast majority of studies dealing with life-course SEP and CVD have been conducted on the European continent. 3 ^, 4 The number of US-based studies is increasing, 3 ^, 4 but, to date, these studies have focused largely on White Americans. Indeed, as others 4 have noted, the paucity of research on life-course SEP and CVD risk in US racial and ethnic minorities represents a significant gap in the literature. We found only 1 study dealing with life-course SEP and CVD risk in Black Americans. This study, 7 which used data from the National Survey of Black Americans, investigated associations between self-reported hypertension and childhood SEP (father’s occupation), adulthood SEP (respondent’s education and occupation), and downward intergenerational social mobility (i.e., father’s occupation was higher than respondent’s). Although adulthood SEP was inversely associated with self-reported hypertension, no associations were observed for childhood SEP or downward social mobility. Thus, neither the latency model nor the pathway effects model was supported in this study. 7 It is not clear to what extent misclassification of respondents on childhood SEP (and, therefore, downward social mobility) or, alternatively, misclassification on hypertension status (because of reliance on self-report data) biased the findings toward the null in this study. Additional research on life-course SEP and hypertension risk in Black Americans that builds upon this initial effort 7 is clearly needed, given the well-documented excess prevalence, 8 ^– 10 seriousness, 11 ^– 13 and earlier age of onset 8 ^, 12 of hypertension in Black Americans. The earlier onset of hypertension in Black adults, relative to Whites, suggests that the origins of the excess risk for this condition among Blacks resides, at least in part, in the problematic social and material life conditions to which numerous Black Americans are exposed in childhood. 14 ^– 16 Using the 3 aforementioned conceptual models 5 ^, 6 of the relationship between life-course SEP and health in adulthood to frame the research questions, we investigated the contribution of relative socioeconomic deprivation—during childhood, adulthood, and over the life course—to risk for hypertension in a community probability sample of Black men aged 25 to 50 years.