Psychological, social and biological determinants of ill health (pSoBid): study protocol of a population-based study

Background: Disadvantaged communities suffer higher levels of physical and mental ill health than more advantaged communities. The purpose of the present study was to examine the psychosocial, behavioural and biological determinants of ill health within population groups in Glasgow that differed in socioeconomic status and in their propensity to develop chronic disease especially coronary heart disease and Type 2 diabetes mellitus. Methods: Participants were selected at random from areas known to be at the extremes of the socioeconomic continuum in Glasgow. Within the categories of least deprived and most deprived, recruitment was stratified by sex and age to achieve an overall sample containing approximately equal numbers of males and females and an even distribution across the age categories 35–44, 45– 54 and 55–64 years. Individuals were invited by letter to attend for assessment of their medical history, risk factor status, cognitive function and psychological profile, morbidity, and carotid intima-media thickness and plaque count as indices of atherosclerosis. Anonymised data on study subjects were collected from the General Practice Administration System for Scotland to analyse characteristics of participants and non-participants

Differences in atherosclerosis according to area level socioeconomic deprivation: cross sectional, population based study

Objectives To examine the relation between area level social deprivation and ultrasound markers of atherosclerosis (common carotid intima-media thickness and plaque score), and to determine whether any differences can be explained by “classic” (currently recognised) or “emerging” (novel) cardiovascular risk factors. Design Cross sectional, population based study. Setting NHS Greater Glasgow Health Board area. Participants 666 participants were selected on the basis of how their area ranked in the Scottish Index of Multiple Deprivation 2004. Approximately equal numbers of participants from the most deprived areas and the least deprived areas were included, as well as equal numbers of men and women and equal numbers of participants from each age group studied (35-44, 45-54, and 55-64 years). Main outcome measures Carotid intima-media thickness and plaque score, as detected by ultrasound. Results The mean age and sex adjusted intima-media thickness was significantly higher in participants from the most deprived areas than in those from the least deprived areas (0.70 mm (standard deviation (SD) 0.16 mm) v 0.68mm(SD 0.12 mm); P=0.015). On subgroup analysis, however, this difference was only apparent in the highest age tertile in men (56.3-66.5 years). The difference in unadjusted mean plaque score between participants from the most deprived and those from the least deprived areas was more striking than the difference in intimamedia thickness (least deprived 1.0 (SD 1.5) v most deprived 1.7 (SD 2.0); P<0.0001). In addition, a significant difference in plaque score was apparent in the two highest age tertiles in men (46.8-56.2 years and 56.3-66. 5 years; P=0.0073 and P<0.001) and the highest age tertile in women (56.3-66.5 years; P<0.001). The difference in intima-media thickness between most deprived and least deprived males remained significant after adjustment for classic risk factors, emerging risk 1.7 (SD 2.0); P<0.0001). In addition, a significant difference in plaque score was apparent in the two highest age tertiles in men (46.8-56.2 years and 56.3-66. 5 years; P=0.0073 and P<0.001) and the highest age tertile in women (56.3-66.5 years; P<0.001). The difference in intima-media thickness between most deprived and least deprived males remained significant after adjustment for classic risk factors, emerging risk factors, and individual level markers of socioeconomic status (P=0.010). Adjustment for classic risk factors and emerging cardiovascular risk factors, either alone or in combination, did not abolish the deprivation based difference in plaque presence (as a binary measure; adjusted odds ratio of 1.73, 95% confidence interval 1.07 to 2.82). However, adjustment for classic risk factors and individual level markers of early life socioeconomic status abolished the difference in plaque presence between the most deprived and the least deprived individuals (adjusted odds ratio 0.94, 95% CI 0.54 to 1.65; P=0.84). Conclusions Deprivation is associated with increased carotid plaque score and intima-media thickness. The association of deprivation with atherosclerosis is multifactorial and not adequately explained by classic or emerging risk factors

Early life socioeconomic adversity is associated in adult life with chronic inflammation, carotid atherosclerosis, poorer lung function and decreased cognitive performance: a crosssectional, population-based study

Background: Socioeconomic gradients in health persist despite public health campaigns and improvements in healthcare. The Psychosocial and Biological Determinants of Ill-health (pSoBid) study was designed to uncover novel biomarkers of chronic disease that may help explain pathways between socioeconomic adversity and poorer physical and mental health. Methods: We examined links between indicators of early life adversity, possible intermediary phenotypes, and markers of ill health in adult subjects (n = 666) recruited from affluent and deprived areas. Classical and novel risk factors for chronic disease (lung function and atherosclerosis) and for cognitive performance were assessed, and associations sought with early life variables including conditions in the parental home, family size and leg length. Results: Associations were observed between father’s occupation, childhood home status (owner-occupier; overcrowding) and biomarkers of chronic inflammation and endothelial activation in adults (C reactive protein, interleukin 6, intercellular adhesion molecule; P < 0.0001) but not number of siblings and leg length. Lung function (forced expiratory volume in 1 second) and cognition (Choice Reaction Time, the Stroop test, Auditory Verbal Learning Test) were likewise related to early life conditions (P < 0.001). In multivariate models inclusion of inflammatory variables reduced the impact and independence of early life conditions on lung function and measures of cognitive ability. Including variables of adult socioeconomic status attenuated the early life associations with disease biomarkers. Conclusions: Adverse levels of biomarkers of ill health in adults appear to be influenced by father’s occupation and childhood home conditions. Chronic inflammation and endothelial activation may in part act as intermediary phenotypes in this complex relationship. Reducing the ‘health divide’ requires that these life course determinants are taken into account

Personality, socio-economic status and inflammation: cross-sectional, population-based study

Background: Associations between socio-economic status (SES), personality and inflammation were examined to determine whether low SES subjects scoring high on neuroticism or hostility might suffer relatively higher levels of inflammation than affluent subjects. Methods: In a cross-sectional design, 666 subjects were recruited from areas of high (most deprived – ‘‘MD’’) and low (least deprived – ‘‘LD’’) deprivation. IL-6, ICAM-1, CRP and fibrinogen were measured along with demographic and healthbehaviour variables, and personality traits of neuroticism, extraversion and psychoticism (hostility). Regression models assessed the prediction of inflammation as a function of personality, deprivation and their interaction. Results: Levels of CRP and IL-6 were an increasing function of neuroticism and extraversion only in LD subjects opposite trends were seen in MD subjects. The result was ascribed parsimoniously to an inflammatory ceiling effect or, more speculatively, to SES-related health-behaviour differences. Psychoticism was strongly associated with ICAM-1 in both MD and LD subjects. Conclusions: The association between neuroticism, CRP and IL-6 may be reduced in MD subjects confirming speculation that the association differs across population sub-groups. The association between psychoticism and ICAM-1 supports evidence that hostility has adverse effects upon the endothelium, with consequences for cardiovascular health. Health interventions may be more effective by accounting for personality-related effects upon biological processes

Associations between personality traits and health behaviours in affluent and deprived groups, and their interactions.

a<p>BMI (body mass index).</p>b<p>Depression = depression sub-scale of GHQ-28.</p>c<p>NART (National Adult Reading Test).</p

Levels of inflammatory markers as a function of the interaction between personality and deprivation group with 95% confidence bands.

<p>Levels of inflammatory markers as a function of the interaction between personality and deprivation group with 95% confidence bands.</p

Description of basic demographics, socioeconomic status, personality and markers of inflammation by area deprivation category.

a<p>Values are presented as Mean (SD) for all participants; or as percentages for categorical variables, adjusted for age and sex;</p>b<p><i>P</i> relates the comparison between the two groups. Categorical variables were compared using Fisher’s exact test, continuous variables were compared using t-tests or Wilcoxon tests as appropriate.</p>c<p>The occupational category could not be determined for n = 1 (0.3%) and n = 16 (5%) of the LD and MD groups respectively. Occupation classified using Registrar General Social Class Classification on basis of current job or, if not currently working, on the basis of participants’ last paid job. Only those who had never been in paid employment were classed as “unemployed.” I - professional occupations; II - managerial and technical occupations; III - manual and non-manual skilled occupations; IV - partly skilled occupations; V - unskilled occupations.</p>d<p>Diet score is the participants self-reported consumption of fruit and vegetables (fresh, cooked and raw) per month.</p>e<p>Physical activity level is a combination of activity at work and recreational exercise.</p>f<p>Data log transformed prior to regression analysis.</p>g<p>Personality trait scores were self-reported, each on a scale of 1 to 12.</p>h<p>Depression = depression sub-scale of GHQ-28.</p>i<p>NART (National Adult Reading Test).</p