Abstract
BackgroundData on the relationship between plasma levels of cholesterol and triglycerides and social class have been inconsistent. Most previous studies have used one classification of social class.MethodsThis was a cross-sectional population based study with data on occupational social class, educational level obtained using a detailed health and lifestyle questionnaire. A total of 10,147 men and 12,304 women aged 45–80 years living in Norfolk, United Kingdom, were recruited using general practice age-sex registers as part of the European Prospective Investigation into Cancer (EPIC-Norfolk). Plasma levels of cholesterol and triglycerides were measured in baseline samples. Social class was classified according to three classifications: occupation, educational level, and area deprivation score according to Townsend deprivation index. Differences in lipid levels by socio-economic status indices were quantified by analysis of variance (ANOVA) and multiple linear regression after adjusting for body mass index and alcohol consumption.ResultsTotal cholesterol levels were associated with occupational level among men, and with educational level among women. Triglyceride levels were associated with educational level and occupational level among women, but the latter association was lost after adjustment for age and body mass index. HDL-cholesterol levels were associated with both educational level and educational level among men and women. The relationships with educational level were substantially attenuated by adjustment for age, body mass index and alcohol use, whereas the association with educational class was retained upon adjustment. LDL-cholesterol levels were not associated with social class indices among men, but a positive association was observed with educational class among women. This association was not affected by adjustment for age, body mass index and alcohol use.ConclusionsThe findings of this study suggest that there are sex differences in the association between socio-economic status and serum lipid levels. The variations in lipid profile with socio-economic status may be largely attributed to potentially modifiable factors such as obesity, physical activity and dietary intake.
Highlights
Data on the relationship between plasma levels of cholesterol and triglycerides and social class have been inconsistent
In the present study we investigated the cross-sectional association between three different measures of socio-economic status at both individual and arealevel and the four lipid parameters commonly used in clinical practice: total cholesterol, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C) and triglycerides in a population-based study of men and women living in Norfolk, United Kingdom
Total cholesterol levels were not associated with socio-economic status using any of the three classification methods
Summary
Data on the relationship between plasma levels of cholesterol and triglycerides and social class have been inconsistent. Socio-economic differences in CHD mortality have been reported consistently [1,2]. Several studies have observed inverse relationships between socio-economic status and cholesterol levels [3,4,5], others have reported higher cholesterol levels among those with higher education or higher-grade of employment [6,7,8] while some found no association at all [9]. In developing countries the association is often positive with those in higher socio-economic status having higher levels of serum lipids [10,11,12]. In most of these studies, socioeconomic status was usually measured using only one indicator of socio-economic status, mainly educational level. In the present study we investigated the cross-sectional association between three different measures of socio-economic status at both individual and arealevel and the four lipid parameters commonly used in clinical practice: total cholesterol, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C) and triglycerides in a population-based study of men and women living in Norfolk, United Kingdom
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