Social
The association between life-course SEP trajectories and cardiometabolic diseases in older adults: a retrospective cohort study in Brazil Taymara Abreu* Taymara Abreu Margot Bonsing Fabiola Bof de Andrade Joline Beulens Joreintje Mackenbach
Background: The burden of cardiometabolic diseases (CMD) has increased in low- and middle-income countries (LMIC), where substantial socioeconomic inequality exist. Socioeconomic position (SEP) can exert influence from early life onwards, implicating childhood and adulthood SEP as determinants of health in later life. However, research in LMIC is scarce and inconsistent.
Aim: To investigate the association between life-course SEP trajectories and CMD outcomes among Brazilians aged 50 years or older.
Methods: We used data from N=8,238 participants of the retrospective cohort study ELSI-Brazil. SEP was measured with a single-variable approach at three time points: subjective SEP (childhood), own education (early adulthood) and subjective SEP (older adulthood). CMD diagnosis and date of onset were self-reported. A robustness check with different SEP indicators was conducted. Latent Class Growth Analysis was used to identify life-course SEP trajectories. Logistic regression with sampling and attrition weights assessed the association between life-course SEP trajectories and CMD. Sensitivity analysis excluded participants diagnosed with CMD more than five years prior to baseline (N=5,743) and explored effect modification by sex.
Results: The main and sensitivity analysis identified two SEP trajectories: upward-stable and upward-downward. In the robustness check we found two upward-downward trajectories. The odds of developing CMD in older adulthood for those in the upward-downward trajectory compared to those in the upward-stable trajectory was 1.08 (95%C 0.95-1.22). We observed similar findings in the robustness check and sensitivity analysis. Stratification by sex did not reveal any differences.
Conclusions: No association between life-course SEP trajectories and CMD in older adulthood was observed in this Brazilian cohort. Due to the scarcity and inconsistency of research, more studies with a longer follow-up and different approaches are needed in LMIC.