title: Childhood Psychosocial Adversity and Adult Neighborhood Disadvantage as Predictors of Cardiovascular Disease: A Cohort Study.
abstract: BACKGROUND
  Childhood adverse psychosocial factors (eg, parental divorce, long-term financial difficulties) and adult neighborhood disadvantage have both been linked to increased cardiovascular disease (CVD). However, their combined effects on disease risk are not known.
  
  
  RESULTS
  Participants were 37 699 adults from the Finnish Public Sector study whose data were linked to a national neighborhood disadvantage grid with the use of residential addresses between the years 2000 and 2008 and who responded to a survey on childhood psychosocial adversities and adult CVD risk behaviors in 2008 to 2009. Survey data were also linked to national registers on hospitalization, mortality, and prescriptions to assess CVD risk factors in 2008 to 2009 and to ascertain incident CVD (coronary heart disease or cerebrovascular disease) between the survey and the end of December 2011 (mean follow-up, 2.94 years; SD=0.44 years). Combined exposure to high childhood adversity and high adult disadvantage was associated with CVD risk factors (hypertension, dyslipidemia, diabetes mellitus, obesity, smoking, heavy alcohol use, and physical inactivity) and with a 2.25-fold (95% confidence interval, 1.39-3.63) hazard of incident CVD compared with a low childhood adversity and low adult disadvantage. This hazard ratio was attenuated by 16.6% but remained statistically significant after adjustment for the CVD risk factors (1.96; 95% confidence interval, 1.22-3.16). Exposure to high childhood adversity or high adult neighborhood disadvantage alone was not significantly associated with CVD in fully adjusted models.
  
  
  CONCLUSIONS
  These findings suggest that individuals with both childhood psychosocial adversity and adult neighborhood disadvantage are at an increased risk of CVD. In contrast, those with only 1 of these exposures have little or no excess risk after controlling for conventional risk factors.
authors.affiliation: From Finnish Institute of Occupational Health (J.I.H., J.P., M.K., J.V.); Department of Public Health, University of Turku, Finland (S.S., J.V.); School of Health Sciences, University of Tampere, Finland (S.S.); Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA (I.K., S.V.S.); Department of Epidemiology and Public Health, University College London Medical School, UK (M.K.); Clinicum, Faculty of Medicine, University of Helsinki, Finland (M.K.); and Turku University Hospital, Finland (J.V.). jaana.halonen@ttl.fi.
authors.forename: Jaana I
authors.initials: JI
authors.lastname: Halonen
authors.affiliation: From Finnish Institute of Occupational Health (J.I.H., J.P., M.K., J.V.); Department of Public Health, University of Turku, Finland (S.S., J.V.); School of Health Sciences, University of Tampere, Finland (S.S.); Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA (I.K., S.V.S.); Department of Epidemiology and Public Health, University College London Medical School, UK (M.K.); Clinicum, Faculty of Medicine, University of Helsinki, Finland (M.K.); and Turku University Hospital, Finland (J.V.).
authors.forename: Sari
authors.initials: S
authors.lastname: Stenholm
authors.affiliation: From Finnish Institute of Occupational Health (J.I.H., J.P., M.K., J.V.); Department of Public Health, University of Turku, Finland (S.S., J.V.); School of Health Sciences, University of Tampere, Finland (S.S.); Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA (I.K., S.V.S.); Department of Epidemiology and Public Health, University College London Medical School, UK (M.K.); Clinicum, Faculty of Medicine, University of Helsinki, Finland (M.K.); and Turku University Hospital, Finland (J.V.).
authors.forename: Jaana
authors.initials: J
authors.lastname: Pentti
authors.affiliation: From Finnish Institute of Occupational Health (J.I.H., J.P., M.K., J.V.); Department of Public Health, University of Turku, Finland (S.S., J.V.); School of Health Sciences, University of Tampere, Finland (S.S.); Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA (I.K., S.V.S.); Department of Epidemiology and Public Health, University College London Medical School, UK (M.K.); Clinicum, Faculty of Medicine, University of Helsinki, Finland (M.K.); and Turku University Hospital, Finland (J.V.).
authors.forename: Ichiro
authors.initials: I
authors.lastname: Kawachi
authors.affiliation: From Finnish Institute of Occupational Health (J.I.H., J.P., M.K., J.V.); Department of Public Health, University of Turku, Finland (S.S., J.V.); School of Health Sciences, University of Tampere, Finland (S.S.); Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA (I.K., S.V.S.); Department of Epidemiology and Public Health, University College London Medical School, UK (M.K.); Clinicum, Faculty of Medicine, University of Helsinki, Finland (M.K.); and Turku University Hospital, Finland (J.V.).
authors.forename: S V
authors.initials: SV
authors.lastname: Subramanian
authors.affiliation: From Finnish Institute of Occupational Health (J.I.H., J.P., M.K., J.V.); Department of Public Health, University of Turku, Finland (S.S., J.V.); School of Health Sciences, University of Tampere, Finland (S.S.); Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA (I.K., S.V.S.); Department of Epidemiology and Public Health, University College London Medical School, UK (M.K.); Clinicum, Faculty of Medicine, University of Helsinki, Finland (M.K.); and Turku University Hospital, Finland (J.V.).
authors.forename: Mika
authors.initials: M
authors.lastname: Kivimäki
authors.affiliation: From Finnish Institute of Occupational Health (J.I.H., J.P., M.K., J.V.); Department of Public Health, University of Turku, Finland (S.S., J.V.); School of Health Sciences, University of Tampere, Finland (S.S.); Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA (I.K., S.V.S.); Department of Epidemiology and Public Health, University College London Medical School, UK (M.K.); Clinicum, Faculty of Medicine, University of Helsinki, Finland (M.K.); and Turku University Hospital, Finland (J.V.).
authors.forename: Jussi
authors.initials: J
authors.lastname: Vahtera
mesh_terms: D000328:Adult / Q000523:psychology*; D000367:Age Factors; D000368:Aged; D002318:Cardiovascular Diseases / Q000453:epidemiology*; D002648:Child; D015331:Cohort Studies; D005190:Family / Q000523:psychology*; D054541:Family Conflict; D005260:Female; D005387:Finland; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011203:Poverty / Q000523:psychology; D011584:Psychology; D012111:Residence Characteristics; D012189:Retrospective Studies; D012307:Risk Factors; D012959:Socioeconomic Factors
keywords: cerebrovascular disorders; circulation; coronary disease; epidemiology; risk factors