Socio-Economic Differences in Cardiovascular Health: Findings from a Cross-Sectional Study in a Middle-Income Country.

Janko Janković,Jelena Marinković,Slavenka Janković,Miloš Erić,Dragana Stojisavljević,C Mary Schooling

doi:10.1371/journal.pone.0141731

Abstract

BackgroundA relatively consistent body of literature, mainly from high-income countries, supports an inverse association between socio-economic status (SES) and risk of cardiovascular disease (CVD). Data from low- and middle-income countries are scarce. This study explores SES differences in cardiovascular health (CVH) in the Republic of Srpska (RS), Bosnia and Herzegovina, a middle-income country.MethodsWe collected information on SES (education, employment status and household’s relative economic status, i.e. household wealth) and the 7 ideal CVH components (smoking status, body mass index, physical activity, diet, blood pressure, total cholesterol, and fasting blood glucose) among 3601 participants 25 years of age and older, from the 2010 National Health Survey in the RS. Based on the sum of all 7 CVH components an overall CVH score (CVHS) was calculated ranging from 0 (all CVH components at poor levels) to 14 (all CVH components at ideal levels). To assess the differences between groups the chi-square test, t-test and ANOVA were used where appropriate. The association between SES and CVHS was analysed with multivariate linear regression analyses. The dependent variable was CVHS, while independent variables were educational level, employment status and wealth index.ResultsAccording to multiple linear regression analysis CVHS was independently associated with education attainment and employment status. Participants with higher educational attainment and those economically active had higher CVHS (b = 0.57; CI = 0.29–0.85 and b = 0.27; CI = 0.10–0.44 respectively) after adjustment for sex, age group, type of settlement, and marital status. We failed to find any statistically significant difference between the wealth index and CVHS.ConclusionThis study presents the novel information, since CVHS generated from the individual CVH components was not compared by socio-economic status till now. Our finding that the higher overall CVHS was independently associated with a higher education attainment and those economically active supports the importance of reducing socio-economic inequalities in CVH in RS.

Highlights

According to multiple linear regression analysis Cardiovascular Health Score (CVHS) was independently associated with education attainment and employment status
This study presents the novel information, since CVHS generated from the individual cardiovascular health (CVH) components was not compared by socio-economic status till
Our finding that the higher overall CVHS was independently associated with a higher education attainment and those economically active supports the importance of reducing socio-economic inequalities in CVH in Republic of Srpska (RS)

Summary

Introduction

The growing body of literature shows that socio-economic status (SES) is strongly associated with risk of cardiovascular diseases (CVD), in high income countries where people with low SES have a greater risk of developing CVD [1,2,3,4]. This issue remains largely unexplored in low- and middle-income countries, which bear over 80% of the world’s burden of CVD [5], but evidence is emerging that the increasing wealth of these countries leads to replication of the patterns seen in high-income countries [1,6]. This study explores SES differences in cardiovascular health (CVH) in the Republic of Srpska (RS), Bosnia and Herzegovina, a middle-income country.

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Conclusion