Socioeconomic and behavioral determinants of cardiovascular diseases among older adults in Belgium and France: A longitudinal analysis from the SHARE study.

Hamid Yimam Hassen,Hilde Bastiaens,Steven Abrams,Kathleen Van Royen,Luisa N Borrell

doi:10.1371/journal.pone.0243422

Hamid Yimam Hassen, Hilde Bastiaens + Show 3 more

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https://doi.org/10.1371/journal.pone.0243422

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Journal: PloS one	Publication Date: Dec 4, 2020
Citations: 9	License type: CC BY 4.0

Affiliation: University of Antwerp, Hasselt University

Abstract

Despite advances in the healthcare system, cardiovascular diseases (CVDs) are still an important public health problem with disparities in the burden within and between countries. Studies among the adult population documented that socioeconomic and environmental factors play a role in the incidence and progression of CVDs. However, evidence is scarce on the socioeconomic determinants and the interplay with behavioral risks among older adults. Therefore, we identified socioeconomic and behavioral determinants of CVDs among older adults. Our sample consisted of 14,322 people aged 50 years and above from Belgium and France who responded to the waves 4, 5, 6 and/or 7 of the Survey of Health Ageing and Retirement in Europe. The effect of determinants on the occurrence of CVD was examined using a Generalized Estimating Equation (GEE) approach for binary longitudinal data. The overall rate of heart attack was 8.3%, which is 7.6% in Belgium and 9.1% in France. Whereas, 2.6% and 2.3% in Belgium and France, respectively, had experienced stroke. In the multivariable GEE model, older age [AOR: 1.057, 95%CI: 1.055-1.060], living in large cities [AOR: 1.14, 95%CI: 1.07-1.18], and retirement [AOR: 1.21, 95%CI: 1.16-1.31] were associated with higher risk of CVD. Furthermore, higher level of education [AOR: 0.82, 95%CI: 0.79-0.90], upper wealth quantile [AOR: 0.82, 95%CI: 0.76-0.86] and having social support [AOR: 0.81, 95%CI: 0.77-0.84] significantly lowers the odds of having CVD. A higher hand grip strength was also significantly associated with lower risk of CVD [AOR: 0.987, 95%CI: 0.984-0.990]. This study demonstrated that older adults who do not have social support, live in big cities, belong to the lowest wealth quantile, and have a low level of education have a higher likelihood of CVD. Therefore, community-based interventions aimed at reducing cardiovascular risks need to give more emphasis to high-risk retired older adults with lower education, no social support and those who live in large cities.

Highlights

Cardiovascular diseases (CVDs) are the leading cause of morbidity and mortality worldwide and constitute a major burden on the healthcare system in all countries [1]
This study demonstrated that older adults who do not have social support, live in big cities, belong to the lowest wealth quantile, and have a low level of education have a higher likelihood of CVD
This study addressed several aspects of cardiovascular disease prevention areas among older adults

Summary

Introduction

Cardiovascular diseases (CVDs) are the leading cause of morbidity and mortality worldwide and constitute a major burden on the healthcare system in all countries [1]. Despite advances in the primary and secondary prevention, there are still disparities in the CVD burden within and across countries, some segment of the population being at a higher risk [6,7,8]. Improvements have been observed in the reduction of CVD morbidities and its associated premature mortality among adults. The burden of CVDs highly varied across segments of the population, older age, the least affluent and deprived communities are disproportionately affected [9,10,11]. Socioeconomic and environmental factors, including income, living condition, level of education play an important role in the development, progression and outcomes of CVDs [12,13,14,15]

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