Inequalities in cardiovascular disease mortality : the role of behavioural, physiological and social risk factors

Beauchamp, Alison, Peeters, Anna, Wolfe, Rory, Turrell, Gavin, Harriss, Linton R., Giles, Graham G., English, Dallas R., McNeil, John, Magliano, Dianna, Harrap, Stephen, Liew, Danny, Hunt, David and Tonkin, Andrew 2010, Inequalities in cardiovascular disease mortality : the role of behavioural, physiological and social risk factors, Journal of epidemiology and community health, vol. 64, no. 6, pp. 542-548, doi: 10.1136/jech.2009.094516.

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Title Inequalities in cardiovascular disease mortality : the role of behavioural, physiological and social risk factors
Author(s) Beauchamp, AlisonORCID iD for Beauchamp, Alison
Peeters, Anna
Wolfe, Rory
Turrell, Gavin
Harriss, Linton R.
Giles, Graham G.
English, Dallas R.
McNeil, John
Magliano, Dianna
Harrap, Stephen
Liew, Danny
Hunt, David
Tonkin, Andrew
Journal name Journal of epidemiology and community health
Volume number 64
Issue number 6
Start page 542
End page 548
Total pages 7
Publisher BMJ Group
Place of publication London, England
Publication date 2010-06
ISSN 0143-005X
Keyword(s) Australia
cardiovascular diseases
educational status
health behavior
risk factors
Summary Background While the relationship between socio-economic disadvantage and cardiovascular disease (CVD) is well established, the role that traditional cardiovascular risk factors play in this association remains unclear. The authors examined the association between education attainment and CVD mortality and the extent to which behavioural, social and physiological factors explained this relationship.

Methods Adults (n=38 355) aged 40–69 years living in Melbourne, Australia were recruited in 1990–1994. Subjects with baseline CVD risk factor data ascertained through questionnaire and physical measurement were followed for an average of 9.4 years with CVD deaths verified by review of medical records and autopsy reports.

Results CVD mortality was higher for those with primary education only, compared with those who had completed tertiary education, with an HR of 1.66 (95% CI 1.10 to 2.49) after adjustment for age, country of birth and gender. Those from the lowest educated group had a more adverse cardiovascular risk factor profile compared with the highest educated group, and adjustment for these risk factors reduced the HR to 1.18 (95% CI 0.78 to 1.77). In analysis of individual risk factors, smoking and waist circumference explained most of the difference in CVD mortality between the highest and lowest education groups.

Conclusions Most of the excess CVD mortality in lower socio-economic groups can be explained by known risk factors, particularly smoking and overweight. While targeting cardiovascular risk factors should not divert efforts from addressing the underlying determinants of health inequalities, it is essential that known risk factors are addressed effectively among lower socio-economic groups.
Language eng
DOI 10.1136/jech.2009.094516
Field of Research 119999 Medical and Health Sciences not elsewhere classified
Socio Economic Objective 970111 Expanding Knowledge in the Medical and Health Sciences
HERDC Research category C1.1 Refereed article in a scholarly journal
Copyright notice ©2010, BMJ Group
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Document type: Journal Article
Collections: Faculty of Health
Population Health
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