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Association of socioeconomic status change between infancy and adolescence and blood pressure in South African young adults: Birth to Twenty Cohort

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posted on 2016-04-12, 13:34 authored by Juliana Kagura, Linda S. Adair, Pedro T. Pisa, Paula GriffithsPaula Griffiths, John M. Pettifor, Shane A. Norris
OBJECTIVE. Social epidemiology models suggest that socioeconomic status (SES) mobility across the life course affects blood pressure. The aim of this study was to investigate the association between SES change between infancy and adolescence, and blood pressure, in young adults, and the impact of early growth on this relationship. SETTING. Data for this study were obtained from a ‘Birth to Twenty’ cohort in Soweto, Johannesburg, in South Africa. PARTICIPANTS. The study included 838 Black participants aged 18 years who had household SES measures in infancy and at adolescence, anthropometry at 0, 2, 4 and 18 years of age and blood pressure at the age of 18 years. METHODS. We computed SES change using asset-based household SES in infancy and during adolescence as an exposure variable, and blood pressure and hypertension status as outcomes. Multivariate linear and logistic regressions were used to investigate the associations between SES change from infancy to adolescence, and age, height and sex-specific blood pressure and hypertension prevalence after adjusting for confounders. RESULTS. Compared to a persistent low SES, an upward SES change from low to high SES tertile between infancy and adolescence was significantly associated with lower systolic blood pressure (SBP) at the age of 18 years (β=−4.85; 95% CI −8.22 to −1.48; p<0.01; r2=0.1804) after adjusting for SES in infancy, small-for-gestational-age (SGA) and weight gain. Associations between SES change and SBP were partly explained by weight gain between birth and the age of 18 years. There was no association between SES mobility and diastolic blood pressure, mean arterial pressure or hypertension status. CONCLUSIONS. Our study confirms that upward SES change has a protective effect on SBP by the time participants reach young adulthood. Socioeconomic policies and interventions that address inequality may have the potential to reduce cardiovascular disease burden related to BP in later life.


The ‘Birth to Twenty’ cohort study was supported by the Wellcome Trust (grant number 092097/Z/10/Z), University of Witwatersrand and South African Medical Research Council, and the South African Human Science Research Council. JK and SAN were supported by the UK-MRC/DfID African research leader scheme. PG is supported by a British Academy mid-career fellowship (Ref: MD120048).



  • Sport, Exercise and Health Sciences

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BMJ Open


KAGURA, J. ... et al., 2016. Association of socioeconomic status change between infancy and adolescence and blood pressure in South African young adults: Birth to Twenty Cohort. BMJ Open, 6, DOI: 10.1136/bmjopen-2015-008805.


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This work is made available according to the conditions of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) licence. Full details of this licence are available at: https://creativecommons.org/licenses/by-nc-nd/4.0/

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