Does cytomegalovirus infection contribute to socioeconomic disparities in all-cause mortality?
The social patterning of cytomegalovirus (CMV) and its implication in aging suggest that the virus may partially contribute to socioeconomic disparities in mortality. We used Cox regression and inverse odds ratio weighting to quantify the proportion of the association between socioeconomic status (SES) and all-cause mortality that was attributable to mediation by CMV seropositivity. Data were from the National Health and Nutrition Examination Survey (NHANES) III (1988-1994), with mortality follow-up through December 2011. SES was assessed as household income (income-to-poverty ratio ≤1.30;>1.30 to≤1.85;>1.85 to≤3.50;>3.50) and education (<high school; high school; >high school). We found strong associations between low SES and increased mortality: hazard ratio (HR) 1.80; 95% confidence interval (CI): 1.57, 2.06 comparing the lowest versus highest income groups and HR 1.29; 95% CI: 1.13, 1.48 comparing <high school versus >high school education. 65% of individuals were CMV seropositive, accounting for 6-15% of the SES-mortality associations. Age modified the associations between SES, CMV, and mortality, with CMV more strongly associated with mortality in older individuals. Our findings suggest that cytomegalovirus may partially contribute to persistent socioeconomic disparities in mortality, particularly among older individuals.
Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA. Electronic address: lfeinst@email.unc.edu.
Lydia
L
Feinstein
Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA. Electronic address: cedougla@email.unc.edu.
Christian E
CE
Douglas
Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA. Electronic address: rebecca7@email.unc.edu.
Rebecca C
RC
Stebbins
Department of Internal Medicine II, Centre for Medical Research, University of Tübingen, Tübingen, Germany; School of Science and Technology, Nottingham Trent University, Nottingham, UK. Electronic address: graham.pawelec@uni-tuebingen.de.
Graham
G
Pawelec
Joseph J. Zilber School of Public Health, University of Wisconsin-Milwaukee, Milwaukee, WI, USA. Electronic address: simaneka@uwm.edu.
Amanda M
AM
Simanek
Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA. Electronic address: aaiello@email.unc.edu.
Allison E
AE
Aiello
D000328:Adult; D000367:Age Factors; D003587:Cytomegalovirus; D003586:Cytomegalovirus Infections / Q000401:mortality*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D012959:Socioeconomic Factors; D014481:United States / Q000453:epidemiology
Aging; Cytomegalovirus; Mortality; NHANES III; Socioeconomic status