In this revision to application 1 R01 HL-64141-01 submitted in response to Program Announcement number 98-098, we propose to identify mechanisms explanatory of the strong inverse association between socioeconomic status (SES) over the life course and cardiovascular disease morbidity and mortality, in a bi-ethnic population-based sample of four U.S. communities. Cumulative and contemporaneous effects of diverse SES measures will be tested for their predictive validity on health outcomes, with consideration of differences by gender and ethnicity in their (additive or interactive) effects. Health outcomes will include non-invasively measured subclinical cardiovascular disease, as well as fatal and non-fatal clinical disease manifestations ascertained over the course of 10 years of follow-up. Earlier life course socioeconomic status and measurements of current socioeconomic status and biomedical cardiovascular risk factors will be integrated with geocoded contemporary social environmental exposures to assess their impact on cardiovascular function, metabolic impairments, allostatic load, and subclinical and clinical disease. Multilevel analyses will be performed with the goal of identifying pathways by which socioeconomic status is related to cardiovascular disease, considering relevant health behavior, life styles, psychosocial stressors/support mechanisms, chronic infection/chronic inflammatory burden, autonomic nervous system dysfunction, and sustained metabolic impairments. The potential modification of the above associations by the social environment will be addressed by these analyses, as well as putative differences by gender and ethnicity. These staged analytic goals are made possible by linking Census-based indicators of the social environment to the rich data resources of the Atherosclerosis Risk in Communities (ARIC) Study, a bi-ethnic, community-based sample of men and women aged 45-64 years at the time of their baseline examination in 1987-1989. This cohort was re-examined every three years through January, 1999 with ascertainment of SES during childhood, early adulthood and in mid-life, health-relevant behaviors, numerous measurements of risk factors, and measures of subclinical cardiovascular disease such as carotid artery wall thickness, arterial distensibility, retinopathy, and lower extremity arterial disease. These data, as well as validated information on hospital discharge diagnoses and on cause-specific mortality accrued over 10 years of follow-up will be made available to the study proposed in this application. Additional life course information on the members of the ARIC cohort will be collected during Year 1 of the study. Our goal is to explicate the associations and interactive effects of individual SES attributes and their social context on pathways of development of cardiovascular disease in individuals and populations. Increased insight into the mechanisms responsible for these associations should strengthen the basis for public health preventive measures.

Agency
National Institute of Health (NIH)
Institute
National Heart, Lung, and Blood Institute (NHLBI)
Type
Research Project (R01)
Project #
5R01HL064142-02
Application #
6530730
Study Section
Epidemiology and Disease Control Subcommittee 2 (EDC)
Program Officer
Nelson, Cheryl R
Project Start
2001-03-01
Project End
2005-02-28
Budget Start
2002-03-01
Budget End
2003-02-28
Support Year
2
Fiscal Year
2002
Total Cost
$363,547
Indirect Cost
Name
University of North Carolina Chapel Hill
Department
Public Health & Prev Medicine
Type
Schools of Public Health
DUNS #
078861598
City
Chapel Hill
State
NC
Country
United States
Zip Code
27599
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Williams, Janice E; Johnson, Anna M; Heiss, Gerardo et al. (2010) Association between exposure to combat-related stress and psychological health in aging men: the Atherosclerosis Risk in Communities (ARIC) Study. J Trauma Stress 23:358-66
Johnson, Anna M; Rose, Kathryn M; Elder Jr, Glen H et al. (2010) Military combat and burden of subclinical atherosclerosis in middle aged men: the ARIC study. Prev Med 50:277-81
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Rose, Kathryn M; Perhac, J Stephen; Bang, Heejung et al. (2008) Historical records as a source of information for childhood socioeconomic status: results from a pilot study of decedents. Ann Epidemiol 18:357-63
Chichlowska, Kristal L; Rose, Kathryn M; Diez-Roux, Ana V et al. (2008) Individual and neighborhood socioeconomic status characteristics and prevalence of metabolic syndrome: the Atherosclerosis Risk in Communities (ARIC) Study. Psychosom Med 70:986-92
Carson, April P; Rose, Kathryn M; Catellier, Diane J et al. (2007) Cumulative socioeconomic status across the life course and subclinical atherosclerosis. Ann Epidemiol 17:296-303
Bidulescu, Aurelian; Rose, Kathryn M; Wolf, Susanne H et al. (2007) Occupation recorded on certificates of death compared with self-report: the Atherosclerosis Risk in Communities (ARIC) Study. BMC Public Health 7:229
Borrell, Luisa N; Beck, James D; Heiss, Gerardo (2006) Socioeconomic disadvantage and periodontal disease: the Dental Atherosclerosis Risk in Communities study. Am J Public Health 96:332-9
Ranjit, Nalini; Diez-Roux, Ana V; Chambless, Lloyd et al. (2006) Socioeconomic differences in progression of carotid intima-media thickness in the Atherosclerosis Risk in Communities study. Arterioscler Thromb Vasc Biol 26:411-6

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