Sex Differences in the Association of Childhood Socioeconomic Status With Adult Blood Pressure Change: The CARDIA Study

Objective To examine sex differences in the relation of childhood socioeconomic status (CSES) to systolic (SBP) and diastolic blood pressure (DBP) trajectories during 15 years, spanning young (mean [M] [standard deviation {SD}] = 30 [3] years) and middle (M [SD] = 45 [3] years) adulthood, independent of adult SES.

Methods A total of 4077 adult participants reported father’s and mother’s educational attainments at study enrollment (Year 0) and own educational attainment at enrollment and at all follow-up examinations. Resting BP also was measured at all examinations. Data from examination Years 5 (when participant M [SD] age = 30 [3] years), 7, 10, 15, and 20 are examined here. Associations of own adult (Year 5), mother’s, and father’s educations with 15-year BP trajectories were examined in separate multilevel models. Fully controlled models included time-invariant covariates (age, sex, race, recruitment center) and time-varying covariates that were measured at each examination (marital status, body mass, cholesterol, oral contraceptives/hormones, and antihypertensive drugs). Analyses of parental education controlled for own education.

Results When examined without covariates, higher education — own (SBP γ = −0.03, DBP γ = −0.03), mother’s (SBP γ = −0.02, DBP γ = −0.02), and father’s (SBP γ = −0.02, DBP γ = −0.01) — were associated with attenuated 15-year increases in BP (p < .001). Associations of own (but not either parent’s) education with BP trajectories remained independent of standard controls. Sex moderated the apparent null effects of parental education, such that higher parental education—especially mother’s, predicted attenuated BP trajectories independent of standard covariates among women (SBP γ = −0.02, p = .02; DBP γ = −0.01, p = .04) but not men (SBP γ = 0.02, p = .06; DBP γ = 0.005, p = .47; p interaction SBP < .001, p interaction DBP = .01).

Conclusions Childhood socioeconomic status may influence women’s health independent of their own adult status.