The proposed research will take advantage of data that were collected as a part of the Coronary Artery Risk Development in Young Adults Study (CARDIA), a longitudinal investigation of cardiovascular disease (CVD) risk factors in an adult community sample, to examine potential explanations for socioeconomic disparities in CVD. A major focus is to understand how changes in socioeconomic status (SES) over the lifecourse influence future CVD risk, and the extent to which the association between SES change and CVD risk is moderated by race/ethnicity and gender. Specifically, emphasis is placed on the possibility that psychosocial factors related to SES may influence future subclinical atherosclerotic burden by modulating processes thought to be related to CVD pathogenesis (blood pressure [BP] and chronic low grade inflammation and oxidative stress) via regulation of adrenal hormone activity. Emphasis also is placed on the possibility that changes in SES over the lifecourse may be paralleled by changes in health behaviors and that the evolution of health behaviors over time might explain the association of SES with CVD risk factors. We take two different approaches to the analysis of lifecourse SES: we examine (a) trajectories of change in SES during young and middle adulthood;and (b) a total lifecourse model that incorporates measures of childhood SES. We also examine whether perceived social standing is associated with CVD risk factors, and whether this association explains the link between objective SES and CVD risk.
The proposed research will make a unique contribution to the study of SES disparities in CVD risk by employing a lifecourse approach that incorporates (a) analysis of change in SES trajectories across young and middle adulthood, (b) measures of childhood as well as adult SES, and (c) examination of whether the influence of SES factors on CVD risk differs according to race/ethnicity and gender. There are several reasons to take a lifecourse approach to the examination of SES disparities in CVD risk. First of all, being able to identify when during the lifecourse SES begins to influence CVD risk, and how the effects of early status combine with those of adult status to further influence risk will enhance our understanding of SES disparities in CVD. Second, revealing an association of lifecourse SES with subclinical atherosclerosis could have important clinical implications insofar as it would allow for identification and tracking of individuals who may be at elevated risk for clinical CVD at early points in the course of the disease that may be more responsive to early preventive treatment. Finally, revealing an association of lifecourse SES with biological and behavioral factors known to contribute to CVD pathogenesis will provide us with additional insight into mechanisms whereby relative socioeconomic disadvantage can be translated into cardiovascular pathology. Obtaining a fuller understanding of when and how socioeconomic factors influence CVD risk, and whether the nature and strength of this influence differs between Blacks and Whites and men and women, can have important implications for public health insofar as it will enable the development of targeted preventive strategies that ultimately can lessen the burden of CVD across the socioeconomic hierarchy.
