Socioeconomic disadvantages in prenatal life may have potential lasting implications for molecular longevity or cellular aging.¹

Compared to more affluent communities, low-income populations in the United States reportedly have poorer chronic disease outcomes and increased risk for the development of chronic illness.^2-4 Compounding these disparities, lower socioeconomic status in the US, determined by a combination of education, occupation, and income measures, has been associated with an increased mortality rate⁵ and accelerated age-related functional declines.⁶

Lower socioeconomic status may influence health and aging at the molecular level. For example, it may shorten telomeres, the DNA protein structures found at the ends of chromosomes that shorten with each cell division until at a certain shortened length, the cell undergoes senescence or apoptosis. In this sense, telomere length has been hypothesized to serve as a biological clock for a cell’s (or a person’s) lifespan. An unhealthy diet, stress, and toxicant exposures may increase the pace of telomere shortening,⁷ and an increased occurrence of all of these is commonly associated with lower socioeconomic status^8-10 due to potential factors such as food insecurity and limited access or resources.

Newborn Telomere Length, SES, & Early Biological Aging

According to a new study, the effect of a low socioeconomic status (SES) on telomeres may span generations. A cohort study published in JAMA in May 2020 found that lower parental socioeconomic status is associated with shorter telomere lengths in newborns, suggesting early biological aging for those children.¹ Specifically, the prospective birth cohort study, conducted in Belgium, included 1,504 mother-newborn pairs who had been recruited between February 1, 2010, and July 1, 2017. Socioeconomic status was determined through assessment of education, occupation, and neighborhood income levels, and telomere length was measured in cord blood and placental tissue. Of the pairs, 1,026 newborns (517 boys) were included in the analysis. Results indicated that:¹

• A higher socioeconomic status was associated with both longer placental and cord blood telomere length.
• Specific to placental tissue, higher socioeconomic status was associated with longer telomere length in newborn boys only.
• Of note, researchers hypothesized that maternal pre-pregnancy BMI, maternal smoking, and birth weight were potential mediators that may impact the relationship between socioeconomic status and newborn telomere length.

SES and Intergenerational Health Impacts

Research has previously indicated an association between telomere length in adults and socioeconomic status.¹¹ Studies have further hypothesized that increased rates of biological aging as well as epigenetic dysregulation are potential mechanisms that illustrate socioeconomic impacts on individual and intergenerational health.^11-13 Under the umbrella of epigenetics, DNA methylation has been proposed as another biomarker of biological aging and a potential link between social adversity, physiological and cellular pathways, and risk of disease.¹³

A 2019 multi-cohort analysis suggested that low education (used as a proxy for socioeconomic status) predicts accelerated biological, or epigenetic, aging.¹³ In addition, a 2012 cohort study investigated the relationship between socioeconomic factors and epigenetic status measured by global DNA methylation (potentially reflective of disease) and found that global DNA hypomethylation was observed in those subjects most socioeconomically deprived.¹⁴ These potential associations between epigenetic and socioeconomic status studied in the individual may fuel those intergenerational mechanisms such as genetic inheritance and social environments that may be involved in transmitting health and well-being across generations.¹⁵ Multigenerational experiences of economic and social disadvantages are often coupled with high levels of psychosocial and physical stressors, for example, potentially resulting in repeated cycles of allostasis that may take a biological toll on regulatory systems and ultimately overall health.¹⁵

Clinical Considerations

In Functional Medicine, understanding each patient’s timeline and story is integral for fostering a collaborative patient-practitioner relationship in order to co-develop an effective, sustainable treatment plan. Prenatal health is a component of that story that helps fully inform these interventions to treat chronic illness by addressing the root causes. How have social, financial, and community conditions potentially impacted the biological aging of your patient? In some cases, biological age calculated through molecular and physiological measurements, rather than chronological age alone, may help clinicians understand a patient’s level of health and risk of disease.¹⁶ Considering that the impact of health disparities may be apparent even as an individual begins life may be an important part of a clinical assessment that includes and organizes all of the elements of a patient’s health journey.

Related Articles and Podcasts

Nathan Price, PhD, on Predictive Biomarkers and Biological Aging

Wisdom on Working With the Underserved

References

1. Martens DS, Janssen BG, Bijnens EM, et al. Association of parental socioeconomic status and newborn telomere length. JAMA Netw Open.2020;3(5):e204057. doi:10.1001/jamanetworkopen.2020.4057
2. Shaw KM, Theis KA, Self-Brown S, Roblin DW, Barker L. Chronic disease disparities by county economic status and metropolitan classification, behavioral risk factor surveillance system, 2013. Prev Chronic Dis. 2016;13:E119. doi:10.5888/pcd13.160088
3. Suarez JJ, Isakova T, Anderson CA, Boulware LE, Wolf M, Scialla JJ. Food access, chronic kidney disease, and hypertension in the U.S. Am J Prev Med. 2015;49(6):912-920. doi:10.1016/j.amepre.2015.07.017
4. Office of Disease Prevention and Health Promotion. Food insecurity. Published 2020. Accessed July 9, 2020. https://www.healthypeople.gov/2020/topics-objectives/topic/social-determinants-health/interventions-resources/food-insecurity
5. Bosworth B. Increasing disparities in mortality by socioeconomic status. Annu Rev Public Health. 2018;39:237-251. doi:10.1146/annurev-publhealth-040617-014615
6. Steptoe A, Zaninotto P. Lower socioeconomic status and the acceleration of aging: an outcome-wide analysis. Proc Natl Acad Sci U S A. 2020;117(26):14911-14917. doi:10.1073/pnas.1915741117
7. Shammas MA. Telomeres, lifestyle, cancer, and aging. Curr Opin Clin Nutr Metab Care. 2011;14(1):28-34. doi:10.1097/MCO.0b013e32834121b1
8. APA Working Group on Stress and Health Disparities. Stress and Health Disparities: Contexts, Mechanisms, and Interventions Among Racial/Ethnic Minority and Low Socioeconomic Status Populations. American Psychological Association; 2017. Accessed July 10, 2020. https://www.apa.org/pi/health-disparities/resources/stress-report.pdf
9. American Psychological Association. Higher stress among minority and low-income populations can lead to health disparities, says report. Published January 8, 2018. Accessed July 10, 2020. https://www.apa.org/news/press/releases/2018/01/stress-minority-income
10. American Lung Association. Disparities in the impact of air pollution. Updated April 20, 2020. Accessed July 12, 2020. https://www.lung.org/clean-air/outdoors/who-is-at-risk/disparities
11. Robertson T, Batty GD, Der G, Fenton C, Shiels PG, Benzeval M. Is socioeconomic status associated with biological aging as measured by telomere length? Epidemiol Rev. 2013;35(1):98-111. doi:10.1093/epirev/mxs001
12. Weihrauch-Blüher S, Richter M, Staege MS. Body weight regulation, socioeconomic status and epigenetic alterations. Metabolism. 2018;85:109-115. doi:10.1016/j.metabol.2018.03.006
13. Fiorito G, McCrory C, Robinson O, et al. Socioeconomic position, lifestyle habits and biomarkers of epigenetic aging: a multi-cohort analysis. Aging (Albany NY). 2019;11(7):2045-2070. doi:10.18632/aging.101900
14. McGuinness D, McGlynn LM, Johnson PC, et al. Socio-economic status is associated with epigenetic differences in the pSoBid cohort. Int J Epidemiol. 2012;41(1):151-160. doi:10.1093/ije/dyr215
15. Cheng TL, Johnson SB, Goodman E. Breaking the intergenerational cycle of disadvantage: the three generation approach. Pediatrics. 2016;137(6):e20152467. doi:10.1542/peds.2015-2467
16. Earls JC, Rappaport N, Heath L, et al. Multi-omic biological age estimation and its correlation with wellness and disease phenotypes: a longitudinal study of 3,558 individuals. J Gerontol A Biol Sci Med Sci. 2019;74(Suppl_1):S52-S60. doi:10.1093/gerona/glz220