RESEARCH REPORTS

Relational pathways between socioeconomic position and cardiovascular risk in a multiethnic urban sample: complexities and their implications for improving health in economically disadvantaged populations

A J Schulz¹, J S House², B A Israel¹, G Mentz¹, J T Dvonch³, P Y Miranda¹, S Kannan³, M Koch⁴

¹ Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI, USA
² Survey Research Center and Department of Sociology, University of Michigan, Ann Arbor, MI, USA
³ Nutrition Department, Chenoweth Laboratory, School of Public Health and Health Sciences, University of Massachusetts, Amherst, MA, USA
⁴ Brightmoor Community Center, Detroit, MI, USA

Correspondence to:
Dr A J Schulz, Department of Health Behavior and Health Education, University of Michigan, School of Public Health, 1420 Washington Heights, Ann Arbor, MI 48109-2029, USA; ajschulz{at}umich.edu

Background: The study was designed to provide evidence of a cascade effect linking socioeconomic position to anthropometric indicators of cardiovascular disease (CVD) risk through effects on psychosocial stress, psychological distress and health-related behaviours, and consider implications for disease prevention and health promotion.

Methods: A cross-sectional stratified two-stage probability sample of occupied housing units in three areas of Detroit, Michigan, was used in the study. 919 adults aged 25 years completed the survey (mean age 46.3; 53% annual household income <$20 000; 57% non-Hispanic black, 22% Latino, 19% non-Hispanic white). Variables included self-report (eg, psychosocial stress, depressive symptoms, health behaviours) and anthropometric measurements (eg, waist circumference, height, weight). The main outcome variables were depressive symptoms, smoking status, physical activity, body mass index and waist circumference.

Results: Income was inversely associated with depressive symptoms, likelihood of current smoking, physical inactivity and waist circumference. These relationships were partly or fully mediated by psychosocial stress. A suppressor effect of current smoking on the relationship between depressive symptoms and waist circumference was found. Independent effects of psychosocial stress and psychological distress on current smoking and waist circumference were found, above and beyond the mediated pathways.

Conclusions: The results suggest that relatively modest improvements in the income of economically disadvantaged people can set in motion a cascade of effects, simultaneously reducing exposure to stressful life conditions, improving mental well-being, increasing health-promoting behaviours and reducing anthropometric risks associated with CVD. Such interventions offer important opportunities to improve population health and reduce health disparities.

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