Socioeconomic Position, Race/Ethnicity, and Inflammation in the Multi-Ethnic Study of Atherosclerosis
Abstract
BACKGROUND: Low socioeconomic position is known to be associated with cardiovascular events and atherosclerosis. Reasons for these associations remain a topic of research. Inflammation could be an important mediating mechanism linking socioeconomic position to cardiovascular risk. METHODS AND RESULTS: This cross-sectional study used data from the baseline examination of the Multi-Ethnic Study of Atherosclerosis (MESA), a study of 6814 men and women 45 to 84 years of age. Race- and ethnicity-stratified regression analyses were used to estimate associations of household income and education with C-reactive protein and interleukin-6 before and after adjustment for infection and medication use, psychosocial factors, behaviors, adiposity, and diabetes mellitus. Low income was associated with higher concentrations of interleukin-6 in all race/ethnic groups. Percent differences associated with 1-SD-lower income were 9% (95% confidence interval [CI], 7 to 11), 6% (95% CI, 1 to 10), 8% (95% CI, 4 to 11), and 8% (95% CI, 3 to 13) for whites, Chinese, blacks, and Hispanics. Low levels of education were associated with higher levels of interleukin-6 only among whites and blacks (percent difference in interleukin-6 associated with 1-SD-lower education: 9% [95% CI, 6 to 12] among Whites, and 7% [95% CI, 3 to 10] among blacks). Similar patterns were observed for C-reactive protein. Adiposity was the single most important factor explaining socioeconomic position associations, especially among blacks and whites. A smaller effect was seen for psychosocial factors and behaviors in all race groups. CONCLUSIONS: Both household income and education are associated with inflammation, but associations vary across race/ethnic groups. Associations likely result from socioeconomic position patterning of adiposity and other factors.
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Persistent economic difficulties predict increased sickness absence.
“Persistent economic difficulties predict increased sickness absence, highlighting the broad impact of financial stress on health [117,118].”
From Comprehensive review of chronic stress pathways and the efficacy of behavioral stress reduction programs (BSRPs) in managing diseases. (2024) · cites this paper as [118]
Low income is associated with higher concentrations of interleukin-6 across all racial and ethnic groups.
“Economic difficulties also contribute to stress, with a low income being associated with higher concentrations of interleukin-6 across all racial and ethnic groups.”
From Comprehensive review of chronic stress pathways and the efficacy of behavioral stress reduction programs (BSRPs) in managing diseases. (2024) · cites this paper as [118]
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“Occupation and education levels have also been associated with a number of other inflammatory biomarkers, including cytokines such as TNF-α, IL-1Rα, and IL-6 ( Steptoe, Owen et al. 2002 ; Ranjit, Diez-Roux et al.”
Blais, C., Hamel, D., & Rinfret, S. (2011) · Canadian Journal of Cardiology · doi:10.1016/j.cjca.2011.10.009 · Cited by 47 · see citing works
“Moreover, the cumulative effects of the SES during life may trigger changes in markers of atherosclerosis.(29,30) The accumulation of multiple behavioural, psychosocial, and metabolic characteristics would be greater for the most deprived, which in turn would influence mortality, even in the context of a public health…”
BackgroundLongitudinal effects of race, ethnicity, and psychosocial disadvantage on systemic inflammation
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“For example, educational disadvantage has been linked to higher CRP levels in epidemiological studies (Ranjit et al., 2007).”
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Cytokines are associated with longitudinal changes in cognitive performance among urban adults
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“Mean LDL cholesterol, mg/dL (SD) 113 (31) 117 (30) 120 (32) 117 (30) 0.”
Construção e validação do "CADE-Q" para educação de pacientes em programas de reabilitação cardíaca
Ghisi, G. L. D. M., Durieux, A., Manfrói, W. C., Herdy, A. H., de Carvalho, T., Andrade, A., & Benetti, M. (2010) · Arquivos Brasileiros de Cardiologia · doi:10.1590/s0066-782x2010005000045 · Cited by 45 · see citing works
“Questões Frequência n(%) Corretas Incorretas Erradas Não sei Q1 77(49,7) 64(41,3) 5(3,2) 9(5,8) Q2 148(95,5) 3(1,9) 2(1,3) 2(1,3) Q3 130(83,9) 15(9,7) 3(1,9) 7(4,5) Q4 111(71,6) 27(17,4) 7(4,5) 10(6,5) Q5 119(76,8) 23(14,8) 2(1,3) 11(7,1) Q6 133(85,8) 11(7,1) 7(4,5) 4(2,6) Q7 109(70,3) 43(27,7) 1(0,6) 2(1,3) Q8 67(43,…”
Cai, A., Dillon, C., Hillegass, W. B., Beasley, T. M., Brott, B. C., Bittner, V., Perry, G. J., Halade, G. V., Prabhu, S. D., & Limdi, N. A. (2019) · Journal of the American Heart Association · doi:10.1161/jaha.119.012874 · Cited by 43 · see citing works
“These factors include severity of comorbid conditions (eg, uncontrolled hypertension), genetics, 45 neighborhood effects, 46 and in fl ammatory burden, 47 among others.”
Mackie, S. L., Dasgupta, B., Hordon, L. D., Gough, A., Green, M., Hollywood, J., Dutta, S., Bejarano, V., Jarrett, S. J., Morgan, A. W., et al. (2011) · Lara D. Veeken · doi:10.1093/rheumatology/ker265 · Cited by 41 · see citing works
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“dependent associations of both SES and conscientiousness with markers of inflammation [25, 55].”
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Body mass and the epidemic of chronic inflammation in early mid-adulthood
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The social environment and IL-6 in rats and humans
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“The lack of association among Hispanic participants occurred primarily among those who did not speak English at home, suggesting an effect of acculturation (Ranjit et al., 2007).”
BackgroundRelation of Educational Level to Inflammation-Sensitive Biomarker Level
Steinvil, A., Shirom, A., Melamed, S., Toker, S., Justo, D., Saar, N., Shapira, I., Berliner, S. A., & Rogowski, O. (2008) · The American Journal of Cardiology · doi:10.1016/j.amjcard.2008.05.055 · Cited by 37 · see citing works
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Individual and Neighborhood Socioeconomic Status and Inflammation in Mexican American Women
Gallo, L. C., Fortmann, A. L., Monteros, K. E. D. L., Mills, P. J., Barrett-Connor, E. L., Roesch, S. C., & Matthews, K. A. (2012) · Psychosomatic Medicine · doi:10.1097/psy.0b013e31824f5f6d · Cited by 35 · see citing works
“Some research in Latinos suggests that neighborhoods characterized as ‘‘ethnic enclaves’’ may confer health advantages that partially offset the deleterious effects of low neighborhood SES, which would weaken neighborhood SES-health associations (78,79).”
BackgroundInfluentialRisk Factors for Lower-Extremity Vein Graft Failure
Monahan, T. S., & Owens, C. D. (2009) · Seminars in Vascular Surgery · doi:10.1053/j.semvascsurg.2009.10.003 · Cited by 34 · see citing works
Financial strain and birth weight: the mediating role of psychological distress
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“…as income, has been linked with heightened concentrations of serum proinflammatory markers, including interleukin-6, tumor necrosis factor-α, and C-reactive protein (Friedman and Herd 2010; Gruenewald et al. 2009; Koster et al. 2006; Loucks et al. 2010; Morozink et al. 2010; Ranjit et al. 2007).”
Baumer, Y., Farmer, N. M., Premeaux, T. A., Wallen, G. R., & Powell‐Wiley, T. M. (2020) · Frontiers in Public Health · doi:10.3389/fpubh.2020.559312 · Cited by 33 · see citing works
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“[23–26].”
No Midpregnancy Fall in Diastolic Blood Pressure in Women With a Low Educational Level
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On behalf of the Moli-sani Study Investigators, Bonaccio, M., Castelnuovo, A. F. D., Pounis, G., Curtis, A. D., Costanzo, S., Persichillo, M., Cerletti, C., Donati, M. B., de Gaetano, G., et al. (2017) · International Journal of Public Health · doi:10.1007/s00038-016-0939-0 · Cited by 33 · see citing works
“Our results are in agreement with the previous evidence showing that both household income and education were associated with inflammation as a likely result of the socioeconomic patterning of adiposity and other factors (Ranjit et al. 2007), while being physically active was suggested as an effective tool to control…”
Well-Being, Aging, and Immunity
Friedman, E. M. (2012) · Oxford University Press eBooks · doi:10.1093/oxfordhb/9780195394399.013.0003 · Cited by 31 · see citing works
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“The present study completed a homogenous population of African-American women, who are a traditionally understudied group (23,24).”
Robson, J. C., Kiran, A., Maskell, J., Hutchings, A., Arden, N. K., Dasgupta, B., Hamilton, W. T., Emin, A., Culliford, D. J., & Luqmani, R. A. (2016) · The Journal of Rheumatology · doi:10.3899/jrheum.151024 · Cited by 30 · see citing works
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Estimating the Short-Term Effects of the Earned Income Tax Credit on Child Health
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Brown, K., Roux, A. V. D., Smith, J. A., Needham, B. L., Mukherjee, B., Ware, E. B., Liu, Y., Cole, S. W., Seeman, T. E., & Kardia, S. L. R. (2020) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2020.104654 · Cited by 27 · see citing works
“An elevated CRP level is also associated with increased risk of mortality (Marsik et al., 2008; Ridker, 2007).”
BackgroundInfluentialMcDade, T. W., & Koning, S. M. (2020) · Social Science & Medicine · doi:10.1016/j.socscimed.2020.113592 · Cited by 27 · see citing works
“Complementary lines of inquiry consider whether inflammation mediates the impact of intermediate psychosocial factors 6 (e.g., stress, depression, social isolation) on morbidity and mortality (Miller et al. 2002, Miller et al. 2003, McDade et al. 2006, Cole et al. 2007, Ranjit et al. 2007).”
BackgroundResultInfluentialDinwiddie, G. Y., Zambrana, R. E., Doamekpor, L. A., & López, L. (2015) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph13010042 · Cited by 27 · see citing works
“However, smoking and heavy drinking have not consistently explained elevated CRP levels for NHBs or Hispanics [28,29].”
BackgroundResultInfluentialPrather, A. A., Janicki‐Deverts, D., Adler, N. E., Hall, M. H., & Cohen, S. (2016) · Annals of Behavioral Medicine · doi:10.1007/s12160-016-9835-3 · Cited by 27 · see citing works
“, T-cell immunity) critical to the adequate protection from infectious agents, including the cold virus [44], and low SES individuals display elevated levels of systemic inflammation [45, 46].”
BackgroundChen, E., Shalowitz, M. U., Story, R. E., Ehrlich, K. B., Levine, C. S., Hayen, R., Leigh, A. K. K., & Miller, G. E. (2016) · Psychosomatic Medicine · doi:10.1097/psy.0000000000000392 · Cited by 26 · see citing works
Neutrophil-to-lymphocyte ratio as a predictor of cardiovascular mortality in cancer survivors
He, Y., Liu, X., Wang, M., Ke, H., & Ge, C. (2024) · Scientific Reports · doi:10.1038/s41598-024-72027-5 · Cited by 26 · see citing works
“Previous studies have explored the association between race and NLR, with some indicating higher NLR levels in non-Hispanic White populations compared to other racial groups 20 .”
Impact of acculturation on cardiovascular risk factors among elderly Mexican Americans
López, L., Peralta, C. A., Lee, A., Hazzouri, A. Z. A., & Haan, M. N. (2014) · Annals of Epidemiology · doi:10.1016/j.annepidem.2014.07.011 · Cited by 22 · see citing works
Fujishiro, K., Roux, A. V. D., Landsbergis, P. A., Kaufman, J. D., Korcarz, C. E., & Stein, J. H. (2014) · Occupational and Environmental Medicine · doi:10.1136/oemed-2014-102311 · Cited by 22 · see citing works
The Effects of Stress at Work and at Home on Inflammation and Endothelial Dysfunction
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“Although the medium category may seem somewhat less robust, prior work has suggested that even small increases in psychological factors may be associated with monotonic increases in risk or levels of health-related outcomes [20].”
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Educational Status, Anger, and Inflammation in the MIDUS National Sample: Does Race Matter?
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Inflammation in Chronic Kidney Disease
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Distal and variably proximal causes: Education, obesity, and health
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“IL-6 levels were found to be significantly higher in intermittent explosive disorder (IED) patients compared to controls, according to Emil et al. [54].”
BackgroundInfluentialExpression of socially sensitive genes: The multi-ethnic study of atherosclerosis
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Socioeconomic Status, Inflammation, and Immune Function
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Demographic Differences in Systemic Inflammatory Response Syndrome Score After Trauma
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“In the Multi Ethnic Study of Atherosclerosis (MESA) study, Blacks had higher mean levels of IL-6 across categorical gradients of education and income (Ranjit et al., 2007).”
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Comprehensive Noninvasive Arterial Vascular Evaluation
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- Authors
- Ranjit, N., Diez-Roux, A. V., Shea, S., Cushman, M., Ni, H., & Seeman, T.
- Affiliations
- University of Vermont (US)
- From the Center for Social Epidemiology and Population Health, University of Michigan, Ann Arbor (N.R., A.V.D.-R.); Departments of Medicine and Epidemiology, Columbia University, New York, NY (S.S.); Department of Medicine, University of Vermont, Burlington (M.C.); Division of Epidemiology and Clinical Applications, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Md (H.N.); and Division of Geriatrics, School of Medicine, University of California at Los Angeles (T...
- Venue
- Circulation
- Published
- 2007-11-20
- Volume
- 116
- Issue
- 21
- Pages
- 2383-2390
- ISSN
- 0009-7322 (ISSN-L)
- 1524-4539
- OpenAlex
- W2113254280
- Cited by
- 168
- References
- 32
- Citations by year
- 2026: 4 · 2025: 9 · 2024: 5 · 2023: 8 · 2022: 7 · 2021: 6 · 2020: 6 · 2019: 14 · 2018: 7 · 2017: 10 · 2016: 10 · 2015: 8 · 2014: 9 · 2013: 6 · 2012: 13
- FWCI
- 13.44
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Circulation (publishedVersion)
- PubMed (publishedVersion)
- Funders
- University of Vermont
- Universidad CES
- National Institutes of Health (n01hc95164-17-0-1, n01hc95165-34-0-1, n01hc95161-24-0-1, n01hc095169-003, n01hc95162-31-0-1, n01hc95160-18-0-1, n01hc95163-22-0-1, n01hc95159-40-0-1)
- National Heart, Lung, and Blood Institute (N01 HC-95159, N01-HC-95160, (N01-HC-95163, N01 HC-95161, N01 HC95165, N01HC95164, R01HL076831, N01 HC-95162, N01 HC95169)
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (R24HD047861)
- Topics
- Social Sciences › Health › Health disparities and outcomes
- Health Sciences › Medicine › Epidemiology › Adipokines, Inflammation, and Metabolic Diseases
- Health Sciences › Medicine › Surgery › Lipoproteins and Cardiovascular Health
- Keywords
- socioeconomic position, household income, educational attainment, inflammation, C-reactive protein, interleukin-6, race and ethnicity, atherosclerosis, adiposity, cardiovascular risk, Multi-Ethnic Study of Atherosclerosis
- MeSH terms
- Aged, Aged, 80 and over, Cross-Sectional Studies, Ethnicity, Female, Humans, Inflammation, Longitudinal Studies, Male, Middle Aged, Risk Factors, Socioeconomic Factors, Biomarkers, Racial Groups, Atherosclerosis
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