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      Association between life-course socioeconomic position and inflammatory biomarkers in older age: a nationally representative cohort study in Taiwan

      research-article
      1 , 3 , 2 , 3 ,
      BMC Geriatrics
      BioMed Central
      Life-course, Socioeconomic position, Inflammation

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          Abstract

          Background

          Evidence of an association between low socioeconomic position (SEP) and inflammatory markers is scant. This study aimed to examine how life-course SEP predicted C-reactive protein (CRP) and interleukin (IL-6) in older age from a national cohort.

          Methods

          We collected data from 1036 participants in the Social Environment and Biomarkers of Aging Study in Taiwan. Four SEP time points, childhood, young adulthood, active professional life, and older age were measured retrospectively. A group-based trajectory analysis method was used to identify the distinct trajectories of life-course SEP, and trajectory group membership was used as the predictor of CRP and IL-6 levels in older age.

          Results

          Three trajectories of life-course SEP were identified within the total sample: Low-Low (36.5%), Low-High (26.8%), and High-High (36.7%). Participants in the High-High group had the lowest levels of CRP and IL-6. Compared with those in the Low-Low group, the participants in the Low-High group had a similar adjusted CRP [−0.032 ln mg/L; 95% confidence interval (CI) − 0.193, 0.128] and IL-6 (0.017 ln pg/mL; 95% CI −0.093, 0.128); the participants in the High-High group had a significantly lower level of adjusted CRP concentration (−0.279 ln mg/L; 95% CI: −0.434, −0.125) and similarly lower IL-6 concentration (−0.129 ln pg/mL; 95% CI −0.236, −0.023) .

          Conclusions

          Life-course SEP is related to the level of CRP and IL-6 in older age. Our data support the notion that life-course SEP predicts inflammatory markers in older age. Low SEP in childhood is related to elevated inflammatory markers in older age. Even after the transition from low SEP in childhood to high SEP in older age, the risk remains. Further study on SEP and inflammation-related disease is warranted.

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          Most cited references25

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          Analyzing developmental trajectories of distinct but related behaviors: a group-based method.

          This article presents a group-based method to jointly estimate developmental trajectories of 2 distinct but theoretically related measurement series. The method will aid the analysis of comorbidity and heterotypic continuity. Three key outputs of the model are (a) for both measurement series, the form of the trajectory of distinctive subpopulations; (b) the probability of membership in each such trajectory group; and (c) the joint probability of membership in trajectory groups across behaviors. This final output offers 2 novel features. First, the joint probabilities can characterize the linkage in the developmental course of distinct but related behaviors. Second, the joint probabilities can measure differences within the population in the magnitude of this linkage. Two examples are presented to illustrate the application of the method.
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            Can we disentangle life course processes of accumulation, critical period and social mobility? An analysis of disadvantaged socio-economic positions and myocardial infarction in the Stockholm Heart Epidemiology Program.

            The accumulation hypothesis would propose that the longer the duration of exposure to disadvantaged socio-economic position, the greater the risk of myocardial infarction. However there may be a danger of confounding between accumulation and possibly more complex combinations of critical periods of exposure and social mobility. The objective of this paper is to investigate the possibility of distinguishing between these alternatives. We used a population based case-control study (Stockholm Heart Epidemiology Programme) of all incident first events of myocardial infarction among men and women, living in the Stockholm region 1992-94. The analyses were restricted to men 53-70 years, 511 cases and 716 controls. From a full occupational history each subject was categorized as manual worker or non-manual at three stages of the life course, childhood (from parent's occupation), at the ages 25-29 and 51-55, resulting in 8 possible socio-economic trajectories. We found a graded response to the accumulation of disadvantaged socio-economic positions over the life course. However, we also found evidence for effects of critical periods and of social mobility. A conceptual analysis showed that there are, for theoretical reasons, only a limited number of trajectories available, too small to form distinct empirical categories of each hypothesis. The empirical task of disentangling the life course hypotheses of critical period, social mobility and accumulation is therefore comparable to the problem of separating age, period, and cohort effects. Accordingly, the interpretation must depend on prior knowledge of more specific causal mechanisms.
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              Psychosocial and behavioral predictors of inflammation in middle-aged and older adults: the Chicago health, aging, and social relations study.

              C-reactive protein (CRP) is emerging as an important predictor of cardiovascular disease (CVD), and chronic inflammation may be a mechanism through which stress affects disease risk. We investigated the contribution of behavioral and psychosocial factors to variation in CRP concentrations in a population-based sample of middle-aged and older adults. A high sensitivity enzyme-linked immunosorbent assay (ELISA) validated for use with dried blood spot samples was used to determine CRP concentrations in a representative sample of 188 52- to 70-year-olds. Demographic (gender, ethnicity, socioeconomic status), anthropometric (height, weight, waist circumference, percent body fat), behavioral (alcohol consumption, smoking, sleep quality, dietary quality), and psychosocial data (perceived stress, chronic stress, depressive symptoms, loneliness, perceived social support) were collected on the same day as blood samples. Psychosocial variables collected the year before were also used to investigate the impact of changing psychosocial environments. Log-transformed CRP concentrations were examined in a series of nested multivariate regression models. African American and female participants were found to have higher CRP concentrations, as did individuals with lower levels of education. However, ethnic differences disappeared after the addition of behavioral and psychosocial variables. Waist circumference, latency to sleep, smoking, and perceived stress were independently associated with increased concentrations of CRP. Psychosocial stress, as well as health behaviors, are important predictors of inflammatory activity in a population-based sample and should be considered in future research on inflammation and CVD.
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                Author and article information

                Contributors
                yuhsuanl@hpa.gov.tw
                minhuajen@gmail.com
                886-2-33668017 , klchien@ntu.edu.tw
                Journal
                BMC Geriatr
                BMC Geriatr
                BMC Geriatrics
                BioMed Central (London )
                1471-2318
                2 September 2017
                2 September 2017
                2017
                : 17
                : 201
                Affiliations
                [1 ]GRID grid.454740.6, Health Promotion Administration, Ministry of Health and Welfare, ; Taipei, Taiwan
                [2 ]GRID grid.418786.4, Eli Lilly and the company, ; Surrey, UK
                [3 ]ISNI 0000 0004 0546 0241, GRID grid.19188.39, Institute of Epidemiology and Preventive Medicine, College of Public Health, , National Taiwan University, ; Mailing address: Rm. 517, 5F., No. 17, Xuzhou Rd., Zhongzheng Dist, Taipei City, 100 Taiwan
                Author information
                http://orcid.org/0000-0003-4979-8351
                Article
                598
                10.1186/s12877-017-0598-x
                5581430
                28865434
                e46bbfbf-59be-4ca7-8823-ca344064801d
                © The Author(s). 2017

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 19 January 2016
                : 24 August 2017
                Funding
                Funded by: US National Institute on Aging, National Institutes of Health
                Award ID: R01AG16790 and R01AG16661
                Funded by: Taiwan Bureau of Health Promotion, Department of Health
                Award ID: government budget, no award number available
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2017

                Geriatric medicine
                life-course,socioeconomic position,inflammation
                Geriatric medicine
                life-course, socioeconomic position, inflammation

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