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J Epidemiol Community Health. 2000 Nov; 54(11): 806–814.
PMCID: PMC1731575

Social distribution of cardiovascular disease risk factors: change among men in England 1984-1993


OBJECTIVE—To investigate change in the social distribution of some of the main risk factors for cardiovascular disease in men in England during a period when inequality in cardiovascular disease mortality widened
DESIGN—Age standardised comparison of the social distribution of seven known risk factors for cardiovascular disease (body mass index, waist to hip ratio, systolic and diastolic blood pressure, consumption of fresh green vegetables, leisure time exercise, cigarette smoking and levels of social support) in two large cross sectional representative samples of the English population.
SUBJECTS—Men aged 20-64 years in the 1984 Health and Lifestyle Survey (excluding Scotland and Wales) first sweep and the 1993 Health Survey for England.
MAIN OUTCOME MEASURES—Mean values of continuous variables; age adjusted proportions of categorical variables; change in the relative index of inequality for each risk factor.
RESULTS—The overall prevalence of cardiovascular disease risk factors improved during the period in which cardiovascular disease mortality was falling. The social distribution of cardiovascular disease risk factors, in contrast, did not become more extreme. Increases in the relative index of inequality for angina from 1.75 to 1.86, for eating vegetables less than once a day from 1.76 in 1984 to 1.96 in 1993, and an apparently larger increase in inequality of social support, from 1.92 to 2.53 were not statistically significant. In most cases the degree of inequality in risk factors tended to narrow non-significantly: for example the relative index of inequality fell from 5.02 in 1984 to 3.07 in 1993 for systolic blood pressure, from 5.60 to 4.29 for current smoking and from 6.24 to 4.19 for eating other than wholemeal bread as the main form of bread in the diet. The two statistically significant changes in inequality were in the direction of narrowing inequality: from a relative index of inequality of 2.12 to 0.90 for diastolic blood pressure (p<0.01) and from 19.3 to 0.87 (p<0.01) for psychological distress as indicated by the General Health Questionnaire.
CONCLUSIONS—Healthier lifestyle options have not been adopted at a significantly faster rate by middle class than working class people over this time period. At the population level the change in risk factors is consistent with falling cardiovascular mortality. The change in the social distribution of risk factors within the population, however, shows little or no relation to the pattern of widening inequality in cardiovascular mortality. This may be because the effect is lagged, or because the adoption of healthier behaviour confers greater benefits on those in higher socioeconomic status groups.

Keywords: cardiovascular disease

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Selected References

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  • Mackenbach JP, Gunning-Schepers LJ. How should interventions to reduce inequalities in health be evaluated? J Epidemiol Community Health. 1997 Aug;51(4):359–364. [PMC free article] [PubMed]
  • Pappas G, Queen S, Hadden W, Fisher G. The increasing disparity in mortality between socioeconomic groups in the United States, 1960 and 1986. N Engl J Med. 1993 Jul 8;329(2):103–109. [PubMed]
  • Quine S, Taylor R, Hayes L. Australian trends in mortality by socioeconomic status using NSW small area data, 1970-89. J Biosoc Sci. 1995 Oct;27(4):409–419. [PubMed]
  • Davis SK, Winkleby MA, Farquhar JW. Increasing disparity in knowledge of cardiovascular disease risk factors and risk-reduction strategies by socioeconomic status: implications for policymakers. Am J Prev Med. 1995 Sep-Oct;11(5):318–323. [PubMed]
  • Bennett S. Cardiovascular risk factors in Australia: trends in socioeconomic inequalities. J Epidemiol Community Health. 1995 Aug;49(4):363–372. [PMC free article] [PubMed]
  • Mackenbach JP, Kunst AE, Cavelaars AE, Groenhof F, Geurts JJ. Socioeconomic inequalities in morbidity and mortality in western Europe. The EU Working Group on Socioeconomic Inequalities in Health. Lancet. 1997 Jun 7;349(9066):1655–1659. [PubMed]
  • Cavelaars AE, Kunst AE, Geurts JJ, Helmert U, Lundberg O, Mielck A, Matheson J, Mizrahi A, Mizrahi A, Rasmussen N, et al. Morbidity differences by occupational class among men in seven European countries: an application of the Erikson-Goldthorpe social class scheme. Int J Epidemiol. 1998 Apr;27(2):222–230. [PubMed]
  • Bartley M, Sacker A, Firth D, Fitzpatrick R. Social position, social roles and women's health in England: changing relationships 1984-1993. Soc Sci Med. 1999 Jan;48(1):99–115. [PubMed]
  • Marmot MG, Smith GD, Stansfeld S, Patel C, North F, Head J, White I, Brunner E, Feeney A. Health inequalities among British civil servants: the Whitehall II study. Lancet. 1991 Jun 8;337(8754):1387–1393. [PubMed]
  • Bartley M, Sacker A, Firth D, Fitzpatrick R. Understanding social variation in cardiovascular risk factors in women and men: the advantage of theoretically based measures. Soc Sci Med. 1999 Sep;49(6):831–845. [PubMed]
  • Pocock SJ, Shaper AG, Cook DG, Phillips AN, Walker M. Social class differences in ischaemic heart disease in British men. Lancet. 1987 Jul 25;2(8552):197–201. [PubMed]
  • Smith GD, Morris J. Increasing inequalities in the health of the nation. BMJ. 1994 Dec 3;309(6967):1453–1454. [PMC free article] [PubMed]
  • Terris M. The development and prevention of cardiovascular disease risk factors: socioenvironmental influences. J Public Health Policy. 1996;17(4):426–441. [PubMed]
  • Stronks K, van de Mheen HD, Looman CW, Mackenbach JP. Cultural, material, and psychosocial correlates of the socioeconomic gradient in smoking behavior among adults. Prev Med. 1997 Sep-Oct;26(5 Pt 1):754–766. [PubMed]
  • Marmot M. Socioeconomic determinants of CHD mortality. Int J Epidemiol. 1989;18(3 Suppl 1):S196–S202. [PubMed]
  • Luepker RV, Rosamond WD, Murphy R, Sprafka JM, Folsom AR, McGovern PG, Blackburn H. Socioeconomic status and coronary heart disease risk factor trends. The Minnesota Heart Survey. Circulation. 1993 Nov;88(5 Pt 1):2172–2179. [PubMed]
  • Lynch JW, Kaplan GA, Cohen RD, Tuomilehto J, Salonen JT. Do cardiovascular risk factors explain the relation between socioeconomic status, risk of all-cause mortality, cardiovascular mortality, and acute myocardial infarction? Am J Epidemiol. 1996 Nov 15;144(10):934–942. [PubMed]
  • Myllykangas M, Pekkanen J, Rasi V, Haukkala A, Vahtera E, Salomaa V. Haemostatic and other cardiovascular risk factors, and socioeconomic status among middle-aged Finnish men and women. Int J Epidemiol. 1995 Dec;24(6):1110–1116. [PubMed]
  • Socio-economic status and risk factors for cardiovascular disease: a multicentre collaborative study in the International Clinical Epidemiology Network (INCLEN). The INCLEN Multicentre Collaborative Group. J Clin Epidemiol. 1994 Dec;47(12):1401–1409. [PubMed]
  • Marmot MG, Rose G, Shipley M, Hamilton PJ. Employment grade and coronary heart disease in British civil servants. J Epidemiol Community Health. 1978 Dec;32(4):244–249. [PMC free article] [PubMed]
  • Kaplan GA, Keil JE. Socioeconomic factors and cardiovascular disease: a review of the literature. Circulation. 1993 Oct;88(4 Pt 1):1973–1998. [PubMed]
  • Bucher HC, Ragland DR. Socioeconomic indicators and mortality from coronary heart disease and cancer: a 22-year follow-up of middle-aged men. Am J Public Health. 1995 Sep;85(9):1231–1236. [PMC free article] [PubMed]
  • Pierce JP, Fiore MC, Novotny TE, Hatziandreu EJ, Davis RM. Trends in cigarette smoking in the United States. Educational differences are increasing. JAMA. 1989 Jan 6;261(1):56–60. [PubMed]
  • Winkleby MA, Fortmann SP, Barrett DC. Social class disparities in risk factors for disease: eight-year prevalence patterns by level of education. Prev Med. 1990 Jan;19(1):1–12. [PubMed]
  • Iribarren C, Luepker RV, McGovern PG, Arnett DK, Blackburn H. Twelve-year trends in cardiovascular disease risk factors in the Minnesota Heart Survey. Are socioeconomic differences widening? Arch Intern Med. 1997 Apr 28;157(8):873–881. [PubMed]
  • Kunst AE, Groenhof F, Andersen O, Borgan JK, Costa G, Desplanques G, Filakti H, Giraldes M do R, Faggiano F, Harding S, et al. Occupational class and ischemic heart disease mortality in the United States and 11 European countries. Am J Public Health. 1999 Jan;89(1):47–53. [PMC free article] [PubMed]
  • Hallqvist J, Lundberg M, Diderichsen F, Ahlbom A. Socioeconomic differences in risk of myocardial infarction 1971-1994 in Sweden: time trends, relative risks and population attributable risks. Int J Epidemiol. 1998 Jun;27(3):410–415. [PubMed]
  • González MA, Rodríguez Artalejo F, Calero JR. Relationship between socioeconomic status and ischaemic heart disease in cohort and case-control studies: 1960-1993. Int J Epidemiol. 1998 Jun;27(3):350–358. [PubMed]
  • Kunst AE, Groenhof F, Mackenbach JP, Health EW. Occupational class and cause specific mortality in middle aged men in 11 European countries: comparison of population based studies. EU Working Group on Socioeconomic Inequalities in Health. BMJ. 1998 May 30;316(7145):1636–1642. [PMC free article] [PubMed]
  • Kunst AE, Groenhof F, Borgan JK, Costa G, Desplanques G, Faggiano F, Hemström O, Martikainen P, Vågerö D, Valkonen T, et al. Socio-economic inequalities in mortality. Methodological problems illustrated with three examples from Europe. Rev Epidemiol Sante Publique. 1998 Dec;46(6):467–479. [PubMed]
  • Law M, Wald N. Why heart disease mortality is low in France: the time lag explanation. BMJ. 1999 May 29;318(7196):1471–1476. [PMC free article] [PubMed]
  • Law MR, Wald NJ, Thompson SG. By how much and how quickly does reduction in serum cholesterol concentration lower risk of ischaemic heart disease? BMJ. 1994 Feb 5;308(6925):367–372. [PMC free article] [PubMed]
  • Otten FW, Bosma HH. The socio-economic distribution of heart diseases: changing gradients in The Netherlands. Soc Sci Med. 1997 May;44(9):1349–1356. [PubMed]
  • Vartiainen E, Pekkanen J, Koskinen S, Jousilahti P, Salomaa V, Puska P. Do changes in cardiovascular risk factors explain the increasing socioeconomic difference in mortality from ischaemic heart disease in Finland? J Epidemiol Community Health. 1998 Jul;52(7):416–419. [PMC free article] [PubMed]

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