Sex-specific socioeconomic inequalities in trajectories of anthropometry, blood pressure and blood-based biomarkers from birth to 18 years: a prospective cohort study

Abstract

AbstractBackgroundEvidence on when socioeconomic inequalities in conventional cardiometabolic risk factors emerge and how these change over time is sparse but important in identifying pathways leading to socioeconomic inequalities in cardiovascular disease (CVD). We examine socioeconomic inequalities in trajectories of cardiometabolic risk factors across childhood and adolescence.MethodsData were from offspring of the Avon Longitudinal Study of Parents and Children (ALSPAC), born in 1991/1992. Socioeconomic position (SEP) was measured using maternal education from questionnaires administered to mothers at 32-weeks’ gestation. Cardiometabolic risk factors were measured from birth/mid-childhood to age 18 years (y) and included fat and lean mass (9y–18y), systolic and diastolic blood pressure (SBP, DBP), pulse rate and glucose (7y-18y), high-density lipoprotein cholesterol (HDL-c), non-HDL-c and triglycerides (birth-18y). We examined the sex-specific associations between SEP and trajectories of risk factors using linear spline multilevel models.ResultsAmong 6,517-8,952 participants with 11,948-42,607 repeated measures, socioeconomic inequalities in fat mass were evident at age 9y and persisted throughout adolescence, with graded associations across levels of SEP among females only. By 18y, fat mass was 12.32% (95% Confidence Interval (CI):6.96,17.68) lower among females and 7.94% (95% CI:1.91,13.97) lower among males with the highest SEP compared to the lowest. Socioeconomic inequalities in SBP and DBP trajectories were evident at 7y, narrowed in early adolescence and re-emerged between ages 16y-18y, particularly among females. Socioeconomic inequalities in lipid trajectories emerged, among females only, between birth and 9y in non-HDL-c, 7y and 18y in HDL-c and 9y and 18y in triglycerides while inequalities in glucose emerged among males only between ages 15y-18y.ConclusionPrevention targeting the early life course may be beneficial for reducing socioeconomic inequalities in CVD especially among females who have greater socioeconomic inequalities in cardiometabolic risk factors than males at the end of adolescence.