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AJPH First Look, published online ahead of print Dec 28, 2006
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February 2007, Vol 97, No. 2 | American Journal of Public Health 234-236
© 2007 American Public Health Association
DOI: 10.2105/AJPH.2006.087429

RESEARCH AND PRACTICE

Association Between Adult and Childhood Socioeconomic Status and Prevalence of the Metabolic Syndrome in African Americans: The Pitt County Study

Jaime C. Lucove, MSPH, Jay S. Kaufman, PhD and Sherman A. James, PhD

At the time of the study, Jaime C. Lucove was with the Department of Epidemiology, University of North Carolina, Chapel Hill. Jay S. Kaufman is with the Department of Epidemiology, University of North Carolina, Chapel Hill. Sherman A. James is with the Terry Sanford Institute of Public Policy, Duke University, Durham, NC.

Correspondence: Requests for reprints should be sent to Jay S. Kaufman, PhD, CB#7435, 2104C McGravran-Greenberg, School of Public Health, University of North Carolina, Chapel Hill, NC 27599 (e-mail: jay_kaufman{at}unc.edu).


   ABSTRACT
TOP
 ABSTRACT
INTRODUCTION
 METHODS
 RESULTS
 DISCUSSION
 References
 

We evaluated the association between socioeconomic status (SES) during childhood and adulthood and prevalence of the metabolic syndrome in African Americans. Higher adult educational status and adult skilled occupation were protective against the metabolic syndrome, but no associations were found between the metabolic syndrome and other SES variables. Differences by gender were observed. Improving access to education among African Americans could reduce risk for the metabolic syndrome, but more research is needed in minority populations.


   INTRODUCTION
TOP
 ABSTRACT
 INTRODUCTION
METHODS
 RESULTS
 DISCUSSION
 References
 
The metabolic syndrome is an accumulation of cardiovascular disease risk factors that often cluster together and are associated with being overweight.1 It is an increasingly common condition in the United States2 and is associated with an elevated burden of diabetes and cardiovascular disease.

Socioeconomic factors during adulthood (e.g., education and occupation) are correlated with the metabolic syndrome.3–7 A study among British civil servants found a negative association between occupational status and prevalence of the metabolic syndrome5; a graded negative association, i.e., a steady, incremental decline, between education and the metabolic syndrome was also found.3 Research supports an association between socioeconomic status (SES) and the metabolic syndrome among children, and the potential mechanisms are low birthweight, poor nutrition, and inadequate physical activity.6,8 Research supports a link between psychosocial stress and the metabolic syndrome.9 However, little is known about associations between SES and the metabolic syndrome among US adults, and no research has been done in ethnic minority populations. We evaluated the association between socioeconomic factors during childhood and adulthood and prevalence of the metabolic syndrome in African Americans.


   METHODS
TOP
 ABSTRACT
 INTRODUCTION
 METHODS
RESULTS
 DISCUSSION
 References
 
Study Participants
We used data from the Pitt County Study, a community-based, prospective investigation of risk factors for hypertension and related disorders in African Americans aged 25 to 50 years in Pitt County, NC, that began in 1988.10,11 A follow-up examination was conducted in 1993, during which participants provided a 12-hour overnight fasting blood sample. Only individuals who were normotensive (N = 1407) in 1988 were invited to participate in 1993, and 85% (n = 1195) did so. Of these individuals, 84% (n = 1006) participated in the fasting blood draw. A second follow-up examination was conducted in 2001 to obtain information on life-course socioeconomic resources.

Study Measures
The outcome for this analysis was the metabolic syndrome, defined as having 3 or more metabolic syndrome components as described by the Adult Treatment Panel III report.1 The following components were measured at the 1993 examination: fasting blood glucose, blood pressure, high-density lipoprotein, triglycerides, and waist circumference. Adult socioeconomic factors were collected by self-report in 1988 and included dichotomous measures of education, home ownership, employment status, and occupation; measures were obtained from Hollingshead scores (Hollingshead scores of 5–9 were coded as nonskilled, and Hollingshead scores of 1–4 were coded as skilled).12 Childhood SES was determined by parental occupation (coded the same as adult occupation, according to Hollingshead scores) and was obtained retrospectively during the 2001 follow-up using an event history calendar, an interviewing methodology whereby easily remembered past events are used to enhance recall of target events.13 Age and gender were determined in 1988.

Statistical Analysis
We calculated baseline characteristics as proportions. Occupation was protective for the metabolic syndrome among men but not among women in categorical analysis. We used Poisson regression with a robust variance estimator to model associations between socioeconomic variables and the metabolic syndrome (1 social exposure per model), first unadjusted and then adjusted for age (continuous variable) and gender. This method calculates prevalence proportion ratios and is preferred over logistic regression because the occurrence outcome, the Metabolic Syndrome, is not rare.14 Analyses were weighted to be representative of the Pitt County, NC, population. No statistical interaction was observed when a gender interaction term was included (P > .20).


   RESULTS
TOP
 ABSTRACT
 INTRODUCTION
 METHODS
 RESULTS
DISCUSSION
 References
 
The metabolic syndrome prevalence was 25%. Higher educational status was protective against the metabolic syndrome (Table 1Go). After we controlled for age and gender, we found that the metabolic syndrome was about 30% less common among those with a high-school education or greater compared with those with less than a high-school education.


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  		TABLE 1—— Prevalence Proportion Ratios (PPRs; With 95% Confidence Intervals [CIs]) for Associations Between Socioeconomic Status and the Metabolic Syndrome: Pitt County Study, Pitt County, NC, 1998–2001
 
A protective association was observed for a skilled occupation but not for an unskilled occupation. No associations were observed for home ownership or childhood SES variables. Among women, being employed was associated with increased prevalence (prevalence proportion ratio = 1.52; 95% confidence interval [CI] = 1.04, 2.21), whereas the converse was found for men (prevalence proportion ratio = 0.48; 95% CI = 0.12, 1.87).


   DISCUSSION
TOP
 ABSTRACT
 INTRODUCTION
 METHODS
 RESULTS
 DISCUSSION
References
 
Our observation that advanced education, and to a lesser degree skilled occupation, was protective against the metabolic syndrome agrees with findings in European studies.3,7 Potential mechanisms for this association include less psychosocial and material stress,15 better health knowledge,16 and better health behaviors.15 These results suggest that improving access to higher education among African Americans could reduce risk for the metabolic syndrome.

The differential association between employment status and the metabolic syndrome by gender could be explained by gender differences in employment motivations, employment opportunities in this cohort, or work-related stress response.17 Although home ownership is a reasonably good indicator of wealth for African Americans,18 it was not associated with the metabolic syndrome in this study. Although childhood SES, measured by parental occupation, was independently predictive of 1988 obesity status among women in this cohort,19 and moderately predictive of 1988 hypertension status among men,20 it did not predict metabolic syndrome status for either gender in our study. These differences could be a result of the selective nature of the 1993 sample compared with the 1988 sample. Additional research is needed on life-course epidemiology of the metabolic syndrome in US racial/ethnic minorities.


   Acknowledgments
 
The Pitt County Study was funded by the National Institutes of Health (grant HL 65645). The analysis and writing of this brief were funded by the National Center for Minority Health and Health Disparities (grant P60 MD000244).

Human Participant Protection
This study satisfied all criteria for the ethical treatment of human participants and was approved by the human subjects institutional review boards at the University of North Carolina, Chapel Hill; Duke University; and the University of Michigan, Ann Arbor.


   Footnotes
 
Peer Reviewed

Contributors
All authors conceptualized ideas, interpreted findings, and reviewed drafts of the article. J. C. Lucove performed statistical analyses and led the writing of the brief. J. S. Kaufman provided statistical consultation. S. A. James was the principal investigator for the Pitt County Study.

Accepted for publication May 2, 2006.


   References
TOP
 ABSTRACT
 INTRODUCTION
 METHODS
 RESULTS
 DISCUSSION
 References
 
1. Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Executive Summary of the Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). JAMA. 2001;285:2486–2497.[Free Full Text]

2. Ford ES, Giles WH, Dietz WH. Prevalence of the metabolic syndrome among US adults: findings from the third National Health and Nutrition Examination Survey. JAMA. 2002;287:356–359.[Abstract/Free Full Text]

3. Silventoinen K, Pankow J, Jousilahti P, Hu G, Tuomilehto J. Educational inequalities in the metabolic syndrome and coronary heart disease among middle-aged men and women. Int J Epidemiol. 2005;34: 327–334.[Abstract/Free Full Text]

4. Kim MH, Kim MK, Choi BY, Shin YJ. Educational disparities in the metabolic syndrome in a rapidly changing society—the case of South Korea. Int J Epidemiol. 2005;34:1266–1273.[Abstract/Free Full Text]

5. Brunner EJ, Marmot MG, Nanchahal K, et al. Social inequality in coronary risk: central obesity and the metabolic syndrome: evidence from the Whitehall II study. Diabetologia. 1997;40: 1341–1349.[CrossRef][Web of Science][Medline]

6. Batty GD, Leon DA. Socio-economic position and coronary heart disease risk factors in children and young people: evidence from UK epidemiological studies. Eur J Public Health. 2002;12:263–272.[Abstract/Free Full Text]

7. Wamala SP, Lynch J, Horsten M, Mittleman MA, Schenck-Gustafsson K, Orth-Gomer K. Education and the metabolic syndrome in women. Diabetes Care. 1999;22:1999–2003.[Abstract/Free Full Text]

8. Lawlor DA, Harro M, Wedderkopp N, et al. Association of socioeconomic position with insulin resistance among children from Denmark, Estonia, and Portugal: cross sectional study. BMJ. 2005; 331:183.[Abstract/Free Full Text]

9. Vitaliano PP, Scanlan JM, Zhang J, Savage MV, Hirsch IB, Siegler IC. A path model of chronic stress, the metabolic syndrome, and coronary heart disease. Psychosom Med. 2002;64:418–435.[Abstract/Free Full Text]

10. Strogatz DS, James SA, Haines PS, et al. Alcohol consumption and blood pressure in black adults: the Pitt County Study. Am J Epidemiol. 1991;133: 442–450.[Abstract/Free Full Text]

11. James SA, Keenan NL, Strogatz DS, Browning SR, Garrett JM. Socioeconomic status, John Henryism, and blood pressure in black adults. The Pitt County Study. Am J Epidemiol. 1992;135:59–67.[Abstract/Free Full Text]

12. Liberatos P, Link BG, Kelsey JL. The measurement of social class in epidemiology. Epidemiol Rev. 1988;10:87–121.[Web of Science][Medline]

13. Belli RF, Shay WL, Stafford FP. Event history calendars and question list surveys: a direct comparison of interviewing methods. Public Opin Q. 2001;65: 45–74.[Abstract]

14. Zou G. A modified Poisson regression approach to prospective studies with binary data. Am J Epidemiol. 2004;159:702–706.[Abstract/Free Full Text]

15. Bjorntorp P. Do stress reactions cause abdominal obesity and comorbidities? Obes Rev. 2001;2: 73–86.[CrossRef][Medline]

16. Krieger N, Williams DR, Moss NE. Measuring social class in US public health research: concepts, methodologies, and guidelines. Annu Rev Public Health. 1997;18:341–378.[CrossRef][Web of Science][Medline]

17. Chandola T, Brunner E, Marmot M. Chronic stress at work and the metabolic syndrome: prospective study. BMJ. 2006;332:521–525.[Abstract/Free Full Text]

18. Oliver ML, Shapiro TM. Black Wealth, White Wealth: A New Perspective on Racial Inequality. New York, NY: Routledge; 1997.

19. James SA, Fowler-Brown A, Raghunathan TE, Van Hoewyk J. Life-course socioeconomic position and obesity in African American women: the Pitt County Study. Am J Public Health. 2006;96: 554–560.[Abstract/Free Full Text]

20. James SA, VanHoewyk J, Belli RF, Strogatz DS, Williams DR. Life-course socioeconomic position and hypertension in African American men: the Pitt County Study. Am J Public Health. 2006;96: 812–817.[Abstract/Free Full Text]




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This Article
Right arrow Abstract Freely available
Right arrow Full Text (PDF)
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97/2/234    most recent
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PubMed
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Right arrow Articles by Lucove, J. C.
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Related Collections
Right arrow Diabetes
Right arrow Obesity, Overweight, Underweight
Right arrow African Americans/Blacks
Right arrow Socioeconomic Factors
Right arrow Cardiovascular Disease

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