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IJE Advance Access originally published online on December 24, 2008
International Journal of Epidemiology 2009 38(3):775-787; doi:10.1093/ije/dyn273
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Published by Oxford University Press on behalf of the International Epidemiological Association © The Author 2008; all rights reserved.

Persistent pathogens linking socioeconomic position and cardiovascular disease in the US

Amanda M Simanek1,2, Jennifer Beam Dowd3,4 and Allison E Aiello1,2,*

1 Center for Social Epidemiology & Population Health School of Public Health-University of Michigan, Ann Arbor, USA.
2 Department of Epidemiology, School of Public Health-University of Michigan, Ann Arbor, USA.
3 School of Health Sciences, Hunter College, City University of New York, NY, USA.
4 CUNY Institute for Demographic Research, City University of New York, NY, USA.

* Corresponding author. Department of Epidemiology, Center for Social Epidemiology & Population Health, University of Michigan-School of Public Health, 3659 SPH Tower, 109 Observatory, Ann Arbor, MI 48109-2029, USA. E-mail: aielloa{at}umich.edu


  Abstract

Background Numerous studies have documented a strong inverse association between cardiovascular disease and socioeconomic position (SEP). Several infections are associated with both cardiovascular disease and SEP; hence infection may form an important link between SEP and cardiovascular disease. This study examines whether seropositivity to cytomegalovirus (CMV), to herpes simplex virus type-1 (HSV-1), and/or to both pathogens mediates the relationship between SEP and cardiovascular disease history in a nationally representative sample of the United States.

Methods We conducted a cross-sectional study of subjects ≥45 years of age, who were tested for seropositivity to CMV, HSV-1 or both pathogens and assessed for cardiovascular disease history in the National Health and Nutrition Examination Survey III. Cardiovascular disease history was defined as history of stroke, heart attack and/or congestive heart failure and SEP as education level.

Results SEP was associated with CMV, HSV-1 and seropositivity to both pathogens. CMV seropositivity was associated with cardiovascular disease history even after adjusting for confounders as well as SEP. The odds of reporting a history of cardiovascular disease for those with less than a high school education compared with those with more than a high school education decreased by 7.7% after adjusting for CMV (Sobel mediation test for CMV, P = 0.0006). In contrast, neither seropositivity to HSV-1 nor to both pathogens was associated with cardiovascular disease history after adjusting for SEP.

Conclusions Persistent pathogens such as CMV infection may explain a portion of the relationship between SEP and cardiovascular disease in the United States. Further studies examining additional pathogens and sociobiological mechanisms are warranted.

Keywords SEP, CMV, HSV-1, co-infection, cardiovascular disease, mediation

Accepted 17 November 2008


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