Inequalities In Heart Disease Research Articles

Regional and socioeconomic disparities in cardiovascular disease in Canada during 2005–2016: evidence from repeated nationwide cross-sectional surveys

IntroductionThe objective of this study is to examine the temporal trends and patterns of regional and socioeconomic disparities in cardiovascular disease (CVD) in Canada during 2005–2016.MethodsA total of 670 000...

Increasing Area Deprivation and Socioeconomic Inequalities in Heart Disease, Stroke, and Cardiovascular Disease Mortality Among Working Age Populations, United States, 1969-2011

We examined the extent to which area- and individual-level socioeconomic inequalities in cardiovascular-disease (CVD), heart disease, and stroke mortality among United States men and women aged 25-64 years changed between 1969 and 2011. National vital statistics data and the National Longitudinal Mortality Study were used to estimate area- and individual-level socioeconomic gradients in mortality over time. Rate ratios and log-linear and Cox regression were used to model mortality trends and differentials. Area socioeconomic gradients in mortality from CVD, heart disease, and stroke increased substantially during the study period. Compared to those in the most affluent group, individuals in the most deprived area group had, respectively 35%, 29%, and 73% higher CVD, heart disease, and stroke mortality in 1969, but 120-121% higher mortality in 2007-2011. Gradients were steeper for women than for men. Education, income, and occupation were inversely associated with CVD, heart disease, and stroke mortality, with individual-level socioeconomic gradients being steeper during 1990-2002 than in 1979-1989. Individuals with low education and incomes had 2.7 to 3.7 times higher CVD, heart disease, and stroke mortality risks than their counterparts with high education and income levels. Although mortality declined for all US groups during 1969-2011, socioeconomic disparities in mortality from CVD, heart disease and stroke remained marked and increased over time because of faster declines in mortality among higher socioeconomic groups. Widening disparities in mortality may reflect increasing temporal areal inequalities in living conditions, behavioral risk factors such as smoking, obesity and physical inactivity, and access to and use of health services. With social inequalities and prevalence of smoking, obesity, and physical inactivity on the rise, most segments of the working-age population in low- and middle-income countries will likely experience increased cardiovascular-disease burden in terms of higher morbidity and mortality rates.

Socioeconomic inequalities and body mass index in Västerbotten County, Sweden: a longitudinal study of life course influences over two decades.

IntroductionLife course socioeconomic inequalities in heart disease, stroke and all-cause mortality are well studied in Sweden. However, few studies have sought to explain the mechanism for such associations mainly due to lack of longitudinal data with multiple measures of socioeconomic status (SES) across the life course. Given the population health concern about how socioeconomic inequality is related to poorer health, we aim to tackle obesity as one of the prime suspects that could explain the association between SES inequality and cardiovascular disease and consequently premature death. The aim of this study is to test which life course model best describes the association between socioeconomic disadvantage and obesity among 60 year old inhabitants of Västerbotten County in Northern Sweden.MethodsA birth cohort consisting of 3340 individuals born between 1930 and 1932 was studied. Body mass index (BMI) at the age of 60 and information on socioeconomic status at three stages of life (ages 40, 50, and 60 years) was collected. Independent samples t-test was used to compare BMI between advantaged and disadvantaged groups and one-way ANOVA was used to compare BMI among eight SES trajectories. We applied a structured modeling approach to examine three different hypothesized life course SES models (accumulation, critical period, and social mobility) in relation to BMI.ResultsWe found sex differences in the way that late adulthood socioeconomic disadvantage is associated with BMI among inhabitants of Northern Sweden. Our study suggests that social adversity in all stages of late adulthood is a particularly important indicator for addressing the social gradients in BMI among women in Northern Sweden and that unhealthy behaviors in terms of smoking and physical inactivity are insufficient to explain the relationships between social and lifestyle inequalities and BMI.ConclusionIn order for local authorities to develop informed preventive efforts, we suggest further research to identify modifiable risk factors across the life course which could explain this health inequality.

Socioeconomic differences in the prevalence of common chronic diseases: an overview of eight European countries

Few studies have compared socioeconomic inequalities in the prevalence of both fatal and non-fatal diseases. This paper aims to give the first international overview for several common chronic diseases. Micro-level data were pooled from non-standardized national health surveys conducted in eight European countries in the 1990s. Surveys ranged in size from 3700 to 41 200 participants. The prevalence of 17 chronic disease groups were analysed in relation to education. Standardized prevalence rates and age-adjusted odds ratios (ORs) were calculated. Most diseases showed higher prevalence among the lower education group. Stroke, diseases of the nervous system, diabetes, and arthritis displayed relatively large inequalities (OR > 1.50). No socioeconomic differences were evident for cancer, kidney diseases, and skin diseases. Allergy was more common in the higher education group. Relative socioeconomic differences were often smaller among the 60-79 age group as compared with the 25-59 age group. Cancer was more prevalent among the lower educated in the 25-59 age group, but among the higher educated in the 60-79 age group. For diabetes, hypertension, and heart disease, socioeconomic differences were larger among women as compared with men. Inequalities in heart disease were larger in northern European countries as compared with southern European countries. There are large variations between chronic diseases in the size and pattern of socioeconomic differences in their prevalence. The large inequalities that are found for some specific fatal diseases (e.g. stroke) and non-fatal diseases (e.g. arthritis) require special attention in equity-oriented research and policies.

Low control beliefs, classical coronary risk factors, and socio-economic differences in heart disease in older persons

The objective of this study was to examine whether it is through their low control beliefs that low socio-economic status groups have higher risks of heart disease, and to examine whether this mechanism is more substantial than and independent of the mechanism via classical coronary risk factors. In a population-based prospective cohort study, participants were selected from 27 general practices in the north-eastern part of The Netherlands. In 1993, there were 3888 men and women, 57 years and older, who were without prevalent heart disease. During the 5-year follow-up period, 287 cases of incident heart disease (acute myocardial infarction and/or congestive heart failure) were registered (7%). Persons with a low socio-economic status had higher risks of heart disease (RR = 1.45 (95% CI: 1.06 – 1.99)) compared with their high status counterparts. On average, 4 percent of the socio-economic differences were accounted for by the classical coronary risk factors (e.g. smoking, hypertension) compared with 30 percent by the control beliefs. The contribution of the latter was largely independent of the former. Our findings support the hypothesis that socio-economic inequalities in heart disease—at least in middle-aged and older persons—may be based upon differences in control beliefs, more than upon differences in smoking rates and other classical risk factors.

Some Contributions from the Social System to Gender Inequalities in Heart Disease

Epidemiological understanding is incomplete if social system influences on statistical rates are not appropriately recognized. To the traditional epidemiological triumvirate of agent, host, and environment, a fourth influence must now be added--contributions from the social system (like government reimbursement policies, organizational priorities, and the variable behavior of providers). This paper has two sections: the first builds a progressively more complex model (from simple reification, through environmental and personal attributes, to social system influences) to depict the relative contribution of diverse influences to the social production of "facts." The second section considers how social system influences affect health statistics--most emphasis is given to the contribution of health provider behavior (using the widely accepted gender inequality in heart disease as an example). Data from a wide range of studies (employing seven different research methods) are consistent with an underlying thesis--that the gender difference in heart disease is as much a function of how providers and the system respond as it is of the biophysiology of patients and how they react to events. The incorporation of system influences permits the development of an epidemiological imagination, or the ability to link intimate health experiences with more remote social-structural influences.