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Meta-Analysis
. 2018 Apr;80(3):278-293.
doi: 10.1097/PSY.0000000000000561.

Socioeconomic Status and Cardiovascular Responses to Standardized Stressors: A Systematic Review and Meta-Analysis

Jennifer Morozink Boylan  1 , Jenny M Cundiff, Karen A Matthews
Affiliations
Meta-Analysis

Socioeconomic Status and Cardiovascular Responses to Standardized Stressors: A Systematic Review and Meta-Analysis

Jennifer Morozink Boylan et al. Psychosom Med. 2018 Apr.

Abstract

Objective: Disparities in cardiovascular health by socioeconomic status (SES) are a pressing public health concern. Hypothesized mechanisms linking low SES to poor health are large cardiovascular responses to and delayed recovery from psychological stress. The current study presents a meta-analysis of the literature on the association of SES with blood pressure and heart rate reactivity to and recovery from acute stress tasks.

Methods: The PubMed database was searched, and 26 unique studies with relevant data were identified (k = 25 reactivity [n = 14,617], k = 6 recovery [n = 1,324]).

Results: Using random-effects models, no significant association between SES and cardiovascular reactivity to stress emerged (r = .008, 95% confidence interval = -.02 to .04), although higher SES was associated with better recovery from stress (r = -.14, 95% confidence interval -.23 to -.05). Stressor type moderated the reactivity effect, wherein higher SES was associated with greater reactivity to cognitive stressors (r = .036, p = .024), not with reactivity to interpersonal stressors (r = -.02, p = .62), but was associated with lower reactivity to tasks with combinations of cognitive, interpersonal, and physical challenges (r = -.12, p = .029). Accounting for publication bias revealed a significant association between SES and reactivity in the opposite direction of hypotheses.

Conclusions: Cardiovascular recovery from acute stress, but not reactivity to stress, may be a key pathway between low SES and risk for cardiovascular diseases. Heterogeneity in effect size and direction, challenges related to working across temporal dynamics, and recommendations for future research are discussed.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Flow diagram of literature search and article selection process.
Figure 2
Figure 2
Forest plot for all reactivity effects aggregated within study (k = 25).
Figure 3
Figure 3
Forest plot of all recovery individual effects aggregated within study (k = 6).
Figure 4
Figure 4
Funnel plot for reactivity effects examining the likelihood of publication bias. Open circles are observed values and black circles are values imputed to correct for potential publication bias.
Figure 5
Figure 5
Funnel plot for recovery effects.
See this image and copyright information in PMC

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