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IJE Advance Access published online on January 19, 2005
International Journal of Epidemiology, doi:10.1093/ije/dyh381
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IJE © International Epidemiological Association 2005; all rights reserved.
Accepted October 25, 2004

Original paper

Socioeconomic status and health: is parasympathetic nervous system activity an intervening mechanism?

Richard P. Sloan 1*, Mei-Hua Huang 2, Stephen Sidney 3, Kiang Liu 4, O. Dale Williams 5, and Teresa Seeman 2

1 Behavioral Medicine Program, Columbia University Medical Center, Box 427, 622 West 168th Street, New York, NY 10032, USA; Division of Behavioral Medicine, Department of Psychiatry, Columbia University, New York, NY, USA; New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, USA
2 Division of Geriatrics, Geffen School of Medicine at UCLA, Los Angeles, CA, USA
3 Kaiser Permanente, Division of Research, Oakland, CA, USA
4 Department of Medicine, Northwestern University, Chicago, IL, USA
5 Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA

* To whom correspondence should be addressed.
Richard P. Sloan, E-mail: rps7{at}columbia.edu


  Abstract

Background The link between socioeconomic status (SES) and health is widely recognized but the pathophysiologic mechanisms are not well understood. We tested the hypothesis that parasympathetic nervous system (PNS) regulation is one such mechanism.

Methods In a cross-sectional study, electrocardiogram-derived RR interval variability (RRV), a non-invasive index of cardiac PNS regulation, and SES, measured as educational attainment and income, were collected in 756 subjects in the CARDIA study of heart disease in young adults.

Results Relative to those with less than a high school education, those with high school to college and post-college education had 26% ({beta} = 0.233) and 43% ({beta} = 0.355) greater low frequency (LF) RRV, respectively, adjusted for age, sex, and race. For high frequency (HF) RRV, race interacted with income: relative to low income whites, intermediate and high income whites had 133 and 191% greater HF power, respectively, while intermediate and high income blacks had 32 and 44% greater HF RRV, respectively, relative to low income blacks.

Conclusions Numerous studies demonstrate that psychosocial stressors reduce cardiac parasympathetic regulation and that SES disparities are associated with increasing social stress proportional to the degree of disparity. Data from the current study suggest that PNS regulation may be a mechanism linking the stressful effects of low SES to increased morbidity and mortality.

Keywords: Parasympathetic nervous system; Socioeconomic status; community study.
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