File(s) under permanent embargo
Inequalities in cardiovascular disease mortality : the role of behavioural, physiological and social risk factors
journal contribution
posted on 2010-06-01, 00:00 authored by Alison Beauchamp, Anna PeetersAnna Peeters, R Wolfe, Gavin Turrell, L Harriss, G Giles, D English, J McNeil, D Magliano, S Harrap, D Liew, D Hunt, A TonkinBackground 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.
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.
History
Journal
Journal of epidemiology and community healthVolume
64Issue
6Pagination
542 - 548Publisher
BMJ GroupLocation
London, EnglandPublisher DOI
ISSN
0143-005XeISSN
1470-2738Language
engPublication classification
C1.1 Refereed article in a scholarly journalCopyright notice
2010, BMJ GroupUsage metrics
Categories
No categories selectedKeywords
Australiacardiovascular diseaseseducational statushealth behavioroverweightrisk factorssmokingScience & TechnologyLife Sciences & BiomedicinePublic, Environmental & Occupational HealthCORONARY-HEART-DISEASEALL-CAUSE MORTALITYFOLLOW-UPEDUCATIONAL INEQUALITIESSOCIOECONOMIC POSITIONHEALTH BEHAVIORSTRENDSWOMENMEN
Licence
Exports
RefWorks
BibTeX
Ref. manager
Endnote
DataCite
NLM
DC