Childhood factors determine migrant CVD death risk

27 March 2008

MedWire News: The risk for death from cardiovascular disease (CVD) among South-Asian men living in the UK may depend on their social and economic situations during childhood, research indicates.

T Tillin (St Mary's and Hammersmith Hospitals, London, UK) and colleagues studied 1420 South-Asian men, aged 40 to 69 years, living in London, of whom 52% were of Punjabi Sikh origin.

Length of education and paternal occupation were used as the primary markers of childhood socioeconomic position, with adult markers including current or most recent occupation at baseline, qualifications and training, supervisory status, and home tenure.

During a mean 17.1 years of follow-up, 217 men died, 143 from CVD.

Men in non-manual occupations as adults were less likely to die from CVD than those in unskilled manual occupations, with an age-adjusted hazard ratio (HR) of 0.55.

Those with at least 11 years of education also had a reduced risk for CVD compared with their less-schooled counterparts, with an HR of 0.66.

A combination of non-manual occupation and at least 11 years of education resulted in an HR of 0.39 compared with the greatest social disadvantage during childhood and adulthood.

Similar but weaker associations were observed when paternal occupation was used to define childhood socioeconomic position.

Writing in the journal Heart, the researchers conclude: "Socioeconomic disadvantage estimated in childhood and middle age appeared to confer a marked increase in risk of CVD death in South-Asian men."

In an accompanying editorial, Justin Zaman (Norfolk and Norwich University Hospital) and Eric Brunner (University College London) added: "Though the poorest socioeconomic groups in India are more likely to die of infectious disease than CVD, with improved public health today's lower castes and classes in India may survive into adulthood only to be tomorrow's Indian ischemic heart disease patients."

Heart 2008; 94: 476-481