Upward mobility may confer adverse cardiometabolic health
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Higher socioeconomic status had been widely regarded to garner better psychological and CV health, but a recent analysis demonstrated that upwardly mobile individuals who achieve greater income than their parents may have adverse cardiometabolic health, more in line with disadvantaged people than consistently advantaged people.
However, psychological stress in upwardly mobile individuals was closer to that of consistently advantaged people than that of disadvantaged people, according to the researchers.
According to a study published in the Journal of the American College of Cardiology, investigators aimed to determine the effects of upward income mobility on stress, depression and metabolic syndrome using data from the National Longitudinal Study of Adolescent Health (Add Health; mean entry age, 16 years; mean assessment age, 29 years; 50% women) and the Midlife in the United States study (MIDUS; mean entry age, 46 years; mean assessment age, 52 years; 54% women). Participants were stratified by socioeconomic factors that included consistently advantaged, or of higher income throughout life (74% in Add Health vs. 63% in MIDUS); upwardly mobile, or lower income in childhood (12% in Add Health vs. 15% in MIDUS); downwardly mobile, or lower income currently (11% in Add Health vs. 15% in MIDUS); and consistently disadvantaged, or lower income throughout life (3% in Add Health vs. 8% in MIDUS).
Socioeconomic status, stress and depression
Upwardly mobile individuals were found to have lower rates of perceived stress than those who were downwardly mobile vs. individuals who were consistently advantaged throughout life, in both the Add Health (mean difference, 0.17; 95% CI, 0.07-0.27 vs. mean difference, 0.23; 95% CI, 0.23-0.43) and MIDUS studies (mean difference, 0.04; 95% CI, –0.07 to 0.16 vs. mean difference, 0.2; 95% CI, 0.06-0.34), according to the study.
For depressive symptoms in the MIDUS study, researchers observed that upwardly mobile participants had similar rates of depressive symptoms to individuals with consistent advantage. Both groups had significantly better symptom profiles compared with those at consistent disadvantage (0.47 standard deviation units lower). In contrast, upwardly mobile participants in the Add Health study had more severe depressive symptoms (RR = 0.17; 95% CI, 0.07-0.27) compared with individuals with consistent advantage, but similar in severity to those with consistent disadvantage (RR = 0.33; 95% CI, 0.23-0.43).
CV impact of socioeconomic status
Moreover, upwardly mobile participants experienced a higher prevalence of metabolic syndrome compared with individuals with consistent advantage (29% vs. 24% in Add Health; 44% vs. 33% in MIDUS). Additionally, rates among upwardly mobile participants were moderately higher than individuals with consistent disadvantage (29% vs. 28% in Add Health; 44% vs. 40% in MIDUS), according to the study.
“Upwardly mobile participants reported substantially less psychological distress than consistently disadvantaged individuals,” Gregory E. Miller, PhD, of the Institute for Policy Research and professor in the department of psychology at Northwestern University, and colleagues wrote. “In fact, on most contrasts their distress levels were comparable to consistently advantaged participants. However, this pattern was reversed was for metabolic syndrome: Here, upwardly mobile participants fared worse than those with consistent advantage, and closely resembled individuals with consistent disadvantage.”
Investigators concluded that upwardly mobile participants were 21% to 27% more likely to show a trade-off pattern between well-being and metabolic syndrome compared with those who are consistently advantaged (Add Health, RR = 1.21; 95% CI, 1.06-1.37; MIDUS, RR = 1.27; 95% CI, 1.07-1.52) and 34% to 36% more likely to experience the trade-off compared with consistently disadvantaged individuals (Add Health, RR = 1.34; 95% CI, 1.01-1.77; MIDUS: RR = 1.36; 95% CI, 1-1.84).
“At a broader level, the patterns in this emerging literature suggest two somewhat counterintuitive conclusions for scientists and clinicians working on cardiovascular disease prevention,” the researchers wrote. “The first is that upward mobility is not always beneficial for cardiometabolic health, even if it improves economic standing and mental health. The second is that psychological well-being and cardiometabolic health are not always in alignment; in fact, the process of achieving upward mobility may cause them to diverge.” – by Scott Buzby
Disclosures: The authors report no relevant financial disclosures.
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