Cardiovascular inflammation in healthy women: multilevel associations with state-level prosperity, productivity and income inequality

BMC Public Health

Lisa F Berkman⁴  Julie E Buring¹  Brent Coull⁵  Carrie E Huisingh²  Mark J Ommerborn²  Paul M Ridker³  Cheryl R Clark² 

[1] Division of Preventive Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA;Center for Community Health and Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA;Division of Cardiovascular Diseases, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA;Department of Society, Human Development and Health, Harvard School of Public Health, Boston, Massachusetts, USA;Department of Biostatistics, Harvard School of Public Health, Boston, Massachusetts, USA

关键词: Women's health;    Socioeconomic factors;    Poverty;    Multilevel analysis;    Inflammation;    Income;    Geography;    C-reactive protein;   

Others  :  1163764
DOI  :  10.1186/1471-2458-12-211

 received in 2011-11-02, accepted in 2012-03-20,  发布年份 2012

【 摘 要 】

Background

Cardiovascular inflammation is a key contributor to the development of atherosclerosis and the prediction of cardiovascular events among healthy women. An emerging literature suggests biomarkers of inflammation vary by geography of residence at the state-level, and are associated with individual-level socioeconomic status. Associations between cardiovascular inflammation and state-level socioeconomic conditions have not been evaluated. The study objective is to estimate whether there are independent associations between state-level socioeconomic conditions and individual-level biomarkers of inflammation, in excess of individual-level income and clinical covariates among healthy women.

Methods

The authors examined cross-sectional multilevel associations among state-level socioeconomic conditions, individual-level income, and biomarkers of inflammation among women (n = 26,029) in the Women's Health Study, a nation-wide cohort of healthy women free of cardiovascular diseases at enrollment. High sensitivity C-reactive protein (hsCRP), soluble intercellular adhesion molecule-1 (sICAM-1) and fibrinogen were measured between 1993 and 1996. Biomarker levels were examined among women within quartiles of state-level socioeconomic conditions and within categories of individual-level income.

Results

The authors found that favorable state-level socioeconomic conditions were correlated with lower hsCRP, in excess of individual-level income (e.g. state-level real per capital gross domestic product fixed effect standardized Βeta coefficient [Std B] -0.03, 95% CI -0.05, -0.004). Individual-level income was more closely associated with sICAM-1 (Std B -0.04, 95% CI -0.06, -0.03) and fibrinogen (Std B -0.05, 95% CI -0.06, -0.03) than state-level conditions.

Conclusions

We found associations between state-level socioeconomic conditions and hsCRP among healthy women. Personal household income was more closely associated with sICAM-1 and fibrinogen than state-level socioeconomic conditions. Additional research should examine these associations in other cohorts, and investigate what more-advantaged states do differently than less-advantaged states that may influence levels of cardiovascular inflammation among healthy women.

【 授权许可】

   
2012 Clark et al; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

Figure 3.

【 参考文献 】

• [1]Hansson GK: Inflammation, atherosclerosis, and coronary artery disease. N Engl J Med 2005, 352:1685-1695.
• [2]Ross R: Atherosclerosis is an inflammatory disease. Am Heart J 1999, 138:S419-S420.
• [3]Jenny NS, Arnold AM, Kuller LH, Sharrett AR, Fried LP, Psaty BM, et al.: Soluble intracellular adhesion molecule-1 is associated with cardiovascular disease risk and mortality in older adults. J Thromb Haemost 2006, 4:107-113.
• [4]Ridker PM, Hennekens CH, Buring JE, Rifai N: C-reactive protein and other markers of inflammation in the prediction of cardiovascular disease in women. N Engl J Med 2000, 342:836-843.
• [5]Abramson JL, Vaccarino V: Relationship between physical activity and inflammation among apparently healthy middle-aged and older US adults. Arch Intern Med 2002, 162:1286-1292.
• [6]Ambrose JA, Barua RS: The pathophysiology of cigarette smoking and cardiovascular disease: an update. J Am Coll Cardiol 2004, 43:1731-1737.
• [7]Ndumele CE, Pradhan AD, Ridker PM: Interrelationships between inflammation, C-reactive protein, and insulin resistance. J Cardiometab Syndr 2006, 1:190-196.
• [8]Albert MA, Glynn RJ, Buring J, Ridker PM: Impact of traditional and novel risk factors on the relationship between socioeconomic status and incident cardiovascular events. Circulation 2006, 114:2619-2626.
• [9]Nazmi A, Diez Roux A, Ranjit N, Seeman TE, Jenny NS: Cross-sectional and longitudinal associations of neighborhood characteristics with inflammatory markers: Findings from the multi-ethnic study of atherosclerosis. Health Place 2010, 16:1104-1112.
• [10]Putnam S, Galea S: Epidemiology and the macrosocial determinants of health. J Public Health Pol 2008, 29:275-289.
• [11]Barker LE, Kirtland KA, Gregg EW, Geiss LS, Thompson TJ: Geographic distribution of diagnosed diabetes in the US: A diabetes belt. Am J Prev Med 2011, 40:434-439.
• [12]Cushman M, McClure LA, Howard VJ, Jenny NS, Lakoski SG, Howard G: Implications of increased C-reactive protein for cardiovascular risk stratification in black and white men and women in the US. Clin Chem 2009, 55:1627-1636.
• [13]Ezzati M, Oza S, Danaei G, Murray CJL: Trends and cardiovascular mortality effects of state-level blood pressure and uncontrolled hypertension in the United States. Circulation 2008, 117:905-914.
• [14]Gregg EW, Kirtland KA, Cadwell BL, Burrows NR, Barker LE, Thompson TJ, et al.: Estimated county-level prevalence of diabetes and obesity--United States, 2007. MMWR Weekly 2009, 58:1259-1263.
• [15]Clark CR, Coull B, Berkman LF, Buring JE, Ridker PM: Geographic Variation in Cardiovascular Inflammation among Healthy Women in the Women's Health Study. PloS one 2011, 6:e27468.
• [16]Diez-Roux AV, Link BG, Northridge ME: A multilevel analysis of income inequality and cardiovascular disease risk factors. Soc Sci Med 2000, 50:673-687.
• [17]Cook NR, Lee IM, Gaziano JM, Gordon D, Ridker PM, Manson JE, et al.: Low-dose aspirin in the primary prevention of cancer: the Women's Health Study: a randomized controlled trial. JAMA 2005, 294:47-55.
• [18]Ridker PM, Cook NR, Lee IM, Gordon D, Gaziano JM, Manson JAE, et al.: A randomized trial of low-dose aspirin in the primary prevention of cardiovascular disease in women. N Engl J Med 2005, 352:1293-1304.
• [19]Rexrode KM, Lee IM, Cook NR, Hennekens CH, Buring JE: Baseline characteristics of participants in the Women's Health Study. J Womens Health Gend Based Med 2000, 9:19-27.
• [20]Ridker PM, Rifai N, Rose L, Buring JE, Cook NR: Comparison of C-reactive protein and low-density lipoprotein cholesterol levels in the prediction of first cardiovascular events. N Engl J Med 2002, 347:1557-1565.
• [21]Rubin DB: Multiple imputation after 18+ years. J Am Stat Assoc 1996, 91:473-489.
• [22]Gutierrez CM, Landefeld JS, Marcuss RD: Gross domestic product by state estimation methodology. [http://www.bea.gov/regional/pdf/gsp/GDPState.pdf] webcite 2006. Accessed May 13, 2011
• [23]Landefeld JS, Seskin EP, Fraumeni BM: Taking the pulse of the economy: Measuring GDP. J Econ Perspect 2008, 22:193-216.
• [24]US Census Bureau: 1990 Census of population and housing, summary file 3. [http://factfinder.census.gov/home/saff/main.html?_lang=en] webcite 1992. Accessed April 22, 2011
• [25]Morrison Institute for Public Policy, Arizona State University: Earnings per employee. [http://arizonaindicators.org/content/earnings-employee] webcite 2011. Accessed May 17, 2011
• [26]Bureau of Economic Analysis: Table CA4 - Personal income and employment summary. [http://www.bea.gov/regional/reis/default.cfm?selTable=CA04] webcite 2011. Accessed April 22, 2011
• [27]Bureau of Economic Analysis: State personal income and employment methodology. [http://www.bea.gov/regional/pdf/spi2009/Complete_Methodology.pdf] webcite 2010. Accessed April 25, 2011
• [28]Rex T: Economy- an expert's insight on the issue in Arizona. [http:/ / arizonaindicators.org/ sites/ default/ files/ content/ publications/ IndicatorInsight-vol2-issue1.pdf] webcite 2010. Accessed April 22, 2011
• [29]The PEW Center on the States: Per employee earnings, 1990. [http:/ / www.pewcenteronthestates.org/ ttw/ trends_map_data_table.aspx?trendID= 9&assessmentID=98&year=1990] webcite 2011. Accessed May 17, 2011
• [30]US Census Bureau: Table S4. Gini ratios by state: 1969, 1979, 1989, 1999. [http://www.census.gov/hhes/www/income/data/historical/state/state4.html] webcite 2011. Accessed April 22, 2011
• [31]D'Agostino RB: Tutorial in biostatistics propensity score methods for bias reduction in the comparison of a treatment to a non-randomized control group. Statistics in medicine 1998, 2281:2265-2281.
• [32]Backlund E, Rowe G, Lynch J, Wolfson MC, Kaplan GA, Sorlie PD: Income inequality and mortality: a multilevel prospective study of 521 248 individuals in 50 US states. Int J Epidemiol 2007, 36:590-596.
• [33]Kennedy BP, Kawachi I, Glass R, Prothrow-Stith D: Income distribution, socioeconomic status, and self rated health in the United States: multilevel analysis. BMJ 1998, 317:917-921.
• [34]Kondo N, Sembajwe G, Kawachi I, van Dam RM, Subramanian SV, Yamagata Z: Income inequality, mortality, and self rated health: meta-analysis of multilevel studies. BMJ 2009, 339:b4471.
• [35]Lochner K, Pamuk E, Makuc D, Kennedy BP, Kawachi I: State-level income inequality and individual mortality risk: a prospective, multilevel study. Am J Public Health 2001, 91:385-391.
• [36]Shi L, Starfield B: Primary care, income inequality, and self-rated health in the United States: a mixed-level analysis. Int J Health Serv 2000, 30:541-556.
• [37]Daniel M, Moore S, Kestens Y: Framing the biosocial pathways underlying associations between place and cardiometabolic disease. Health Place 2008, 14:117-132.
• [38]Nordstrom CK, Diez Roux AV, Jackson SA, Gardin JM: The association of personal and neighborhood socioeconomic indicators with subclinical cardiovascular disease in an elderly cohort. The cardiovascular health study. Soc Sci Med 2004, 59:2139-2147.
• [39]Dietz WH, Benken DE, Hunter AS: Public health law and the prevention and control of obesity. Milbank Quarterly 2009, 87:215-227.
• [40]Mays GP, Smith SA: Geographic variation in public health spending: correlates and consequences. Health Serv Res 2009, 44:1796-1817.
• [41]Weissman JS, Witzburg R, Linov P, Campbell EG: Termination from Medicaid: how does it affect access, continuity of care, and willingness to purchase insurance? J Health Care Poor Underserved 1999, 10:122-137.
• [42]Osypuk TL, Acevedo-Garcia D: Beyond individual neighborhoods: A geography of opportunity perspective for understanding racial/ethnic health disparities. Health Place 2010, 16:1113-1123.
• [43]Pollitt RA, Kaufman JS, Rose KM, Diez-Roux AV, Zeng D, Heiss G: Early-life and adult socioeconomic status and inflammatory risk markers in adulthood. Eur J Epidemiol 2007, 22:55-66.
• [44]Dow WH, Rehkopf DH: Socioeconomic gradients in health in international and historical context. Ann NY Acad Sci 2010, 1186:24-36.