Neighborhood, household, and individual socioeconomic position in early life and childhood cardiovascular health measures: an international cross-cohort study

Structured AbstractO_ST_ABSBackgroundC_ST_ABSCardiovascular disease (CVD) is socioeconomically patterned and risk accrues from early life. Evidence in younger populations is scarce. We investigated the extent to which early life socioeconomic position (SEP) affects cardiovascular health (CVH) in children and adolescents, and the extent of mediation by body mass index (BMI). Methods and ResultsWe analysed 5 longitudinal cohorts: the Barwon Infant Study (BIS, Australia, mean age 4.1 years, n=708); Born in Bradford (United Kingdom, mean age 9.3 years, n=4576); the Longitudinal Study of Australian Childrens Child Health CheckPoint (LSAC-CP, Australia, mean 12.0 years, n=1874); the Northern Finland Birth Cohort 1986 (NFBC1986) (Finland, mean 16.0 years, n=9467); and the Avon Longitudinal Study of Parents and Children (ALSPAC, United Kingdom, mean 17.8 years, n=4875). Exposures were neighborhood disadvantage, household SEP, and maternal education (in pregnancy/at birth). Outcomes were carotid intima-media thickness, pulse wave velocity, blood pressure, and lipids (in childhood/adolescence). From 12 years, those with lower SEP had worse CVH, adjusted for age, sex, and ethnicity. For example, LSAC-CP 12-year-olds in the most disadvantaged neighborhoods had higher pulse wave velocity ({beta} = 0.1 m/s; 95% CI, 0.03-0.2; P=0.003) than those in the most advantaged, and NFBC1986 16-year-olds whose mothers had the lowest education had higher triglycerides ({beta} = 0.07 mmol/L; 95% CI, 0.0-0.1; P=0.04) than those whose mothers had the highest education. Hypothetical reductions in CVH differences by shifting BMI distributions varied by cohort and exposure. ConclusionsThe adverse effects of lower SEP on CVH are apparent from mid-childhood. Prevention should address intermediate mechanisms and upstream neighborhood, household, and maternal factors. Clinical PerspectiveO_ST_ABSWhat Is New?C_ST_ABSO_LIThis is the first and largest multicohort study to date to investigate the effects of multiple indicators SEP on CVH across multiple time points in childhood and adolescence, comprehensively assessed by vascular measures and lipids. C_LIO_LIEffects of low SEP on adverse CVH were consistent across several high-income contexts from 12 years of age. C_LIO_LIBMI was an important mediator in most relationships. C_LI What Are the Clinical Implications?O_LIThe effects of socioeconomic conditions on CVH are likely established by mid-childhood. C_LIO_LIClinicians must advocate for policy efforts to provide equitable socioeconomic resources for neighborhoods, families and children. C_LIO_LIIntervening on BMI may reduce socioeconomic inequalities in CVH in children and adolescents. C_LI