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 & Community Health, 64. pp. 542-548.

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Abstract

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.

Item ID:	40470
Item Type:	Article (Research - C1)
ISSN:	1470-2738
Funders:	National Health and Medical Research Council (NHMRC), Victorian Health Promotion Unit (VicHealth), The Cancer Council Victoria, Monash University
Projects and Grants:	NHMRC ID No 209057, NHMRC ID No 334032, NHMRC ID No 396414, NHMRC ID No 465352, NHMRC ID No 390109
Date Deposited:	16 Sep 2015 02:59
FoR Codes:	11 MEDICAL AND HEALTH SCIENCES > 1102 Cardiovascular Medicine and Haematology > 110201 Cardiology (incl Cardiovascular Diseases) @ 50% 11 MEDICAL AND HEALTH SCIENCES > 1117 Public Health and Health Services > 111706 Epidemiology @ 50%
SEO Codes:	92 HEALTH > 9201 Clinical Health (Organs, Diseases and Abnormal Conditions) > 920103 Cardiovascular System and Diseases @ 40% 92 HEALTH > 9204 Public Health (excl. Specific Population Health) > 920413 Social Structure and Health @ 30% 92 HEALTH > 9204 Public Health (excl. Specific Population Health) > 920401 Behaviour and Health @ 30%
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