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Health Inequalities: Embodied Evidence Across Biological Layers

20 Pages Posted: 24 Jan 2019

See all articles by Paolo Vineis

Paolo Vineis

Imperial College London - MRC-PHE Centre for Environment and Health; IIGM - Italian Institute for Genomic Medicine

Cyrille Delpierre

University of Toulouse 3, Paul Sabatier University - UMR LEASP

Raphaële Castagné

University of Toulouse 3, Paul Sabatier University - UMR LEASP

Giovanni Fiorito

IIGM - Italian Institute for Genomic Medicine

Cathal McCrory

Trinity College (Dublin) - Department of Gerontology

Mika Kivimäki

University College London - Department of Epidemiology and Public Health

Silvia Stringhini

Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital

Cristian Carmeli

University of Lausanne - Institute of Social and Preventive Medicine (IUMSP)

Michelle Kelly-Irving

University of Toulouse 3, Paul Sabatier University - UMR LEASP

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Abstract

Background: Socioeconomic disparities have been documented in major non-communicable diseases and their risk factors, such as obesity, hypertension, diabetes, smoking, physical inactivity, unhealthful diet and heavy drinking. However, a key research question has remained unanswered: is there a separate biological embodiment of socio-economic conditions underlying health disparities, independent of those risk factors? As lifelong socioeconomic circumstances cannot be randomised, one way forward is the examination of different biological layers of evidence, including molecular changes.

Methods: In this paper we report the association of socio-economic disadvantage with (a) long-term health outcomes, before and after taking risk factors into account; (b) biological intermediaries that increase susceptibility to disease, such as childhood obesity; (c) intermediate circulating biomarkers and omic measurements (transcriptomics, DNA methylation, inflammatory proteins, allostatic load); and (d) immunity. In our Lifepath consortium, these analyses have been performed in several cohort studies, countries and contexts, and at different stages of the life course in up to 1.7 million subjects.

Findings: The findings show consistent associations of social disparities with unfavourable health outcomes spanning inflammatory biomarkers, DNA or RNA-based markers, infection, indicators of physical functioning and mortality. Although each of these associations has a different set of confounders, a dose-response relationship is nevertheless consistently observed, thus showing the power of our multi-layered approach.

Interpretation: This new evidence supports biological embodiment of social disadvantage, in addition to the impact of known (mainly behavioural) risk factors for disease.

Funding Statement: This study was supported by the European Commission (Horizon 2020 grant number 633666) and the Swiss State Secretariat for Education, Research and Innovation SERI.

Declaration of Interests: The authors declare they have no conflicting interests.

Keywords: socio-economic disparities, health, aging, embodiment, biomarkers, omics, triangulation

Suggested Citation

Vineis, Paolo and Delpierre, Cyrille and Castagné, Raphaële and Fiorito, Giovanni and McCrory, Cathal and Kivimäki, Mika and Stringhini, Silvia and Carmeli, Cristian and Kelly-Irving, Michelle, Health Inequalities: Embodied Evidence Across Biological Layers (January 19, 2019). Available at SSRN: https://ssrn.com/abstract=3320219

Paolo Vineis (Contact Author)

Imperial College London - MRC-PHE Centre for Environment and Health ( email )

London, W2 1PG
United Kingdom

IIGM - Italian Institute for Genomic Medicine ( email )

Via Nizza 52
Turin, 10126
Italy

Cyrille Delpierre

University of Toulouse 3, Paul Sabatier University - UMR LEASP

Toulouse
France

Raphaële Castagné

University of Toulouse 3, Paul Sabatier University - UMR LEASP

Toulouse
France

Giovanni Fiorito

IIGM - Italian Institute for Genomic Medicine

Via Nizza 52
Turin, 10126
Italy

Cathal McCrory

Trinity College (Dublin) - Department of Gerontology

Dublin, 8
Ireland

Mika Kivimäki

University College London - Department of Epidemiology and Public Health ( email )

London, WC1E 6BT
United Kingdom

Silvia Stringhini

Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital ( email )

Corniche Road 10
Lausanne, 1010
Switzerland

Cristian Carmeli

University of Lausanne - Institute of Social and Preventive Medicine (IUMSP)

Corniche Road 10
Lausanne, 1010
Switzerland

Michelle Kelly-Irving

University of Toulouse 3, Paul Sabatier University - UMR LEASP

Toulouse
France