Socio-economic Status and Immunosenescence
Across the world, wealth and health go hand in hand. Those with fewer educational and economic resources live shorter lives and experience the onset of chronic disease and loss of functioning at an earlier age on average than their more advantaged peers (
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Socio-economic Status and Immunosenescence Allison E. Aiello and Jennifer Beam Dowd
9.1
Introduction
Across the world, wealth and health go hand in hand. Those with fewer educational and economic resources live shorter lives and experience the onset of chronic disease and loss of functioning at an earlier age on average than their more advantaged peers (Adler and Stewart 2010; Mackenbach 2010). Recent estimates show over a 6-year difference in life expectancy at age 25 for those below the US poverty line compared to those in the top 35 % of the income distribution (Braveman et al. 2010). In Europe, similar socio-economic differences are seen but sometimes of different magnitude across countries. Educational inequalities range from a relative mortality risk that is four times higher for men with the lowest compared to the highest educational attainment in the Czech Republic, Hungary, and Lithuania, to less than two times that of those with the most education in Sweden and Spain (Mackenbach et al. 2008). While the biological mechanisms underlying these socio-economic health inequalities or “disparities” are not well understood, they are often discussed in the context of accelerated aging (Crimmins et al. 2009). Among the biological systems that have been investigated, studies of cardiovascular, metabolic, and neuroendocrine markers are the most common (Dowd et al. 2009b; Seeman et al. 2008). Despite the importance of immunosenescence in aging, research on the contribution of the immune system to health disparities until recently has been quite limited. In this chapter, we will give an overview of recent epidemiological work identifying associations between socio-economic factors and various markers related to immunosenescence, including pathogen burden and immune response to persistent infections such as cytomegalovirus (CMV). CMV infection, in particular, may play A. E. Aiello () Department of Epidemiology, Center for Social Epidemiology & Population Health, University of Michigan 3659 SPH Tower, 109 Observatory Ann Arbor, MI 48109-2029, USA e-mail: [email protected] J. B. Dowd Hunter College, City University of New York (CUNY), New York, NY, USA
J. A. Bosch et al. (eds.), Immunosenescence, DOI 10.1007/978-1-4614-4776-4_9, © Springer Science+Business Media New York 2013
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a direct role in immune system aging, and has even been called the “driving force” behind age-associated alterations to the T-cell immune system (Koch et al. 2006). Infection with this virus increases CMV specific T-cell proliferation, reducing the availability of other T-cells carrying receptors specific for other antigens. This process is referred to as taking up the “immunological space” and limits the capacity of the immune system to mount an efficient immune response in elderly individuals (Trzonkowski et al. 2004). Next, we will touch on the lifecourse framework that motivates much epidemiological and social science research in this area. Overall, socio-economic status (SES) is strongly associated w
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