title: Multiple sources of psychosocial disadvantage and risk of coronary heart disease.
abstract: OBJECTIVE
  To examine the co-occurrence of multiple sources of psychosocial disadvantage in association with risk of incident coronary heart disease (CHD). It was hypothesized that increased co-occurring psychosocial disadvantage would be associated with increased risk of CHD in a monotonic fashion. While both social and psychological disadvantage are associated with increased risk of CHD, indicators of psychosocial disadvantage are traditionally examined individually in relationship to CHD. However, multiple sources of psychosocial disadvantage tend to co-occur.
  
  
  METHODS
  Hypotheses were examined using data from the First National Health and Nutrition Examination Survey and its follow-up studies (n = 6913). Indicators of psychosocial disadvantage (education, income, employment, single parenting, marital status, depressive and anxious symptoms) and covariates were derived from baseline interviews and incident CHD from hospital records/death certificates collected over 22 years of follow-up. Hypotheses were evaluated using Cox proportional hazards models.
  
  
  RESULTS
  Results indicated that greater co-occurrence of psychosocial disadvantage conferred increased CHD risk. Relative to no disadvantage, one indicator of psychosocial disadvantage (relative risk (RR) = 1.28; 95% confidence interval (CI) = 1.10-1.48), two to three indicators of psychosocial disadvantage (RR = 1.56; 95% CI = 1.33-1.84), and four or more indicators of psychosocial disadvantage (RR = 2.63; 95% CI = 2.01-3.44) were associated with increased risk of incident CHD. Results persisted in covariate-adjusted models. A significant interaction by gender was observed such that the co-occurrence of psychosocial risk and its association with incident CHD were stronger among women than among men.
  
  
  CONCLUSIONS
  Results indicate the importance of considering patterns of co-occurring psychosocial risk factors in relationship to CHD.
authors.affiliation: Department of Psychiatry, University of Pittsburgh School of Medicine, 3811 O'Hara Street, Pittsburgh, PA 15217, USA.
authors.forename: Rebecca C
authors.initials: RC
authors.lastname: Thurston
authors.forename: Laura D
authors.initials: LD
authors.lastname: Kubzansky
mesh_terms: D000328:Adult; D000368:Aged; D001007:Anxiety / Q000453:epidemiology; D015992:Body Mass Index; D015331:Cohort Studies; D003327:Coronary Disease / Q000453:epidemiology* / Q000523:psychology*; D003863:Depression / Q000453:epidemiology; D004522:Educational Status; D004651:Employment; D005260:Female; D006801:Humans; D007182:Income; D008297:Male; D017533:Marital Status; D008875:Middle Aged; D012307:Risk Factors; D012737:Sex Factors; D012923:Social Class; D014481:United States / Q000453:epidemiology