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Early life socioeconomic position and mortality from cardiovascular diseases: an application of causal mediation analysis in the Stockholm Public Health Cohort

Authors :
Daniel Falkstedt
Ilona Koupil
Muhammad Zakir Hossin
Source :
BMJ Open, Vol 9, Iss 6 (2019)
Publication Year :
2019
Publisher :
BMJ Publishing Group, 2019.

Abstract

Objective We aimed to quantify the mediating impact of adult social and behavioural mechanisms in the association between childhood socioeconomic position (SEP) and cardiovascular disease (CVD) mortality by employing a weighting approach to mediation analysis.Design Prospective cohort study.Setting Stockholm County, Sweden.Participants 19 720 individuals who participated in the Stockholm Public Health Cohort survey in 2002 and were older than 40 years.Primary and secondary outcome measures The primary outcome was CVD mortality. Non-CVD mortality was additionally analysed for comparison.Methods Study subjects were followed in routine registers from 2002 to 2011 for mortality. Data on father’s SEP and adult social and behavioural factors came from questionnaire survey. The inverse odds weighting method was used to estimate the total effect, the natural direct effect and the natural indirect effect (NIE) in Poisson regression models. All results were adjusted for gender, age, country of birth and marital status. Multiple imputation was used to handle missing data.Results The total effect of manual versus non-manual father’s SEP on CVD mortality was estimated as an incidence rate ratio (IRR) of 1.24 (95% CI 1.09 to 1.41). When the social and behavioural factors were accounted for, the IRR for the NIE was 1.09 (95% CI 1.04 to 1.14), suggesting a mediation of 44% of the total effect. As for non-CVD mortality, father’s manual SEP was associated with 1.15 fold excess risk (IRR: 1.15; 95% CI 1.04 to 1.27) of which the effect represented by the whole set of mediators was 1.06 (95% CI 1.01 to 1.10).Conclusion Adult social and behavioural factors had a considerable mediating effect on the early life social origin of mortality from CVDs and other causes. Future research employing causal mediation analysis may nevertheless have to consider additional factors for a fuller understanding of the mechanisms.

Subjects

Subjects :
Medicine

Details

Language :
English
ISSN :
20446055
Volume :
9
Issue :
6
Database :
Directory of Open Access Journals
Journal :
BMJ Open
Publication Type :
Academic Journal
Accession number :
edsdoj.673731d095bc45769bf2f9f0643f073a
Document Type :
article
Full Text :
https://doi.org/10.1136/bmjopen-2018-026258