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Sex differences in the relationship between socioeconomic status and cardiovascular disease: a systematic review and meta-analysis

journal contribution
posted on 01.06.2017, 00:00 authored by Kathryn BackholerKathryn Backholer, S A E Peters, S H Bots, Anna PeetersAnna Peeters, Rachel HuxleyRachel Huxley, M Woodward
BACKGROUND: Low socioeconomic status (SES) is a known risk factor for cardiovascular disease (CVD) but whether its effects are comparable in women and men is unknown. METHODS: PubMed MEDLINE was systematically searched. Studies that reported sex-specific estimates, and associated variability, of the relative risk (RR) for coronary heart disease (CHD), stroke or CVD according to a marker of SES (education, occupation, income or area of residence), for women and men were included. RRs were combined with those derived from cohort studies using individual participant data. Data were pooled using random effects meta-analyses with inverse variance weighting. Estimates of the ratio of the RRs (RRR), comparing women with men, were computed. RESULTS: Data from 116 cohorts, over 22 million individuals, and over 1 million CVD events, suggest that lower SES is associated with increased risk of CHD, stroke and CVD in women and men. For CHD, there was a significantly greater excess risk associated with lower educational attainment in women compared with men; comparing lowest with highest levels, the age-adjusted RRR was 1.24 (95% CI 1.09 to 1.41) and the multiple-adjusted RRR was 1.34 (1.09 to 1.63). For stroke, the age-adjusted RRR was 0.93 (0.72 to 1.18), and the multiple-adjusted was RRR 0.79 (0.53 to 1.19). Corresponding results for CVD were 1.18 (1.03 to 1.36), 1.23 (1.03 to 1.48), respectively. Similar results were observed for other markers of SES for all three outcomes. CONCLUSIONS: Reduction of socioeconomic inequalities in CHD and CVD outcomes might require different approaches for men and women.

History

Journal

Journal of epidemiology and community health

Volume

71

Issue

6

Pagination

550 - 557

Publisher

BMJ Group

Location

London, Eng.

ISSN

0143-005X

eISSN

1470-2738

Language

eng

Publication classification

C Journal article; C1 Refereed article in a scholarly journal

Copyright notice

2016, BMJ Publishing Group