Social class and cardiovascular disease risk factor changes in West Germany 1984–1991

Abstract

The aim was to investigate whether the associations between social class and cardiovascular disease risk factors have changed over time in West Germany. Data from the first, second and third cross-sectional, independent and representative German National Health Surveys were analysed. Eligible survey candidates were males and females with German nationality aged 25–69 years. Survey 1 was carried out in 1984–1986 (n=4, 790, response rate = 66.0%), survey 2 in 1987–1988 (n=5, 335, response rate = 71.4%) and survey 3 in 1990–1991 (n=5, 311, response rate = 69.0%). Social class was assessed using an additive index comprising income, education and occupational status. Risk factors were measured by a self-administered questionnaire and clinical examination, in particular, the prevalence of current smoking, hypertension, hypercholesterolemia and obesity and levels of systolic blood pressure, serum cholesterol, body mass index and overall estimated cardiovascular risk. Risk factor prevalence did not change significantly between 1984 and 1991, with the exceptions of obesity in females and hypercholesterolemia in males, which both increased. The overall estimated cardiovascular risk and prevalence of all risk factors, with the exception of hypercholesterolemia, was greater in the lower social classes. Social class gradients increased between 1984 and 1991 for cigarette smoking in females, hypertension in men and overall cardiovascular risk in females. In conclusion, we found that despite the highly developed medical care system in West Germany, in the absence of an organized health education programme no progress was made in the period from 1984 to 1991 in lowering cardiovascular disease risk factors or in reducing the substantial social class gradient for cardiovascular risk.