Association of Lifecourse Socioeconomic Status with Chronic Inflammation and Type 2 Diabetes Risk: The Whitehall II Prospective Cohort Study

Silvia Stringhini, G. David da Batty, Pascal Bovet, Martin J. Shipley, Michael G. Marmot, Meena Kumari, A. Tabák, Mika Kivimäki

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Abstract

Background:Socioeconomic adversity in early life has been hypothesized to "program" a vulnerable phenotype with exaggerated inflammatory responses, so increasing the risk of developing type 2 diabetes in adulthood. The aim of this study is to test this hypothesis by assessing the extent to which the association between lifecourse socioeconomic status and type 2 diabetes incidence is explained by chronic inflammation.Methods and Findings:We use data from the British Whitehall II study, a prospective occupational cohort of adults established in 1985. The inflammatory markers C-reactive protein and interleukin-6 were measured repeatedly and type 2 diabetes incidence (new cases) was monitored over an 18-year follow-up (from 1991-1993 until 2007-2009). Our analytical sample consisted of 6,387 non-diabetic participants (1,818 women), of whom 731 (207 women) developed type 2 diabetes over the follow-up. Cumulative exposure to low socioeconomic status from childhood to middle age was associated with an increased risk of developing type 2 diabetes in adulthood (hazard ratio [HR] = 1.96, 95% confidence interval: 1.48-2.58 for low cumulative lifecourse socioeconomic score and HR = 1.55, 95% confidence interval: 1.26-1.91 for low-low socioeconomic trajectory). 25% of the excess risk associated with cumulative socioeconomic adversity across the lifecourse and 32% of the excess risk associated with low-low socioeconomic trajectory was attributable to chronically elevated inflammation (95% confidence intervals 16%-58%).Conclusions:In the present study, chronic inflammation explained a substantial part of the association between lifecourse socioeconomic disadvantage and type 2 diabetes. Further studies should be performed to confirm these findings in population-based samples, as the Whitehall II cohort is not representative of the general population, and to examine the extent to which social inequalities attributable to chronic inflammation are reversible.Please see later in the article for the Editors' Summary.

Original languageEnglish
Article numbere1001479
JournalPLoS Medicine
Volume10
Issue number7
DOIs
Publication statusPublished - Jul 2013

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Medical problems
Social Class
Type 2 Diabetes Mellitus
Cohort Studies
Prospective Studies
Inflammation
Confidence Intervals
Hazards
Trajectories
Incidence
C-Reactive Protein
Population
Interleukin-6
Phenotype

ASJC Scopus subject areas

  • Medicine(all)

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Stringhini, S., da Batty, G. D., Bovet, P., Shipley, M. J., Marmot, M. G., Kumari, M., ... Kivimäki, M. (2013). Association of Lifecourse Socioeconomic Status with Chronic Inflammation and Type 2 Diabetes Risk: The Whitehall II Prospective Cohort Study. PLoS Medicine, 10(7), [e1001479]. https://doi.org/10.1371/journal.pmed.1001479

Association of Lifecourse Socioeconomic Status with Chronic Inflammation and Type 2 Diabetes Risk : The Whitehall II Prospective Cohort Study. / Stringhini, Silvia; da Batty, G. David; Bovet, Pascal; Shipley, Martin J.; Marmot, Michael G.; Kumari, Meena; Tabák, A.; Kivimäki, Mika.

In: PLoS Medicine, Vol. 10, No. 7, e1001479, 07.2013.

Research output: Contribution to journalArticle

Stringhini, Silvia ; da Batty, G. David ; Bovet, Pascal ; Shipley, Martin J. ; Marmot, Michael G. ; Kumari, Meena ; Tabák, A. ; Kivimäki, Mika. / Association of Lifecourse Socioeconomic Status with Chronic Inflammation and Type 2 Diabetes Risk : The Whitehall II Prospective Cohort Study. In: PLoS Medicine. 2013 ; Vol. 10, No. 7.
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