CMV and Social Class

The prevalence of CMV infection varies with social class: "In developed countries, 10% to 15% of children are infected with CMV by early adolescence; this varies by socioeconomic class, with greater seroprevalence correlating with lower income and homosexual adolescents and men... From late adolescence to adulthood, seroprevalence of CMV in the United States increases from 15% to 50%, but more than 95% of homosexual men and nearly 100% of HIV-infected homosexual men are CMV-seropositive." (From: Treatment of cytomegalovirus (CMV) retinitis in the era of highly active anti-retroviral therapy. DF Martin. Medscape HIV/AIDS Clinical Management 1999 Aug 30;4. Link died


Cytomegalovirus seroprevalence among women of childbearing age during a 10-year period. GS Marshall, GG Stout. Am J Perinatol 2005 Oct;22(7):371-376. "Overall, 58% of 2992 women were seropositive. After stratification by socioeconomic status (SES), nonwhite race was strongly associated with seropositivity (odds ratio, 3.0; 95% confidence interval [CI], 2.5 to 3.8), and after stratification by race, lower SES also was associated (odds ratio, 2.0; 95% CI, 1.7 to 2.3). There were no trends in seroprevalence over time in any demographic group... Seropositivity ranged from 40% among older, white primigravidas of upper SES to 89% among older, nonwhite, multigravid women of lower SES."

Marshall - Am J Perinatol 2005 abstract / PubMed

Seroprevalence of Cytomegalovirus Infection in the United States, 1988–1994. SAS Staras, SC Dollard, KW Radford, WD Flanders, RF Pass, MJ Cannon. Clin Infect Dis 2006;43:1143-1151. Based on age-specific CMV seroprevalences from the Third National Health and Nutrition Examination Survey (NHANES III). "CMV seroprevalence increased gradually with age, from 36.3% in 6–11-year-olds to 90.8% in those aged 80 years. CMV seroprevalence differed by race and/or ethnicity as follows: 51.2% in non-Hispanic white persons, 75.8% in non-Hispanic black persons, and 81.7% in Mexican Americans."

Staras - Clin Infect Dis 2006 abstract / PubMed
Staras / Clin Infect Dis 2006 full article

Incidence of cytomegalovirus infection among the general population and pregnant women in the United States. FA Colugnati, SA Staras, SC Dollard, MJ Cannon. BMC Infect Dis 2007 Jul 2;7:71. Based on age-specific CMV seroprevalences from the Third National Health and Nutrition Examination Survey (NHANES III). "The average age of CMV infection was 28.6 years. Force of infection was significantly higher among non-Hispanic Blacks (5.7) and Mexican Americans (5.1) than among non-Hispanic Whites (1.4). Force of infection was significantly higher in the low household income group (3.5) than in the middle (2.1) and upper (1.5) household income groups."

Colugnati / BMC Infect Dis 2007 full article

Socioeconomic gradients in immune response to latent infection. JB Dowd, MN Haan, L Blythe, K Moore, AE Aiello. Am J Epidemiol 2008 Jan 1;167(1):112-20. 1,503 California participants in the 1998-1999 Sacramento Area Latino Study on Aging aged 60-100 years. "The odds ratio for being in a higher tertile of cytomegalovirus antibodies was 1.54 (95% confidence interval: 1.18, 2.01) for those in the lowest educational group, and the odds ratio for being in a higher tertile of herpes simplex virus type 1 was 1.63 (95% confidence interval: 1.25, 2.13). The relation between education and cytomegalovirus and herpes simplex virus type 1 antibody levels remained strong after controlling for baseline health conditions, smoking status, and body mass index." Comment: They seem to be missing the fundamental point that lower SES people are more likely to have high antibody levels to CMV because they are more likely to have been infected in the first place, not because of any inherent defect of immune function. Note that in the full article, they do not appear to have restricted the analysis of antibody levels to only those persons who have been infected by the virus!

Dowd - Am J Epidemiol 2008 abstract / PubMed
Dowd / Am J Epidemiol 2008 full article

Socioeconomic and race/ethnic patterns in persistent infection burden among U.S. adults. A Zajacova, JB Dowd, AE Aiello. J Gerontol A Biol Sci Med Sci 2009 Feb;64(2):272-279. 19,275 subjects from NHANES III. "This study identified socioeconomic and racial or ethnic disparities in the burden of multiple persistent infections in a nationally representative sample of U.S. adults. The individual infections are positively correlated with one another, suggesting a nonrandom clustering of infections within individuals. Moreover, this clustering is systematically associated with socioeconomic characteristics. Adults with more education and income have a lower burden of persistent infections throughout adulthood, and non-Hispanic white adults have a lower burden than minority adults. These findings suggest that the burden of persistent infection may be one pathway through which lower socioeconomic position “gets under the skin” and leads to an earlier onset of disease and mortality."

Zajacova - J Gerontol A Biol Sci Med Sci 2009 full article / PubMed Central

Persistent pathogens linking socioeconomic position and cardiovascular disease in the US. AM Simanek, JB Dowd, AE Aiello. Int J Epidemiol 2009 Jun;38(3):775-87. NHANES subjects >/=45 years old. Socioeconomic position "was associated with CMV, HSV-1 and seropositivity to both pathogens. CMV seropositivity was associated with cardiovascular disease history even after adjusting for confounders as well as SEP. The odds of reporting a history of cardiovascular disease for those with less than a high school education compared with those with more than a high school education decreased by 7.7% after adjusting for CMV (Sobel mediation test for CMV, P = 0.0006)." "Approximately 87.9% (N = 6811/7752) of those tested for CMV and 86.2% (N = 3499/4059) tested for HSV-1 were seropositive (data not shown). Of those tested for both CMV and HSV-1, 77.1% were seropositive to both pathogens, 19.0% were seropositive to one of the pathogens and 4.0% were seronegative to both." They found that 40% of cardiovascular disease prevalence was attributable to CMV seropositivity.

Simanek / Int J Epidemiol 2009 full article

Commentary: Understanding the pathophysiology of poverty. FJ Nieto. Int J Epidemiol 2009 Jun;38(3):787-790. "With these caveats in mind, the most striking finding of Simanek et al.'s study is that the relatively modest OR of CVD associated with CMV infection translates into an estimate of the population attributable risk or attributable fraction of CVD of ∼ 40%... What is striking about this 40% attributable fraction estimate is the implication that eliminating CMV infection would prevent as many CVD cases as the complete removal of smoking and almost twice as many as the elimination of either hypercholesterolaemia or hypertension from the population."

Nieto / Int J Epidemiol 2009 full article

Socioeconomic and psychosocial gradients in cardiovascular pathogen burden and immune response: The multi-ethnic study of atherosclerosis. AE Aiello, A Diez-Roux, AM Noone, N Ranjit, M Cushman, MY Tsai, M Szklo. Brain Behav Immun 2009 Jul;23(5):663-71. 999 subjects. "Low education was a strong and significant independent predictor of higher pathogen burden after adjustment for covariates (adjusted odds ratio (OR) 95% confidence interval (CI) 1.37, 1.19-1.57)."

Aiello - Brain Behav Immun 2009 abstract / PubMed

Socioeconomic differentials in immune response. JB Dowd, AE Aiello. Epidemiology 2009 Nov;20(6):902-908. 9721 respondents aged 25 years and older in the Third National Health and Nutrition Examination Survey (NHANES III, 1988-1994). "Among CMV-seropositive respondents, those with less education, lower income, and nonwhite race/ethnicity had higher levels of CMV antibodies at all ages. On average, each additional year of age was associated with CMV antibody levels that were 0.03 units higher (95% confidence interval = 0.03 to 0.04), whereas each additional year of education was associated with antibody levels that were 0.05 units lower (0.02 to 0.09). A doubling of family income was associated with antibody levels that were 0.25 units lower (0.11 to 0.39), the equivalent of 8 fewer years of age-related CMV antibody response. These relationships remained strong after controlling for baseline health conditions, smoking status, and BMI."

Dowd & Aiello - Epidemiology 2009 author manuscript / PubMed Central

Cytomegalovirus seroprevalence in the United States: the national health and nutrition examination surveys, 1988-2004. SL Bate, SC Dollard, MJ Cannon. Clin Infect Dis 2010 Jun 1;50(11):1439-1447. NHANES III (1988–1994) and NHANES 1999–2004 aged 6-49. "For NHANES 1999–2004, the overall age-adjusted CMV seroprevalence was 50.4%. CMV seroprevalence was higher among non-Hispanic black and Mexican American children compared with non-Hispanic white children and increased more quickly in subsequent age groups. CMV seropositivity was independently associated with older age, female sex, foreign birthplace, low household income, high household crowding, and low household education. Compared with NHANES 1988–1994, the overall age-adjusted CMV seroprevalence for NHANES 1999–2004 was not significantly different." Table 1, seroprevalence was 66.3% in low income versus 37.7% in high income level.

Bate / Clin Infect Dis 2010 full article

Review of cytomegalovirus seroprevalence and demographic characteristics associated with infection. MJ Cannon, DS Schmid, TB Hyde. Rev Med Virol 2010 Jul;20(4):202-213. "In this literature review, we found that CMV infection was relatively common among women of reproductive age, with seroprevalence ranging from 45 to 100%. CMV seroprevalence tended to be highest in South America, Africa and Asia and lowest in Western Europe and United States. Within the United States, CMV seroprevalence showed substantial geographic variation as well, differing by as much as 30 percentage points between states, though differences might be explained by variation in the types of populations sampled. Worldwide, seroprevalence among non-whites tended to be 20-30 percentage points higher than that of whites (summary prevalence ratio (PR) = 1.59, 95% confidence interval (CI) = 1.57-1.61). Females generally had higher seroprevalences than males, although in most studies the differences were small (summary PR = 1.13, 95% CI = 1.11-1.14). Persons of lower socioeconomic status were more likely to be CMV seropositive (summary PR = 1.33, 95% CI = 1.32-1.35)."

Cannon - Rev Med Virol 2010 abstract / PubMed

Family poverty is associated with cytomegalovirus antibody titers in U.S. children. JB Dowd, TM Palermo, AE Aiello. Health Psychol 2012 Jan;31(1):5-10. 2,226 children aged 6-16 from the 1999-2004 National Health and Nutrition Examination Survey (NHANES). "Poverty was significantly associated with increased antibody levels among seropositive individuals. The association between income and antibody levels exhibited a threshold effect, with additional income beyond the poverty line not associated with increased antibody titers."

Dowd - Health Psychol 2012 author manuscript / PubMed Central

Cytomegalovirus (CMV) seroprevalence in pregnant women, bone marrow donors and adolescents in Germany, 1996-2010. G Enders, A Daiminger, L Lindemann, F Knotek, U Bäder, S Exler, M Enders. Med Microbiol Immunol 2012 Aug;201(3):303-309. CMV IgG seropositive rate in 40,324 pregnant women and in 31,093 female and male bone marrow donors over 15 consecutive years (1996-2010), plus 1305 healthy adolescents in 1999. "The most influencing factor on CMV seropositivity appeared to be the socioeconomic status (SES), which we characterized by type of health insurance: Seroprevalence in women with low, middle and upper SES was 91.8, 46.9 and 33.7%, respectively."

Enders - Med Microbiol Immunol 2012 abstract / PubMed

Seroepidemiology of Epstein-Barr virus and cytomegalovirus among Israeli male young adults. H Levine, RD Balicer, V Rozhavski, T Halperin, M Shreberk, N Davidovitch, M Huerta-Hartal, OE Ankol. Ann Epidemiol 2012 Nov;22(11):783-788. "Overall seroprevalence rates were 87% for EBV and 59% for CMV. An association between the seroprevalence of EBV and CMV was observed. Seroconversion was 56% for EBV as compared with 31% for CMV. Lower paternal education was found to be associated with both EBV and CMV seroprevalence. Lower socioeconomic status, North African origin, and urban residence were found to be associated with CMV seropositivity, as was smoking for EBV seropositivity."

Levine - Ann Epidemiol 2012 abstract / PubMed

Consistent Associations between Measures of Psychological Stress and CMV Antibody Levels in a Large Occupational Sample. JL Rector, JB Dowd, A Loerbroks, VE Burns, P Moss, MN Jarczok, T Stalder, K Hoffman, JE Fischer, JA Bosch. Brain Behav Immun 2014 May;38:133-141. Occupational cohort of 887, 88% men. "Confirming prior reports, lower SES (education and job status) was positively associated with infection status. Among those infected (N=329), higher CMV-IgG were associated with increased anxiety (β=.14, p<.05), depression (β=.11, p=.06), vital exhaustion (β=.14, p<.05), and decreased SF-12 mental health (β=-.14, p<.05), adjusting for a range of potential confounders. Exploratory analyses showed that these associations were generally stronger in low SES individuals. We found no evidence that elevated inflammation or HPA-function mediated any of the associations."

Rector - Brain Behav Immun 2014 abstract / PubMed

Cytomegalovirus infection in the Netherlands: Seroprevalence, risk factors, and implications. MJ Korndewal, L Mollema, I Tcherniaeva, F van der Klis, AC Kroes, AM Oudesluys-Murphy, AC Vossen, HE de Melker. J Clin Virol 2015 Feb;63:53-58. 6386 individuals by ELISA. "The CMV seroprevalence in the general population (6 months-79 years) was 45.6%. Age and country of origin were the most prominent independent risk factors. The seroprevalence was significantly lower in native Dutch and Western individuals (41.5%) than in non-Western individuals (76.7%). Multivariable logistic regression analysis showed that age, lower educational level, first-generation migrancy, and among native Dutch/Western individuals, female gender and having contact with young children, were independently associated with CMV seropositivity. The geometric mean concentrations of antibodies increased with age and were higher in women than in men."

Korndewal - J Clin Virol 2015 abstract / PubMed

Coprevalence of Epstein-Barr Virus, Cytomegalovirus, and Herpes Simplex Virus Type-1 Antibodies Among United States Children and Factors Associated With Their Acquisition. AS Delaney, W Thomas, HH Balfour Jr. J Pediatric Infect Dis Soc 2015 Dec;4(4):323-329. From NHANES 2003-2004. "Overall, 36% of children had antibody against 2 or more of the viruses. Coprevalence with EBV, CMV, and HSV-1 was higher in females, in non-Hispanic blacks, and Mexican Americans, compared with non-Hispanic whites, and in those without health insurance. Antibody prevalence was associated with (1) lower household income and education and (2) greater crowding. Nearly all children with CMV antibody or HSV-1 antibody had been infected with EBV."

Delaney - J Pediatric Infect Dis Soc 2015 abstract / PubMed

The Excess Burden of Cytomegalovirus in African American Communities: A Geospatial Analysis. PM Lantos, SR Permar, K Hoffman, GK Swamy. Open Forum Infect Dis 2015 Nov 20;2(4):ofv180. 1884 subjects. "Cytomegalovirus seropositivity was significantly more prevalent among African Americans than whites (73% vs 42%; OR = 3.31; 95% confidence interval [CI], 2.7–4.1). Children who were tested before 10 years of age had similar rates of seropositivity in both groups. In contrast, among 10- to 19-year-olds, African Americans had a CMV seroprevalence more than twice that of their white counterparts (58% vs 26%; OR = 3.99; 95% CI, 1.9–8.7), and this discrepancy remained true through age 50. Only among individuals 60 years of age and older were the seroprevalence rates similar among races."

Lantos - Open Forum Infect Dis 2015 full article / PubMed Central

Does Cytomegalovirus Infection Contribute to Socioeconomic Disparities in All-cause Mortality? L Feinstein, CE Douglas, RC Stebbins, G Pawele, AM Simanek, AE Aiello. Mech Ageing Dev 2016 Sep;158:53-61. In NHANES: "We found strong associations between low SES and increased mortality: hazard ratio (HR) 1.80; 95% confidence interval (CI): 1.57, 2.06 comparing the lowest versus highest income groups and HR 1.29; 95% CI: 1.13, 1.48 comparing <high school versus >high school education. 65% of individuals were CMV seropositive, accounting for 6-15% of the SES-mortality associations."

Feinstein - Mech Ageing Dev 2016 abstract / PubMed

Sociodemographic factors associated with IgG and IgM seroprevalence for human cytomegalovirus infection in adult populations of Pakistan: a seroprevalence survey. SIbrahim, AA Siddiqui, AR Siddiqui, W Ahmed, PA Moss, EM Lalani. BMC Public Health 2016 Oct 22;16(1):1112. "The seroprevalence of HCMV-IgG and IgM was 93.2 and 4.3 % respectively. 95.3 % of individuals who were IgM seropositive were also seropositive for IgG. Around 6 % (15/250) of women of childbearing age remained uninfected and were therefore susceptible to primary infection. HCMV-IgG seroprevalence was associated with being female (p = 0.001), increasing age (p = 0.002) and crowding index (p = 0.003) and also with lower levels of both education (p < 0.001) and income (p = 0.008)."

Ibrahim - BMC Public Health 2016 full article / PubMed Central
Ibrahim / BMC Public Health 2016 full article

Associations of social environment, socioeconomic position and social mobility with immune response in young adults: the Jerusalem Perinatal Family Follow-Up Study.GM Lawrence, Y Friedlander, R Calderon-Margalit, DA Enquobahrie, JY Huang, RP Tracy, O Manor, DS Siscovick, H Hochner. BMJ Open 2017 Dec 21;7(12):e016949. 1319 subjects. "Lower levels of household and socioeconomic components in either childhood or adulthood were associated with higher anti-CMV IgG titre level and seropositivity at age 32. Compared with individuals with stable favourable components, anti-CMV IgG titre level and risk for seropositivity were higher in stable unfavourable household and socioeconomic components (household: β=3.23, P<0.001; relative risk (RR)=1.21, P<0.001; socioeconomic: β=2.20, P=0.001; RR=1.14, P=0.01), downward household mobility (β=4.32, P<0.001; RR=1.26, P<0.001) and upward socioeconomic mobility (β=1.37, P=0.04; RR=1.19, P<0.001)."

Lawrence / BMJ Open 2017 full article

Neighborhood Disadvantage is Associated with High Cytomegalovirus Seroprevalence in Pregnancy. PM Lantos, K Hoffman, SR Permar, P Jackson, BL Hughes, A Kind, G Swamy. J Racial Ethn Health Disparities 2018 Aug;5(4):782-786. 3527 women. "Our unadjusted spatial models identified clustering of high CMV odds in poor, urban neighborhoods and clustering of low CMV odds in more affluent suburbs (local odds ratio 0.41 to 1.90). Adjustment for both individual race and neighborhood ADI largely eliminated this spatial variability."

Lantos - J Racial Ethn Health Disparities 2018 abstract / PubMed

Racial and Ethnic Differences in the Prevalence of Congenital Cytomegalovirus Infection. KB Fowler, SA Ross, M Shimamura, A Ahmed, AL Palmer, MG Michaels, DI Bernstein, PJ Sánchez, KN Feja, A Stewart, S Boppana. J Pediatr 2018 Sep;200:196-201.e1. "Black infants had the highest cCMV prevalence (9.5 per 1000 live births; 95% CI, 8.3-11.0), followed by multiracial infants (7.8 per 1000 live births; 95% CI, 4.7-12.0). Significantly lower prevalence rates were observed in non-Hispanic white infants (2.7 per 1000 live births; 95% CI, 2.2-3.3), Hispanic white infants (3.0 per 1000 live births; 95% CI, 2.4-3.6), and Asian infants (1.0 per 1000 live births; 95% CI, 0.3-2.5)."

Fowler - J Pediatr 2018 abstract / PubMed

Socioeconomic status and central adiposity as determinants of stress-related biological responses relevant to cardiovascular disease risk.A Steptoe, TJ Hiltl, JB Dowd, M Hamer. Brain Behav Immun 2019 Mar;77:16-24. " The prevalence of positive CMV serostatus was 44.8% in the higher SES/small WHR group compared with 66.0% in the lower SES/large WHR group." "[T]he interaction suggests that infectious pathways to cardiovascular disease risk may be particularly important among less affluent people with central adiposity."

Steptoe - Brain Behav Immun 2019 abstract / PubMed
Steptoe / Brain Behav Immun 2019 full article
Steptoe - Brain Behav Immun 2019 abstract / PubMed Central

Life Course Socioeconomic Disadvantage and the Aging Immune System: Findings from the Health and Retirement Study. GA Noppert, RC Stebbins, JB Dowd, RA Hummer, AE Aiello. J Gerontol B Psychol Sci Soc Sci 2020 Sep 3 [Epub ahead of print]. 8,168 respondents aged 50+ years. "Those with less than a high school education had 2.00 (95% CI: 1.67, 2.40) times the odds of being in a higher CMV category compared to those with a college degree or greater. In addition, we also observed a significant association with parental education and CMV response. Individuals with parents having 8 years or less of schooling had 2.32 (95% CI: 2.00, 2.70) times the odds of higher CMV response compared to those whose parents had greater than a high school education."

Noppert - J Gerontol B Psychol Sci Soc Sci 2020 abstract / PubMed

See Also:

CMV Impairs Immunity
CMV & other infections cause heart disease
The Surgeon General Lies That Smoking Causes Heart Disease
CMV Causes Rheumatoid Arthritis
CMV is Implicated in Leukemia
Infections Cause Hearing Loss [CMV]
Infections Cause Diabetes [CMV]
Influenza Causes Deaths From Heart and Respiratory Disease [CMV]


cast 09-14-20