Socioeconomic status and C-reactive protein levels in the US population: NHANES IV.

C-reactive protein (CRP), a marker of inflammation, has been identified as a risk factor for cardiovascular disease and mortality. Using data on adults aged 20 and over from the fourth National Health and Nutrition Examination Survey, a nationally representative cross-sectional survey, we examined the association between socioeconomic status and CRP in US adults (N=7634). Socioeconomic variation in CRP occurred only at very high levels of CRP (>10.0 mg/L). There was no significant difference in the prevalence of moderate (1.1-3.0 mg/L) or high values of CRP (3.1-10.0mg/L) by socioeconomic status; however, among those with family income at or below the poverty level, 15.7% had very high levels of CRP (greater than 10.0 mg/L), compared to only 9.1% of those in families above the poverty level. Logistic regression results indicate that acute illness, chronic conditions, and differential health behaviors account for about two-thirds of this association. African Americans, Hispanics, and women were more likely to have high levels of CRP. Obesity was the largest risk factor for every level of CRP above normal. Results suggest that differences in very high CRP may be due to factors beyond acute illness and may also reflect chronic health, behavioral and disease processes associated with low socioeconomic status.