title: Associations of life course socioeconomic position and job stress with carotid intima-media thickness. The Brazilian Longitudinal Study of Adult Health (ELSA-Brasil).
abstract: BACKGROUND
  The association between life course socioeconomic position (SEP) and subclinical atherosclerosis is not consistent across studies. Socioeconomic adversities early in life are related to an increased probability of a low occupational grade and more stressful jobs in adulthood. However, the role of job stress in explaining the life course social gradient in subclinical atherosclerosis is unknown.
  
  
  OBJECTIVE
  To examine whether life course SEP is associated with carotid intima-media thickness (IMT) and to investigate whether this association is partially mediated by job stress.
  
  
  METHODS
  This study used baseline data (2008-2010) for 8806 current workers from ELSA-Brasil. Maternal education, social class of first occupation and social class of current occupation were used to evaluate childhood, youth and adulthood SEP, respectively. Accumulation of risk across the life course was also evaluated. Job stress was assessed by the Swedish Demand-Control-Support Questionnaire. Directed acyclic graph and linear regression models were used.
  
  
  RESULTS
  Low childhood SEP was associated with increased IMT only in women, but low youth and adulthood SEP were associated with higher IMT in both genders. The simultaneous adjustment for all SEP indicators showed that only adulthood SEP continued to be associated with IMT. However, higher IMT values were observed among men and women sequentially exposed to low SEP in more than one period of life. High-strain jobs and low job control were not associated with IMT independent of SEP.
  
  
  CONCLUSIONS
  Our results support a model of the cumulative effects of exposures to SEP across the life span because the highest IMT values were observed in individuals sequentially exposed to low SEP in more than one period of life. We did not find that job stress explained the association between life course SEP and IMT, suggesting that strategies to address socioeconomic inequalities in CVD should target additional steps beyond reducing job stress.
authors.affiliation: Postgraduate Program in Public Health, Faculty of Medicine, Universidade Federal de Minas Gerais, Avenida Professor Alfredo Balena, 190, Belo Horizonte, Minas Gerais 31930-800, Brazil; Department of Social and Behavioral Sciences, Harvard School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA.
authors.forename: Lidyane V
authors.initials: LV
authors.lastname: Camelo
authors.affiliation: Postgraduate Program in Public Health, Faculty of Medicine, Universidade Federal de Minas Gerais, Avenida Professor Alfredo Balena, 190, Belo Horizonte, Minas Gerais 31930-800, Brazil; School of Nutrition, Universidade Federal de Ouro Preto, Campus Universitário, Morro do Cruzeiro, 35400-000 Ouro Preto, Minas Gerais, Brazil.
authors.forename: Luana
authors.initials: L
authors.lastname: Giatti
authors.affiliation: Escola Nacional de Saúde Pública, Fundação Oswaldo Cruz, Av. Brasil, 4365, Manguinhos, 21040-360 Rio de Janeiro, Rio de Janeiro, Brazil.
authors.forename: Dóra
authors.initials: D
authors.lastname: Chor
authors.affiliation: Laboratory of Health and Environment Education, Fundação Oswaldo Cruz, Av. Brasil, 4365, Manguinhos, 21040-360 Rio de Janeiro, Rio de Janeiro, Brazil.
authors.forename: Rosane Härter
authors.initials: RH
authors.lastname: Griep
authors.affiliation: Center for Clinical and Epidemiologic Research, Hospital Universitário, Universidade de São Paulo, Avenida Professor Lineu Prestes, 2565, 3o andar, Cidade Universitária, 05508-000 São Paulo, São Paulo, Brazil.
authors.forename: Isabela M
authors.initials: IM
authors.lastname: Benseñor
authors.affiliation: Internal Medicine Department, School of Medicine, Universidade de São Paulo, Avenida Doutor Arnaldo, 455, Cerqueira César, 01246-903 São Paulo, São Paulo, Brazil.
authors.forename: Itamar S
authors.initials: IS
authors.lastname: Santos
authors.affiliation: Department of Social and Behavioral Sciences, Harvard School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA.
authors.forename: Ichiro
authors.initials: I
authors.lastname: Kawachi
authors.affiliation: Postgraduate Program in Public Health, Faculty of Medicine, Universidade Federal de Minas Gerais, Avenida Professor Alfredo Balena, 190, Belo Horizonte, Minas Gerais 31930-800, Brazil. Electronic address: sbarreto@medicina.ufmg.br.
authors.forename: Sandhi Maria
authors.initials: SM
authors.lastname: Barreto
mesh_terms: D000328:Adult; D000368:Aged; D000375:Aging; D050197:Atherosclerosis / Q000208:ethnology / Q000209:etiology*; D001938:Brazil; D017536:Carotid Artery, Common / Q000033:anatomy & histology; D059168:Carotid Intima-Media Thickness; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009790:Occupations; D012307:Risk Factors; D012923:Social Class; D013315:Stress, Psychological / Q000150:complications*; D011795:Surveys and Questionnaires
keywords: Atherosclerosis; Cardiovascular disease; Health inequalities; IMT; Job stress; Life course; Socioeconomic position