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IJE Advance Access published online on December 24, 2008
International Journal of Epidemiology, 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,*

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