Association of Life-Course Social Mobility With Cardiovascular Disease and Modifiable Risk Factors: Evidence From the Longitudinal Aging Study in India.

Abstract

Assessing cardiovascular disease risk in relation to life-course socioeconomic position may provide insights into social mobility patterns; however, to the authors' knowledge, this association remains unexplored in India. Whereas studies from high-income countries demonstrate an inverse association between life-course socioeconomic position and cardiovascular disease, results from lower-income countries are heterogeneous. This study examines the association between life-course social mobility, cardiovascular disease, and modifiable risk factors among middle-aged and older Indians. This study utilized data from the Longitudinal Aging Study in India (2017-2018), a nationally representative cross-sectional study of adults aged ≥45 years. On the basis of socioeconomic position during childhood (family financial position) and adulthood (monthly per-capita expenditure; household assets), life-course social mobility was classified into 4 categories: consistently high, upward mobility, downward mobility, and consistently low. Associations were examined using regression models. The analytical sample included 65,364 respondents. Social mobility patterns indicated that 40.29% remained in consistently high socioeconomic position, 19.32% in consistently low socioeconomic position, whereas 19.57% experienced upward mobility, and 20.82% experienced downward mobility. Compared with those with consistently low socioeconomic position, those in consistently high socioeconomic position were associated with greater odds of congestive heart failure (AOR=1.80; 95% CI=1.21, 2.69), heart attack (AOR=1.70; 95% CI=1.35, 2.16), abnormal heart rhythm (AOR=1.43; 95% CI=1.05, 1.94), heart diseases (AOR=1.37; 95% CI=1.15, 1.63), and composite cardiovascular disease (AOR=1.23; 95% CI=1.07, 1.42). Furthermore, upward social mobility was associated with higher odds of all cardiovascular disease outcomes except abnormal heart rhythm and stroke. Life-course social mobility also showed a graded association with hypertension, BMI, central adiposity, and diabetes. The positive associations persisted when using adult asset-based social mobility, coarsened exact matching, and multiple sensitivity analyses with various socioeconomic position indicators. The findings suggest that in settings undergoing rapid epidemiologic transition, such as India, life-course social mobility may confer increased cardiovascular disease risk, underscoring the importance of considering country-specific life-course socioeconomic processes in cardiovascular disease prevention strategies.