Abstract
BackgroundSocioeconomic inequalities in cardiovascular disease seem to widen or endure in Sweden. However, research on inequalities in antecedent cardiovascular risk factors (CVRFs), and particularly what underpins them, is scarce. The present study aimed 1) to estimate income-related inequalities in eight biological cardiovascular risk factors in Swedish middle-aged women and men; and 2) to examine the contribution of demographic, socioeconomic, behavioural and psychosocial determinants to the observed inequalities.MethodsParticipants (N = 12,481) comprised all 40- and 50-years old women and men who participated in the regional Västerbotten Intervention Programme in Northern Sweden during 2008, 2009 and 2010. All participants completed a questionnaire on behavioural and psychosocial conditions, and underwent measurements with respect to eight CVRFs (body mass index; waist circumference; total cholesterol; high-density lipoprotein cholesterol; low-density lipoprotein cholesterol; triglycerides; systolic/diastolic blood pressure; glucose tolerance). Data on cardiovascular risk, psychosocial and health behaviours were linked to national register data on income and other socioeconomic and demographic factors. To estimate income inequalities in each CVRF concentration indexes were calculated, and to examine the contribution of the underlying determinants to the observed inequalities a Wagstaff-type decomposition analysis was performed separately for women and men.ResultsHealth inequalities ranged from small to substantial with generally greater magnitude in women. The highest inequalities among women were seen in BMI, triglycerides and HDL-cholesterol (Concentration index = − 0.1850; − 0.1683 and − 0.1479 respectively). Among men the largest inequalities were seen in glucose regulation, BMI and abdominal obesity (Concentration index = − 0.1661; − 0.1259 and − 0.1172). The main explanatory factors were, for both women and men socioeconomic conditions (contributions ranging from 54.8 to 76.7% in women and 34.0–72.6% in men) and health behaviours (contributions ranging from 6.9 to 20.5% in women and 9.2 to 26.9% in men). However, the patterns of specific dominant explanatory factors differed between CVRFs and genders.ConclusionTaken together, the results suggest that the magnitude of income-related inequalities in CVRFs and their determinants differ importantly between the risk factors and genders, a variation that should be taken into consideration in population interventions aiming to prevent inequalities in manifest cardiovascular disease.
Highlights
Socioeconomic inequalities in cardiovascular disease seem to widen or endure in Sweden
In Northern Sweden, increasing and decreasing trends have been observed for different Cardiovascular risk factors (CVRF) [11,12,13,14], with educational inequalities persisting in both CVRFs [11,12,13,14] and in manifest cardiovascular disease (CVD) [15]
During the health examination a number of cardiovascular risk markers are measured (e.g. Body Mass Index (BMI), blood pressure, glucose tolerance, blood lipids (Low-density and High-density lipoproteins (LDL and HDL)) and each individual completes a comprehensive questionnaire including questions related to self-reported health, lifestyle behaviours, social network and support, working conditions, physical activities, tobacco and alcohol consumption [27]
Summary
Socioeconomic inequalities in cardiovascular disease seem to widen or endure in Sweden. The present study aimed 1) to estimate income-related inequalities in eight biological cardiovascular risk factors in Swedish middle-aged women and men; and 2) to examine the contribution of demographic, socioeconomic, behavioural and psychosocial determinants to the observed inequalities. Whereas inequalities in manifest cardiovascular disease, which may appear and accentuate with aging [3] would be expected to be preceded by corresponding inequalities in cardiovascular risk factors (CVRFs), research on multiple CVRFs inequalities, and what explains them, is scarce. The present study seeks to contribute to this topic by estimating income-related inequalities in a range of biological cardiovascular risk factors in middle-aged women and men, and decomposing them by demographic, socioeconomic, family, psychosocial and behavioural factors. Despite increasing income inequalities in Sweden [16], most Swedish research has focused on education rather than income inequalities
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