Why do children from poorer families suffer more heart disease in adulthood?A study using linked electronic health&social records of 100m Brazilians

Lead Research Organisation: London Sch of Hygiene and Trop Medicine
Department Name: Epidemiology and Population Health


Why do children from poorer families suffer more heart disease in adulthood? A study using linked electronic health and social records of 100 million Brazilians

Motivating questions

Why do children from poorer families suffer more heart disease in adulthood? Are there specific developmental mechanisms behind this or is it just that poor children tend to become poor adults?
Is the situation different in Brazil (middle income, rapidly developed over last 50 years) compared to Western Europe/USA where most of the existing research has been conducted?
Can we use processes like rural-urban migration and social mobility as "natural experiments" to better understand how poor living conditions early in life determine adult heart disease risk?
What methods can we use for better causal inference in lifecourse research in big routine datasets?


The overall aim of my PhD is to forward global understanding of the mechanisms by which socioeconomic position influences cardiovascular health throughout the lifecourse. I propose to use a dataset consisting of linked routine social and health data on roughly 100 million people in Brazil. This will have uniquely high power to examine the social and biological pathways through which early life disadvantage leads to cardiovascular disease (CVD) and the role of adult life socioeconomic position on this process. In doing this, I will explore use of methods for making stronger causal inference using thin routine data in lifecourse epidemiology research.


The effect of early life deprivation on CVD has been clearly illustrated in high-income settings, although the precise operating pathways are less well understood and the possibly modifying role of adult life socioeconomic position has been difficult to tease out due to high correlations between socioeconomic position in early and adult life. Investigating this question in Brazil has several advantages compared to in high income settings: a) rapid and uneven development over the past few decades leading to greater lifecourse socioeconomic exposure variation, and b) different socioeconomic patterning of disease risks leading to different confounding structures and thus the potential for robust causal inference from cross-country comparisons.

Establishing the causal pathways from early life socioeconomic disadvantage to CVD in low- and middle-income settings is a priority for the development and appropriate targeting of public health interventions - for example for determining the relative importance of biological pathways such as early life undernutrition compared to social pathways like formation of behavioural habits in childhood which continue into adulthood.

Research questions

These are currently being finalised and will be updated soon.

The data

I propose to use Brazilian national routine data. This includes hospitalisation, mortality and certain disease notification records available from the early 2000's, all linked together deterministically. These have been linked probabilistically to the national social registry, Cadastro Unico (n=100 million) which contains data on all Brazilian families registering for national social assistance since 2003.


During this PhD training I will gain key quantitative skills for the managing and analysing large routine health datasets in epidemiological research. To gain these skills I will participate in relevant modules of the MSc in medical statistics at LSHTM, and also attend short courses on causal inference at LSHTM and big data at the Farr Institute.

Key words

Cardiovascular disease; lifecourse; social determinants of health; big data; Brazil


10 25 50
Description Series of workshops in secondary schools to learn about careers in public health 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Schools
Results and Impact I led a group of MRC PhD students in getting funding for, developing and delivering a public engagement activity with local schools. We visited 3 schools in the London area to deliver a total of 6 2-hour workshops on careers in public health. A class of between 20 and 40 students in year 10/11 were asked to help answer questions to advise the government on how to stop a simulated malaria outbreak that had just begun in London. Students were asked at the beginning of the session for what careers they thought would be involved in this work. They then got to see how people at LSHTM would be involved - epidemiologist, entomologists, statisticians, modellers and diagnosticians - to demonstrate the range of science careers available in public health. Each career had a stand where students learned about the work of that profession in 15 minutes with interactive learning tools used. School students asked lots of questions about epidemiology/public health and career paths involved, and we received excellent written feedback from the teachers present. All 3 schools have invited us to come back and deliver the workshop to further classes.
Year(s) Of Engagement Activity 2018,2019