title: Material hardship alters the diurnal rhythm of salivary cortisol.
abstract: BACKGROUND
  In the quest for biological mechanisms underlying socioeconomic differences in health outcomes, attention has turned to the role of the hypothalamic-pituitary-adrenocortical axis. As there is some evidence that both acute and chronic stress raise cortisol levels, and material hardship is a stressor, we examined the relationship of chronic material hardship with salivary cortisol levels over the day.
  
  
  METHODS
  The data are from a survey of a sample of poor women aged 18-54. Up to four repeated measures of salivary cortisol levels were obtained from 188 women in this sample and modelled as a diurnal profile. Self-reports of a variety of sources of material hardship over the preceding year were combined into a single scale. Specific dimensions of the subjects' cortisol profiles were compared across levels of material hardship.
  
  
  RESULTS
  Salivary cortisol varied over the day, and by level of reported material hardship. Upon awakening, salivary cortisol levels were comparable across hardship levels. But soon after waking, women at low levels of hardship experienced both a significantly sharper morning surge and subsequently a sharper decline in salivary cortisol (16.0 and 29.5 nmol/l/h) than women with high hardship levels (5.9 and 24.3 nmol/l/h). These differences in cortisol diurnal pattern tended to be related in a dose-response way to levels of material hardship.
  
  
  CONCLUSIONS
  Material hardship among poor women is associated with changes in the diurnal rhythms of cortisol, particularly in the waking response, which is blunted in women with high levels of hardship.
authors.affiliation: Center for Social Epidemiology & Population Health, Department of Epidemiology, School of Public Health, University of Michigan, MI, USA. nranjit@umich.edu
authors.forename: Nalini
authors.initials: N
authors.lastname: Ranjit
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Young
authors.forename: George A
authors.initials: GA
authors.lastname: Kaplan
mesh_terms: D000293:Adolescent; D000328:Adult; D002940:Circadian Rhythm / Q000502:physiology*; D005260:Female; D006297:Health Services Accessibility / Q000191:economics; D006798:Housing; D006801:Humans; D006854:Hydrocortisone / Q000032:analysis / Q000378:metabolism*; D008875:Middle Aged; D011203:Poverty; D012463:Saliva / Q000378:metabolism*; D012959:Socioeconomic Factors; D013315:Stress, Psychological / Q000378:metabolism* / Q000503:physiopathology
chemical_list: D006854:Hydrocortisone