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

Beauchamp, Alison, Peeters, Anna, Wolfe, Rory, Turrell, Gavin, Harriss, Linton, Giles, Graham, English, Dallas R., McNeil, John, Magliano, Dianna, Harrap, Stephen, Liew, Danny, Hunt, David, & Tonkin, Andrew (2010) Inequalities in cardiovascular disease mortality : the role of behavioural, physiological and social risk factors. Journal of Epidemiology & Community Health: An International Peer-Reviewed Journal for Health Professionals and Researchers in all Areas of Epidemiology, 64(6), pp. 542-548.

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Abstract

Background: While the relationship between socioeconomic disadvantage and cardiovascular disease (CVD) is well established, the role that traditional cardiovascular risk factors play in this association remains unclear. We 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 to those who had completed tertiary education, with a hazard ratio (HR) of 1.66 (95% confidence interval [CI] 1.11-2.49) after adjustment for age, country of birth and gender. Those from the lowest educated group had a more adverse cardiovascular risk factor profile compared to the highest educated group, and adjustment for these risk factors reduced the HR to 1.18 (95% CI 0.78-1.77). 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 socioeconomic 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 socioeconomic groups.

Impact and interest:

12 citations in Scopus
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14 citations in Web of Science®

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ID Code: 30217
Item Type: Journal Article
Keywords: Epidemiology, Cardiovascular Disease, Primary Prevention, Risk Factors, Socioeconomic Status
DOI: 10.1136/jech.2009.094516
ISSN: 0143-005X
Subjects: Australian and New Zealand Standard Research Classification > MEDICAL AND HEALTH SCIENCES (110000) > PUBLIC HEALTH AND HEALTH SERVICES (111700) > Public Health and Health Services not elsewhere classified (111799)
Australian and New Zealand Standard Research Classification > MEDICAL AND HEALTH SCIENCES (110000) > PUBLIC HEALTH AND HEALTH SERVICES (111700) > Epidemiology (111706)
Divisions: Current > QUT Faculties and Divisions > Faculty of Health
Current > Institutes > Institute of Health and Biomedical Innovation
Current > Schools > School of Public Health & Social Work
Copyright Owner: Copyright 2009 B M J Publishing Group.
Deposited On: 15 Feb 2010 10:13
Last Modified: 25 Jul 2014 13:43

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