• Poppy Alice Carson Mallinson, Judith Lieber, and Sanjay Kinra.
• Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom. Electronic address: poppy.mallinson1@lshtm.ac.uk.
• Am J Prev Med. 2021 Nov 1; 61 (5): e251-e266.

IntroductionSocioeconomic disadvantage in childhood is strongly associated with a higher risk of cardiovascular disease in high-income countries. However, the association in low- and middle-income countries, where childhood poverty remains prevalent, has not been reviewed.MethodsThe authors systematically searched Embase, MEDLINE, and Global Health databases for articles on the association between childhood socioeconomic position and risk of cardiovascular disease in adulthood in low- and middle-income countries until September 2020. Outcomes included measures of cardiovascular disease, its subclinical markers (e.g., carotid intima-media thickness), and its major risk factors (e.g., hypertension, dyslipidemia, diabetes). Where available, associations were extracted before and after adjustment for socioeconomic position in adulthood. Results were synthesized qualitatively by outcome. The study protocol is registered on PROSPERO (CRD42018086984).ResultsThe search returned 3,568 unique abstracts, from which 29 eligible articles from 14 middle-income countries were identified, representing >150,000 participants. The most commonly reported outcomes were cardiovascular risk factors; very few studies reported prevalent measures of cardiovascular disease, and no studies reported cardiovascular disease incidence or mortality. Of the 46 reported associations between childhood socioeconomic position and risk of cardiovascular disease, 8 were inverse, 0 were positive, and 38 showed no clear evidence of association. All articles had high (16/29) or medium (13/29) risk of bias.ConclusionsCurrent evidence from middle-income countries provides little support for an association between childhood socioeconomic position and risk of cardiovascular disease, and evidence from low-income countries is lacking. It would be premature to consider childhood poverty as a target for cardiovascular disease prevention in these settings.Copyright © 2021 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

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