Psychosocial and socioeconomic determinants of cardiovascular mortality in Eastern Europe: A multicentre prospective cohort study.

Ruzena Kubinova,Mika Kivimäki,Sofia Malyutina,Hynek Pikhart,Martin Bobak,Andrew Steptoe,Michael Marmot,Taavi Tillmann,Anne Peasey,Abdonas Tamosiunas,Andrzej Pajak

doi:10.1371/journal.pmed.1002459

Abstract

BackgroundEastern European countries have some of the highest rates of cardiovascular disease (CVD) mortality, much of which cannot be adequately accounted for by conventional CVD risk factors. Psychosocial and socioeconomic factors may affect risk of CVD, but relatively few studies on this issue have been undertaken in Eastern Europe. We investigated whether various psychosocial factors are associated with CVD mortality independently from each other and whether they can help explain differences in CVD mortality between Eastern European populations.MethodsParticipants were from the Health, Alcohol and Psychological factors in Eastern Europe (HAPIEE) cohort study in Russia, Poland and the Czech Republic, including a total of 20,867 men and women aged 43–74 years and free of CVD at baseline examination during 2002–2005. Participants were followed-up for CVD mortality after linkage to national mortality registries for a median of 7.2 years.ResultsDuring the follow-up, 556 participants died from CVD. After mutual adjustment, six psychosocial and socioeconomic factors were associated with increased risk of CVD death: unemployment, low material amenities, depression, being single, infrequent contacts with friends or relatives. The hazard ratios [HRs] for these six factors ranged between 1.26 [95% confidence interval 1.14–1.40] and 1.81 [95% confidence interval 1.24–2.64], fully adjusted for each other, and conventional cardiovascular risk factors. Population-attributable fractions ranged from 8% [4%–13%] to 22% [11%–31%] for each factor, when measured on average across the three cohorts. However, the prevalence of psychosocial and socioeconomic risk factors and their HRs were similar between the three countries. Altogether, these factors could not explain why participants from Russia had higher CVD mortality when compared to participants from Poland/Czech Republic. Limitations of this study include measurement error that could lead to residual confounding; and the possibilities for reverse causation and/or unmeasured confounding from observational studies to lead to associations that are not causal in nature.ConclusionsSix psychosocial and socioeconomic factors were associated with cardiovascular mortality, independent of each other. Differences in mortality between cohorts from Russia versus Poland or Check Republic remained unexplained.

Highlights

Psychosocial and socioeconomic risk factors, such as unemployment, low social support, and depression, are associated with increased risk of cardiovascular disease (CVD) [1, 2]
Six psychosocial and socioeconomic factors were associated with increased risk of CVD death: unemployment, low material amenities, depression, being single, infrequent contacts with friends or relatives
The prevalence of psychosocial and socioeconomic risk factors and their hazard ratio (HR) were similar between the three countries

Summary

Introduction

Psychosocial and socioeconomic risk factors, such as unemployment, low social support, and depression, are associated with increased risk of cardiovascular disease (CVD) [1, 2]. Eastern European countries have some of the highest rates of CVD mortality in the world, most of which cannot be adequately accounted for by conventional CVD risk factors [7]. The 2015 Global Burden of Disease study highlighted how the Eastern European region deviates strikingly from the otherwise tight correlation between life expectancy and socioeconomic development (see figure 10 from reference[9]). This deviation remains an important global health question that could inform development goals elsewhere. Eastern European countries have some of the highest rates of cardiovascular disease (CVD) mortality, much of which cannot be adequately accounted for by conventional CVD risk factors. We investigated whether various psychosocial factors are associated with CVD mortality independently from each other and whether they can help explain differences in CVD mortality between Eastern European populations

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Results

Conclusion