Unfavourable life-course social gradient of coronary heart disease within Spain: a low-incidence welfare-state country

Int J Public Health. 2013 Feb;58(1):65-77. doi: 10.1007/s00038-012-0374-9. Epub 2012 Jun 7.

Abstract

Objective: Social position has yet to be established as a risk factor of coronary heart disease (CHD). Our aim was to investigate an individual life-course social position gradient link with CHD incidence in the EPIC-Spain cohort.

Methods: 41,066 participants, mostly 30-65 years old, and free of cardiovascular disease at baseline (1992-1996) were followed up for a mean of 10.4 years. A combined score of paternal occupation in childhood and own adult education was used to assess individual life-course risk accumulation. Hazard ratios of CHD were estimated using Cox models, stratifying by centre, and age, and adjusting for cardiovascular risk factors.

Results: 583 participants (80 % men) developed a definite CHD event. Paternal occupational class IV was associated with CHD in all models in men. The educational gradient remained significant after adjusting for diet and physical activity (p = 0.01). All adjusted risk of incident CHD rose by 23 % (95 % CI 6-42 %) per category increase of life-course social position score in men. No significant associations were found in women.

Conclusions: Individual life-course social position gradient was adversely related to incident CHD in Spanish men.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Cohort Studies
  • Coronary Disease / epidemiology*
  • Diet
  • Educational Status*
  • Employment*
  • Female
  • Humans
  • Incidence
  • Life Style
  • Male
  • Middle Aged
  • Proportional Hazards Models
  • Prospective Studies
  • Risk Factors
  • Sex Factors
  • Social Class
  • Spain / epidemiology
  • Waist Circumference