Abstract
BackgroundSome recent research has suggested that health-related behaviours, such as smoking, might explain much of the socio-economic inequalities in coronary heart disease (CHD) risk. In a large prospective study of UK women, we investigated the associations between education and area deprivation and CHD risk and assessed the contributions of smoking, alcohol consumption, physical activity and body mass index (BMI) to these inequalities.MethodsAfter excluding women with heart disease, stroke or cancer at recruitment, 1,202,983 women aged 56 years (SD 5 years) on average, were followed for first coronary event (hospital admission or death) and for CHD mortality. Relative risks of CHD were estimated by Cox regression, and the extent to which any association could be accounted for by smoking, alcohol, physical inactivity, and BMI was assessed by calculating the percentage reduction in the relevant likelihood-ratio (LR) statistic after adjustment for these factors, separately and together.ResultsA total of 71,897 women had a first CHD event (hospital admission or death) and 6032 died from CHD during 12 years follow-up. In analyses adjusted by age, birth cohort and region of residence only, lower levels of education and greater deprivation were associated with higher risks of CHD (P heterogeneity < 0.0001 for each); associations for education were found within every level of deprivation and for deprivation were found within every level of education. Smoking, alcohol consumption, physical inactivity and BMI accounted for most of the associations (adjustment for all four factors together reduced the LR statistics for education and for deprivation by 76 % and 71 %, respectively, for first CHD event; and by 87 % and 79 %, respectively, for CHD mortality). Of these four factors, adjustment for smoking resulted in the largest reduction in the LR statistic. Given the large reduction in the predictive values of education and deprivation after adjustment for only four health-related behavioural factors recorded just at recruitment, residual confounding might plausibly account for the remaining associations.ConclusionsMost of the association between CHD risk and education and area deprivation in UK women is accounted for by health-related behaviours, particularly by smoking and to a lesser extent by alcohol consumption, physical inactivity and BMI.Electronic supplementary materialThe online version of this article (doi:10.1186/s12916-016-0687-2) contains supplementary material, which is available to authorized users.
Highlights
Some recent research has suggested that health-related behaviours, such as smoking, might explain much of the socio-economic inequalities in coronary heart disease (CHD) risk
In a sample of this cohort, we have shown that 92 % of hospital admission diagnoses coded to International Classification of Diseases 10th Revision (ICD-10): I20-I25 were confirmed as CHD by primary care physicians [33]
We found that the influence of area deprivation on CHD risk appears to be substantially mediated through health-related behaviours, consistent with previous evidence [19, 26]
Summary
Some recent research has suggested that health-related behaviours, such as smoking, might explain much of the socio-economic inequalities in coronary heart disease (CHD) risk. In a large prospective study of UK women, we investigated the associations between education and area deprivation and CHD risk and assessed the contributions of smoking, alcohol consumption, physical activity and body mass index (BMI) to these inequalities. The extent to which these health-related behaviours explain socioeconomic inequalities in CHD risk, and the relative importance of the different behaviours, is unclear given that previous estimates have varied between studies and some behaviours, such as alcohol consumption and physical inactivity, have rarely been examined as explanatory factors [16]. Our aim was to examine the associations between education and area deprivation and risk of CHD in this cohort, and to investigate the extent to which smoking, alcohol consumption, physical inactivity and body mass index (BMI) can, separately and jointly, account for the associations
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