Social Integration and Concentrations of C-Reactive Protein Among US Adults

doi:10.1016/j.annepidem.2005.08.005

Annals of Epidemiology

Volume 16, Issue 2, February 2006, Pages 78-84

https://doi.org/10.1016/j.annepidem.2005.08.005 Get rights and content

Purpose

This study tests whether social integration is associated with C-reactive protein (CRP) level, a biologic risk factor for cardiovascular disease.

Methods

Using data from 14,818 participants aged ≥ 20 years from the Third National Health and Nutrition Examination Survey (1988 to 1994), we created a social network index using marital status; number of contacts with family, friends, and neighbors; frequency of religious service attendance; and participation in voluntary organizations. Serum CRP concentration was measured by means of latex-enhanced nephelometry, a low-sensitivity assay, and dichotomized into 3 mg/L or less and greater than 3 mg/L.

Results

After adjustment for multiple potential confounders, men aged ≥ 60 years with the fewest ties were more likely to have an elevated CRP concentration than men with the most ties (odds ratio = 1.80; 95% confidence interval, 1.11–2.92). This occurred in a dose-response manner, with each decrease in number of ties associated with an increase in the proportion of men with elevated CRP levels. The association between social networks and CRP level after multivariate adjustment was not significant in women or younger men.

Conclusion

In this nationally representative cohort, CRP level was associated with social integration in older men, but not women or younger men. There may be sex- and age-related differences in biologic processes influenced by social integration.

Introduction

A substantial body of research has shown in prospective studies that social integration (a measure of close social relationships and social ties to community) is predictive of mortality from a number of causes, including cardiovascular disease (CVD) 1, 2, 3, 4, 5. There tends to be a dose-response relationship, and the strength of association tends to be stronger and more consistent in men than women 2, 6, 7.

Biologic mechanistic evidence is one of several aids to determine causality 8, 9. Currently, biologic mechanisms by which social integration may cause CVD remain poorly understood. Emerging risk factors for CVD, such as inflammatory markers, represent novel biologic pathways by which social integration may influence CVD. Inflammation is a recently established risk factor for the onset and progression of CVD (10), and one of the most studied inflammatory markers is C-reactive protein (CRP). A recent meta-analysis of 22 prospective studies found that coronary heart disease was predicted with an odds ratio of 1.58 (95% confidence interval [CI], 1.48–1.68) for the upper tertile compared with the lower tertile of CRP concentration (11).

Associations between social integration and markers of inflammation have not been well characterized. Therefore, we analyzed data from the Third National Health and Nutrition Examination Survey (NHANES III) with the objective to examine the association between social integration and CRP concentration. Because sex differences have been reported in the effects of social integration on mortality 2, 6, 7, we performed sex-specific analyses.

Section snippets

Methods

NHANES III was carried out from 1988 to 1994. Using a multistage stratified sampling design, a representative sample of the civilian noninstitutionalized population was recruited into the survey. After an interview in the home, participants were invited to attend one of three examination sessions: morning, afternoon, or evening. Some participants unable to attend the examination because of health reasons received a limited examination at home. Details about the survey and its methods have been

Results

Of the 16,573 participants aged ≥20 years who attended the mobile examination center, 15,555 had data for both the SNI and CRP concentration. After eliminating participants with missing data for other study variables, 14,818 participants remained in the analysis. Selected characteristics of the study population are listed in Table 1. Distribution of the SNI differed significantly between men and women (p_chi-square = 0.001; Table 1). A greater percentage of men were socially isolated than women.

Discussion

These results from a nationally representative sample of US adults suggest that social integration may be associated inversely with CRP concentration in older men. The relation between social integration and inflammation has been studied minimally, and to date, research has focused primarily on the hemostatic/inflammatory marker fibrinogen. A significant association between fibrinogen concentration and social integration was shown 17, 18, 19, 20, 21, 22, although after adjusting for

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Social Integration and Concentrations of C-Reactive Protein Among US Adults

Purpose

Methods

Results

Conclusion

Introduction

Section snippets

Methods

Results

Discussion

Ann Epidemiol

Cytokine

Brain Behav Immun

Cytokine

Biol Psychiatry

Social networks, host resistance, and mortality: A nine-year follow-up study of Alameda County residents

Am J Epidemiol

Social relationships and health

Science

Social network ties and mortality among the elderly in the Alameda County study

Am J Epidemiol

Lack of social support and incidence of coronary heart disease in middle-aged Swedish men

Psychosom Med

Social ties and change in social ties in relation to subsequent total and cause-specific mortality and coronary heart disease incidence in men

Am J Epidemiol

Gender differences in cardiovascular morbidity and mortality: The contribution of social networks and support

Ann Behav Med

Gender differences in social support and physical health

Health Psychol

Causation and causal inference

Markers of inflammation and cardiovascular disease: Application to clinical and public health practice: A statement for healthcare professionals from the Centers for Disease Control and Prevention and the American Heart Association

Circulation

C-Reactive protein and other circulating markers of inflammation in the prediction of coronary heart disease

N Engl J Med

Centers for Disease Control and Prevention. The Third National Health and Nutrition Examination Survey (NHANES III 1988-94) Reference Manuals and Reports