Association of childhood socioeconomic status with subsequent coronary heart disease in physicians.
BACKGROUND
Adult socioeconomic status (SES) is an independent risk factor for the development of coronary heart disease (CHD), but whether low childhood SES has an effect in adults who have achieved high SES is unknown.


METHODS
We examined the risk of CHD and mortality associated with low childhood SES in 1131 male medical students from The Johns Hopkins Precursors Study, a prospective cohort of graduates of The Johns Hopkins University School of Medicine from 1948 to 1964 with a median follow-up of 40 years.


RESULTS
Of 1131 subjects, 216 (19.1%) were from low-SES families. Medical students from low-SES families were slightly older at graduation (26.8 vs 26.2 years; P = .004) and gained more weight over time (P = .01). Low childhood SES conferred a 2.40-fold increased hazard of developing CHD on or before age 50 years (95% confidence interval, 1.21-4.74) but not at older ages. The impact of low SES on early CHD was not reduced by adjusting for other CHD risk factors, including body mass index, cholesterol level, amount of exercise, depression, coffee drinking, smoking, hypertension, diabetes mellitus, and parental CHD history. Low childhood SES did not confer an increased risk of all-cause mortality.


CONCLUSIONS
Low childhood SES is associated with an increased incidence of CHD before age 50 years among men with high adulthood SES. This risk is not mediated by traditional risk factors for CHD. These findings highlight the importance of childhood events on the development of CHD early in adulthood and the persistent effects of low SES.
Kittleson
Michelle M
MM
Divisions of Cardiology, Department of Medicine, The Johns Hopkins School of Medicine, Baltimore, MD 21205, USA. mkittleson@mednet.ucla.edu
Meoni
Lucy A
LA
Wang
Nae-Yuh
NY
Chu
Audrey Y
AY
Ford
Daniel E
DE
Klag
Michael J
MJ
D000328:Adult; D000368:Aged; D002648:Child; D015331:Cohort Studies; D003327:Coronary Disease / Q000453:epidemiology* / Q000209:etiology / Q000401:mortality; D006801:Humans; D008297:Male; D008396:Maryland / Q000453:epidemiology; D008875:Middle Aged; D010820:Physicians / Q000706:statistics & numerical data*; D011203:Poverty; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012923:Social Class