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Global epidemiology, health burden and effective interventions for elevated blood pressure and hypertension. Nat Rev Cardiol 2021; 18:785-802. [PMID: 34050340 PMCID: PMC8162166 DOI: 10.1038/s41569-021-00559-8] [Citation(s) in RCA: 487] [Impact Index Per Article: 162.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/19/2021] [Indexed: 02/07/2023]
Abstract
High blood pressure is one of the most important risk factors for ischaemic heart disease, stroke, other cardiovascular diseases, chronic kidney disease and dementia. Mean blood pressure and the prevalence of raised blood pressure have declined substantially in high-income regions since at least the 1970s. By contrast, blood pressure has risen in East, South and Southeast Asia, Oceania and sub-Saharan Africa. Given these trends, the prevalence of hypertension is now higher in low-income and middle-income countries than in high-income countries. In 2015, an estimated 8.5 million deaths were attributable to systolic blood pressure >115 mmHg, 88% of which were in low-income and middle-income countries. Measures such as increasing the availability and affordability of fresh fruits and vegetables, lowering the sodium content of packaged and prepared food and staples such as bread, and improving the availability of dietary salt substitutes can help lower blood pressure in the entire population. The use and effectiveness of hypertension treatment vary substantially across countries. Factors influencing this variation include a country's financial resources, the extent of health insurance and health facilities, how frequently people interact with physicians and non-physician health personnel, whether a clear and widely adopted clinical guideline exists and the availability of medicines. Scaling up treatment coverage and improving its community effectiveness can substantially reduce the health burden of hypertension.
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Oyekale AS. Effect of Obesity and Other Risk Factors on Hypertension among Women of Reproductive Age in Ghana: An Instrumental Variable Probit Model. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E4699. [PMID: 31779087 PMCID: PMC6926784 DOI: 10.3390/ijerph16234699] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 11/06/2019] [Accepted: 11/08/2019] [Indexed: 12/12/2022]
Abstract
Background: The growing incidence of mortality as a result cardiovascular diseases (CVDs) is a major public health concern in several developing countries. In Ghana, unhealthy food consumption pattern and sedentary lifestyle are promoting overweight and obesity, with significant consequences on the incidence of CVDs. Specifically, hypertension morbidity is now a public health concern among Ghanaian health policy makers. This paper analysed the effect of body mass index (BMI)/arm circumference and other associated factors on hypertension risk among women of reproductive ages in Ghana. Methods: The data were collected as Demographic and Health Survey (DHS) in 2014. This paper analysed the subset of the data that were collected from eligible women 15-49 years of age. The total sample was 9396, while 9367 gave consents to have their blood pressure measured. Data were analysed with instrumental probit regression model with consideration of potential endogeneity of BMI and arm circumference. Results: The results showed that 25% of the women were either overweight or obese, while 13.28% were hypertensive. Women from the Greater Accra (18.15%), Ashanti (15.53%) and Volta (15.02%) regions had the highest incidences of hypertension. BMI and arm circumferences were truly endogenous and positively associated with the probability of being hypertensive. Other factors that influenced hypertension were age of women, region of residence, urban/rural residence, being pregnant, access to medical insurance, currently working, consumption of broth cubes, processed can meats, salted meat and fruits. Conclusion: It was concluded that hypertension risk was positively associated with being overweight, obesity, age and consumption of salted meat.It was inter aliaemphasized that engagement in healthy eating with less consumption of salted meats, and more consumption of fruits would assist in controlling hypertension among Ghanaian women.
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Affiliation(s)
- Abayomi Samuel Oyekale
- Department of Agricultural Economics and Extension, North-West University, Mafikeng Campus, Mmabatho 2735, South Africa
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Gardiner S, Robins S, Terry D. Acute circulatory complications in people with diabetes mellitus type 2: How admission varies between urban and rural Victoria. Aust J Rural Health 2019; 27:49-56. [PMID: 30693995 DOI: 10.1111/ajr.12459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/19/2018] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE To identify the extent to which rurality influences the admission and mortality rates for acute circulatory complications among people with type 2 diabetes mellitus. DESIGN Retrospective study. SETTING All Victorian hospitals. PARTICIPANTS State-wide hospital admissions from 1 July 2010 to 30 June 2015 using the Victorian Admitted Episodes Dataset. Data included patients with type 2 diabetes mellitus and diagnosis of acute cardiovascular events, acute cerebrovascular haemorrhage or infarction, acute peripheral vascular events or hypertensive diseases. MAIN OUTCOME MEASURE Rates of admission and mortality were calculated for local government areas and Department of Health regions. Regression analysis identified the influence between admission rates and various predictor variables. RESULTS In total, 5785 emergency hospital admissions occurred during the study period, with the highest and lowest mortality and admission rates occurring in rural areas. Moderately high admission rates were identified in urban areas. Cardiovascular events far outnumbered other acute circulatory admissions. Regression analysis identified a number of significant socioeconomic variables, primarily for metropolitan residents. Socioeconomic disadvantage was the only significant factor in rural areas. CONCLUSION Victorian admission and mortality rates for acute circulatory complications are greatest in rural areas; yet, there is considerable heterogeneity in the admission rates within both rural and metropolitan areas. Furthermore, socioeconomic status is more influential than remoteness in determining emergency admissions. Further research needs to investigate the particular variables that lead to poorer outcomes rurally, investigate socioeconomic disadvantage in rural areas and have greater emphasis on peripheral vascular disease prevention.
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Affiliation(s)
- Samantha Gardiner
- Melbourne Medical School, The University of Melbourne, Parkville, Victoria, Australia
| | - Shalley Robins
- Melbourne Medical School, The University of Melbourne, Parkville, Victoria, Australia
| | - Daniel Terry
- School of Nursing, Midwifery and Healthcare, Federation University, Ballarat, Victoria, Australia
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Mosquera PA, San Sebastian M, Ivarsson A, Gustafsson PE. Decomposition of gendered income-related inequalities in multiple biological cardiovascular risk factors in a middle-aged population. Int J Equity Health 2018; 17:102. [PMID: 30005665 PMCID: PMC6045866 DOI: 10.1186/s12939-018-0804-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 06/19/2018] [Indexed: 01/22/2023] Open
Abstract
Background Socioeconomic inequalities in cardiovascular disease seem to widen or endure in Sweden. However, research on inequalities in antecedent cardiovascular risk factors (CVRFs), and particularly what underpins them, is scarce. The present study aimed 1) to estimate income-related inequalities in eight biological cardiovascular risk factors in Swedish middle-aged women and men; and 2) to examine the contribution of demographic, socioeconomic, behavioural and psychosocial determinants to the observed inequalities. Methods Participants (N = 12,481) comprised all 40- and 50-years old women and men who participated in the regional Västerbotten Intervention Programme in Northern Sweden during 2008, 2009 and 2010. All participants completed a questionnaire on behavioural and psychosocial conditions, and underwent measurements with respect to eight CVRFs (body mass index; waist circumference; total cholesterol; high-density lipoprotein cholesterol; low-density lipoprotein cholesterol; triglycerides; systolic/diastolic blood pressure; glucose tolerance). Data on cardiovascular risk, psychosocial and health behaviours were linked to national register data on income and other socioeconomic and demographic factors. To estimate income inequalities in each CVRF concentration indexes were calculated, and to examine the contribution of the underlying determinants to the observed inequalities a Wagstaff-type decomposition analysis was performed separately for women and men. Results Health inequalities ranged from small to substantial with generally greater magnitude in women. The highest inequalities among women were seen in BMI, triglycerides and HDL-cholesterol (Concentration index = − 0.1850; − 0.1683 and − 0.1479 respectively). Among men the largest inequalities were seen in glucose regulation, BMI and abdominal obesity (Concentration index = − 0.1661; − 0.1259 and − 0.1172). The main explanatory factors were, for both women and men socioeconomic conditions (contributions ranging from 54.8 to 76.7% in women and 34.0–72.6% in men) and health behaviours (contributions ranging from 6.9 to 20.5% in women and 9.2 to 26.9% in men). However, the patterns of specific dominant explanatory factors differed between CVRFs and genders. Conclusion Taken together, the results suggest that the magnitude of income-related inequalities in CVRFs and their determinants differ importantly between the risk factors and genders, a variation that should be taken into consideration in population interventions aiming to prevent inequalities in manifest cardiovascular disease.
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Affiliation(s)
- Paola A Mosquera
- Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, SE-901 87, Umeå, Sweden.
| | - Miguel San Sebastian
- Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, SE-901 87, Umeå, Sweden
| | - Anneli Ivarsson
- Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, SE-901 87, Umeå, Sweden
| | - Per E Gustafsson
- Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, SE-901 87, Umeå, Sweden
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Panagiotakos DB, Pitsavos C, Manios Y, Polychronopoulos E, Chrysohoou CA, Stefanadis C. Socio-Economic Status in Relation to Risk Factors Associated with Cardiovascular Disease, in Healthy Individuals from the ATTICA Study. ACTA ACUST UNITED AC 2017. [DOI: 10.1177/204748730501200111] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Social status has been related with the prevalence and incidence of cardiovascular disease. The aim of this study is to investigate the relationships between socio-economic status (SES) and clinical and biochemical factors related to coronary heart disease, in a sample of cardiovascular disease-free men and women. Design Cross-sectional survey. Methods During 2001-2002, 1514 men (20-87 years old) and 1528 women (20-89 years old) from the Attica region (Greece) were randomly enrolled into the study. Trends in established and emerging cardiovascular risk factors were examined across the participants' socio-economic status. A special index was developed (years of school by annual income) and three socio-economic classes were created. Results An inverse relationship was found regarding all lipids and glucose levels across the tertiles of the SES index. An inverse association was observed between body mass index, waist-to-hip ratio and SES in men, but not in women. Furthermore, compared to the lowest tertile, individuals who were classified in the highest SES tertile had lower levels of C-reactive protein, fibrinogen, homocysteine, tumour necrosis factor-α, interleukin-6 levels and white blood cell counts, even after adjusting for various potential confounders. Finally, a considerable proportion of men and women reported lack of health knowledge and education. Conclusions An inverse association between SES and factors related to cardiovascular risk exists, but the causal pathway itself requires more detailed explanation before the social status can have explanatory power.
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Affiliation(s)
- Demosthenes B. Panagiotakos
- First Cardiology Department, School of Medicine, University of Athens, Athens
- Department of Nutrition and Dietetics, Harokopio University, Athens, Greece
| | - Christos Pitsavos
- First Cardiology Department, School of Medicine, University of Athens, Athens
| | - Yannis Manios
- Department of Nutrition and Dietetics, Harokopio University, Athens, Greece
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Kim YJ, Lee JS, Park J, Choi DS, Kim DM, Lee KH, Kim HY, Kim SG, Lee J. Trends in socioeconomic inequalities in five major risk factors for cardiovascular disease in the Korean population: a cross-sectional study using data from the Korea National Health and Nutrition Examination Survey, 2001-2014. BMJ Open 2017; 7:e014070. [PMID: 28515188 PMCID: PMC5623416 DOI: 10.1136/bmjopen-2016-014070] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 02/17/2017] [Accepted: 03/02/2017] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To examine trends in socioeconomic inequalities in major cardiovascular disease (CVD) risk factors among the Korean population. DESIGN Cross-sectional study. SETTING A nationally representative population survey database. PARTICIPANTS A total of 42 725 Koreans, aged 25-64 years, who participated in the Korean National Health and Nutrition Examination Survey (KNHANES) II (2001) to VI (2013-2014). MAIN OUTCOME MEASURES Trends in socioeconomic inequalities in five major CVD risk factors (smoking, obesity, diabetes, hypertension and hypercholesterolaemia). RESULTS Gender differences were noted in the time trends in socioeconomic inequalities in smoking, obesity, diabetes and hypertension. Among men, low socioeconomic status (SES) was associated with higher prevalence of smoking, but not with obesity, diabetes or hypertension. The magnitudes of socioeconomic inequalities in smoking, obesity and diabetes remained unchanged, and the magnitude of the inequality in hypertension decreased over time. However, among women, low SES was associated with higher prevalence of smoking, obesity, diabetes and hypertension. Time trends towards increasing socioeconomic inequalities, measured by income, in smoking, obesity and diabetes were found in women. Unlike the other CVD risk factors, hypercholesterolaemia was not associated with socioeconomic inequality. CONCLUSIONS SES had a stronger impact on major CVD risk factors among Korean women than men. Moreover, socioeconomic inequalities in smoking, obesity and diabetes worsened among Korean women over time. Public policies to prevent smoking, obesity and diabetes in women with lower SES are needed to address inequalities.
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Affiliation(s)
- Yoon Jung Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Hangang Sacred Heart Hospital, Hallym University Medical Center, Seoul, Republic of Korea
| | - Ji Sung Lee
- Clinical Research Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Juri Park
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University Medical Center, Seoul, Republic of Korea
| | - Dong Seop Choi
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Doo Man Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University Medical Center, Seoul, Republic ok Korea
| | - Kee-Hyoung Lee
- Department of Pediatrics, Korea University College of Medicine, Seoul, Republic of Korea
| | - Ho Yeon Kim
- Department of Obstetrics and Gynecology, Inha University Hospital, Incheon, Republic of Korea
| | - Sin Gon Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Juneyoung Lee
- Department of Biostatistics, Korea University College of Medicine, Seoul, Republic of Korea
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Osler M, Jørgensen T, Davidsen M, Grønbaek M, Brønnum-Hansen H, Madsen M, Gerdes U, Schroll M. Socioeconomic status and trends in alcohol drinking in the Danish MONICA population, 1982- 92. Scand J Public Health 2016; 29:40-3. [PMID: 11355715 DOI: 10.1177/14034948010290010901] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aims: To examine trends in alcohol drinking in different educational groups. Methods: Data from three cross-sectional WHO MONICA surveys conducted in 1982-84, 1987, and 1991-92 were analysed to estimate trends in abstention, moderate, heavy, and sporadic heavy alcohol use in relation to level of education, age and smoking. In total, 6,695 Danish men and women aged 30, 40, 50, and 60 years were included. Results: Alcohol drinking decreased in both men and women during the study period, but changes were only significant among the highest educated. In the highest educated men the prevalence of moderate alcohol use increased from 77 to 82%, while heavy alcohol use declined from 19 to 12%. In the highest educated women the prevalence of abstention increased from 15 to 22%, while moderate alcohol use declined from 78 to 68%. Conclusion: During the 1980s, alcohol drinking decreased among the highest educated men and women and an educational gradient in alcohol drinking widened in men and attenuated in women.
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Affiliation(s)
- M Osler
- Institute of Public Health, University of Copenhagen, Denmark.
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Manderbacka K, Arffman M, Lumme S, Keskimäki I. Are there socioeconomic differences in outcomes of coronary revascularizations--a register-based cohort study. Eur J Public Health 2015; 25:984-9. [PMID: 25958240 DOI: 10.1093/eurpub/ckv086] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Earlier studies have reported socioeconomic differences in coronary heart disease incidence and mortality and in coronary treatment, but less is known about outcomes of care. We examined trends in income group differences in outcomes of coronary revascularizations among Finnish residents in 1998-2010. METHODS First revascularizations for 45-84-year-old Finns were extracted from the Hospital Discharge Register in 1998-2009 and followed until 31 December 2010. Income was individually linked to them and adjusted for family size. We examined the risk of major adverse cardiac events (MACEs), coronary mortality and re-revascularization. We calculated age-standardized rates with direct method and Cox regression models. RESULTS Altogether 69 076 men and 27 498 women underwent revascularization during the study period. Among men [women] in the 1998 cohort, 41% [35%] suffered MACE during 29 days after the operation and 30% [28%] in the 2009 cohort. Myocardial infarction mortality within 1 year was 2% among both genders in both cohorts. Among men [women] 9% [14%] underwent revascularization within 1 year after the operation in 1998 and 12% [12%] in 2009. Controlling for age, co-morbidities, year, previous infarction and disease severity, an inverse income gradient was found in MACE incidence within 29 days and in coronary mortality. The excess MACE risk was 1.39 and excess mortality risk over 1.70 among both genders in the lowest income quintile. All income group differences remained stable from 1998 to 2010. CONCLUSIONS In health care, more attention should be paid to prevention of adverse outcomes among persons with low socioeconomic position undergoing revascularization.
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Affiliation(s)
- Kristiina Manderbacka
- 1 Health and Social Systems Research Unit, Department of Health and Social Care Systems, National Institute for Health and Welfare, P. O. Box 30, 00271 Helsinki, Finland
| | - Martti Arffman
- 1 Health and Social Systems Research Unit, Department of Health and Social Care Systems, National Institute for Health and Welfare, P. O. Box 30, 00271 Helsinki, Finland
| | - Sonja Lumme
- 1 Health and Social Systems Research Unit, Department of Health and Social Care Systems, National Institute for Health and Welfare, P. O. Box 30, 00271 Helsinki, Finland
| | - Ilmo Keskimäki
- 1 Health and Social Systems Research Unit, Department of Health and Social Care Systems, National Institute for Health and Welfare, P. O. Box 30, 00271 Helsinki, Finland School of Health Sciences, University of Tampere, 33014 Tampere, Finland
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Cohen AK, Rai M, Rehkopf DH, Abrams B. Educational attainment and obesity: a systematic review. Obes Rev 2013; 14:989-1005. [PMID: 23889851 PMCID: PMC3902051 DOI: 10.1111/obr.12062] [Citation(s) in RCA: 258] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2013] [Revised: 05/14/2013] [Accepted: 05/28/2013] [Indexed: 01/17/2023]
Abstract
Although previous systematic reviews considered the relationship between socioeconomic status and obesity, almost 200 peer-reviewed articles have been published since the last review on that topic, and this paper focuses specifically on education, which has different implications. The authors systematically review the peer-reviewed literature from around the world considering the association between educational attainment and obesity. Databases from public health and medicine, education, psychology, economics, and other social sciences were searched, and articles published in English, French, Portuguese and Spanish were included. This paper includes 289 articles that report on 410 populations in 91 countries. The relationship between educational attainment and obesity was modified by both gender and the country's economic development level: an inverse association was more common in studies of higher-income countries and a positive association was more common in lower-income countries, with stronger social patterning among women. Relatively few studies reported on lower-income countries, controlled for a comprehensive set of potential confounding variables and/or attempted to assess causality through the use of quasi-experimental designs. Future research should address these gaps to understand if the relationship between educational attainment and obesity may be causal, thus supporting education policy as a tool for obesity prevention.
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Affiliation(s)
- A K Cohen
- Division of Epidemiology, University of California Berkeley School of Public Health, Berkeley, California, USA
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Manderbacka K, Peltonen R, Lumme S, Keskimäki I, Tarkiainen L, Martikainen P. The contribution of health policy and care to income differences in life expectancy--a register based cohort study. BMC Public Health 2013; 13:812. [PMID: 24010957 PMCID: PMC3846484 DOI: 10.1186/1471-2458-13-812] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2013] [Accepted: 09/05/2013] [Indexed: 12/02/2022] Open
Abstract
Background Growing mortality differences between socioeconomic groups have been reported in both Finland and elsewhere. While health behaviours and other lifestyle factors are important in contributing to health differences, some researchers have suggested that some of the mortality differences attributable to lifestyle factors could be preventable by health policy measures and that health care may play a role. It has also been suggested that its role is increasing due to better results in disease prevention, improved diagnostic tools and treatment methods. This study aimed to assess the impact of mortality amenable to health policy and health care on increasing income disparities in life expectancy in 1996-2007 in Finland. Methods The study data were based on an 11% random sample of Finnish residents in 1988–2007 obtained from individually linked cause of death and population registries and an oversample of deaths. We examined differences in life expectancy at age 35 (e35) in Finland. We calculated e35 for periods 1996-97 and 2006-07 by income decile and gender. Differences in life expectancies and change in them between the richest and the poorest deciles were decomposed by cause of death group. Results Overall, the difference in e35 between the extreme income deciles was 11.6 years among men and 4.2 years among women in 2006-07. Together, mortality amenable to health policy and care and ischaemic heart disease mortality contributed up to two thirds to socioeconomic differences. Socioeconomic differences increased from 1996-97 by 3.4 years among men and 1.7 years among women. The main contributor to changes was mortality amenable through health policy measures, mainly alcohol related mortality, but also conditions amenable through health care, ischaemic heart disease among men and other diseases contributed to the increase of the differences. Conclusions The results underline the importance of active health policy and health care measures in tackling socioeconomic health inequalities.
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Affiliation(s)
- Kristiina Manderbacka
- Service System Research Unit, National Institute for Health and Welfare, P,O, Box 30, Helsinki 00271, Finland.
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Di Cesare M, Khang YH, Asaria P, Blakely T, Cowan MJ, Farzadfar F, Guerrero R, Ikeda N, Kyobutungi C, Msyamboza KP, Oum S, Lynch JW, Marmot MG, Ezzati M. Inequalities in non-communicable diseases and effective responses. Lancet 2013; 381:585-97. [PMID: 23410608 DOI: 10.1016/s0140-6736(12)61851-0] [Citation(s) in RCA: 425] [Impact Index Per Article: 38.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
In most countries, people who have a low socioeconomic status and those who live in poor or marginalised communities have a higher risk of dying from non-communicable diseases (NCDs) than do more advantaged groups and communities. Smoking rates, blood pressure, and several other NCD risk factors are often higher in groups with low socioeconomic status than in those with high socioeconomic status; the social gradient also depends on the country's stage of economic development, cultural factors, and social and health policies. Social inequalities in risk factors account for more than half of inequalities in major NCDs, especially for cardiovascular diseases and lung cancer. People in low-income countries and those with low socioeconomic status also have worse access to health care for timely diagnosis and treatment of NCDs than do those in high-income countries or those with higher socioeconomic status. Reduction of NCDs in disadvantaged groups is necessary to achieve substantial decreases in the total NCD burden, making them mutually reinforcing priorities. Effective actions to reduce NCD inequalities include equitable early childhood development programmes and education; removal of barriers to secure employment in disadvantaged groups; comprehensive strategies for tobacco and alcohol control and for dietary salt reduction that target low socioeconomic status groups; universal, financially and physically accessible, high-quality primary care for delivery of preventive interventions and for early detection and treatment of NCDs; and universal insurance and other mechanisms to remove financial barriers to health care.
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Affiliation(s)
- Mariachiara Di Cesare
- MRC-HPA Centre for Environment and Health, Department of Epidemiology and Biostatistics, Imperial College London, London, UK
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Nagelhout GE, de Korte-de Boer D, Kunst AE, van der Meer RM, de Vries H, van Gelder BM, Willemsen MC. Trends in socioeconomic inequalities in smoking prevalence, consumption, initiation, and cessation between 2001 and 2008 in the Netherlands. Findings from a national population survey. BMC Public Health 2012; 12:303. [PMID: 22537139 PMCID: PMC3356226 DOI: 10.1186/1471-2458-12-303] [Citation(s) in RCA: 94] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2012] [Accepted: 04/26/2012] [Indexed: 11/25/2022] Open
Abstract
Background Widening of socioeconomic status (SES) inequalities in smoking prevalence has occurred in several Western countries from the mid 1970’s onwards. However, little is known about a widening of SES inequalities in smoking consumption, initiation and cessation. Methods Repeated cross-sectional population surveys from 2001 to 2008 (n ≈ 18,000 per year) were used to examine changes in smoking prevalence, smoking consumption (number of cigarettes per day), initiation ratios (ratio of ever smokers to all respondents), and quit ratios (ratio of former smokers to ever smokers) in the Netherlands. Education level and income level were used as indicators of SES and results were reported separately for men and women. Results Lower educated respondents were significantly more likely to be smokers, smoked more cigarettes per day, had higher initiation ratios, and had lower quit ratios than higher educated respondents. Income inequalities were smaller than educational inequalities and were not all significant, but were in the same direction as educational inequalities. Among women, educational inequalities widened significantly between 2001 and 2008 for smoking prevalence, smoking initiation, and smoking cessation. Among low educated women, smoking prevalence remained stable between 2001 and 2008 because both the initiation and quit ratio increased significantly. Among moderate and high educated women, smoking prevalence decreased significantly because initiation ratios remained constant, while quit ratios increased significantly. Among men, educational inequalities widened significantly between 2001 and 2008 for smoking consumption only. Conclusions While inequalities in smoking prevalence were stable among Dutch men, they increased among women, due to widening inequalities in both smoking cessation and initiation. Both components should be addressed in equity-oriented tobacco control policies.
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Affiliation(s)
- Gera E Nagelhout
- STIVORO Dutch Expert Centre on Tobacco Control, PO Box 16070, 2500 BB, The Hague, the Netherlands.
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Worrall-Carter L, Edward KL, Page K. Women and cardiovascular disease: at a social disadvantage? Collegian 2012; 19:33-7. [PMID: 22482280 DOI: 10.1016/j.colegn.2011.09.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
BACKGROUND Cardiovascular disease is the most common cause of death in Australian women. The genesis and progression of cardiovascular disease is modulated by a complex interplay of genetic, physiological, social and economic circumstances. Increasingly the impact of racial, ethic, social and economic inequalities is identified as predictors of cardiovascular disease outcome. Despite important advances over the last 30 years in reducing age adjusted mortality from cardiovascular disease, it continues to represent a major social and economic burden nationally and internationally. AIM This paper provides a critical review of the social issues impacting upon women in Australia. It also identifies areas for future interventions with a view to improving outcomes in women with cardiovascular disease. METHOD The bibliographic databases; CINAHL, MEDLINE, PsycARTICLES, were searched for relevant studies using the search terms 'women', 'cardiovascular disease', and 'socio-economic status'. FINDINGS While some gains have been made in reducing the risk factor profile and rates of death from cardiovascular disease, it is clear that gender, race and socioeconomic disparities persist. CONCLUSIONS New approaches are required to improve health differentials for CVD, and reduce the impact of gender, racial, ethic, social and economic factors on health disparities.
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Affiliation(s)
- Linda Worrall-Carter
- St Vincent's/ACU Centre for Nursing Research & The Cardiovascular Research Centre, 4/486 Albert Street, East Melbourne, Australia.
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Ernstsen L, Strand BH, Nilsen SM, Espnes GA, Krokstad S. Trends in absolute and relative educational inequalities in four modifiable ischaemic heart disease risk factors: repeated cross-sectional surveys from the Nord-Trøndelag Health Study (HUNT) 1984-2008. BMC Public Health 2012; 12:266. [PMID: 22471945 PMCID: PMC3434116 DOI: 10.1186/1471-2458-12-266] [Citation(s) in RCA: 100] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2011] [Accepted: 04/03/2012] [Indexed: 12/18/2022] Open
Abstract
Background There has been an overall decrease in incident ischaemic heart disease (IHD), but the reduction in IHD risk factors has been greater among those with higher social position. Increased social inequalities in IHD mortality in Scandinavian countries is often referred to as the Scandinavian “public health puzzle”. The objective of this study was to examine trends in absolute and relative educational inequalities in four modifiable ischaemic heart disease risk factors (smoking, diabetes, hypertension and high total cholesterol) over the last three decades among Norwegian middle-aged women and men. Methods Population-based, cross-sectional data from The Nord-Trøndelag Health Study (HUNT): HUNT 1 (1984–1986), HUNT 2 (1995–1997) and HUNT 3 (2006–2008), women and men 40–59 years old. Educational inequalities were assessed using the Slope Index of Inequality (SII) and The Relative Index of Inequality (RII). Results Smoking prevalence increased for all education groups among women and decreased in men. Relative and absolute educational inequalities in smoking widened in both genders, with significantly higher absolute inequalities among women than men in the two last surveys. Diabetes prevalence increased in all groups. Relative inequalities in diabetes were stable, while absolute inequalities increased both among women (p = 0.05) and among men (p = 0.01). Hypertension prevalence decreased in all groups. Relative inequalities in hypertension widened over time in both genders. However, absolute inequalities in hypertension decreased among women (p = 0.05) and were stable among men (p = 0.33). For high total cholesterol relative and absolute inequalities remained stable in both genders. Conclusion Widening absolute educational inequalities in smoking and diabetes over the last three decades gives rise to concern. The mechanisms behind these results are less clear, and future studies are needed to assess if educational inequalities in secondary prevention of IHD are larger compared to educational inequalities in primary prevention of IHD. Continued monitoring of IHD risk factors at the population level is therefore warranted. The results emphasise the need for public health efforts to prevent future burdens of life-style-related diseases and to avoid further widening in socioeconomic inequalities in IHD mortality in Norway, especially among women.
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Affiliation(s)
- Linda Ernstsen
- Sør-Trøndelag University College, Mauritz Hansens gt 2, 7004, Trondheim, Norway.
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Millett C, Laverty AA, Stylianou N, Bibbins-Domingo K, Pape UJ. Impacts of a national strategy to reduce population salt intake in England: serial cross sectional study. PLoS One 2012; 7:e29836. [PMID: 22238665 PMCID: PMC3251604 DOI: 10.1371/journal.pone.0029836] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2011] [Accepted: 12/06/2011] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND The UK introduced an ambitious national strategy to reduce population levels of salt intake in 2003. The aim of this study was to evaluate the impact of this strategy on salt intake in England, including potential effects on health inequalities. METHODS Secondary analysis of data from the Health Survey for England. Our main outcome measure was trends in estimated daily salt intake from 2003-2007, as measured by spot urine. Secondary outcome measures were knowledge of government guidance and voluntary use of salt in food preparation over this time period. RESULTS There were significant reductions in salt intake between 2003 and 2007 (-0.175 grams per day per year, p<0.001). Intake decreased uniformly across all other groups but remained significantly higher in younger persons, men, ethnic minorities and lower social class groups and those without hypertension in 2007. Awareness of government guidance on salt use was lowest in those groups with the highest intake (semi-skilled manual v professional; 64.9% v 71.0% AOR 0.76 95% CI 0.58-0.99). Self reported use of salt added at the table reduced significantly during the study period (56.5% to 40.2% p<0.001). Respondents from ethnic minority groups remained significantly more likely to add salt during cooking (white 42.8%, black 74.1%, south Asian 88.3%) and those from lower social class groups (unskilled manual 46.6%, professional 35.2%) were more likely to add salt at the table. CONCLUSIONS The introduction a national salt reduction strategy was associated with uniform but modest reductions in salt intake in England, although it is not clear precisely which aspects of the strategy contributed to this. Knowledge of government guidance was lower and voluntary salt use and total salt intake was higher among occupational and ethnic groups at greatest risk of cardiovascular disease.
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Affiliation(s)
- Christopher Millett
- Department of Primary Care and Public Health, Imperial College London, London, United Kingdom
| | - Anthony A. Laverty
- Department of Primary Care and Public Health, Imperial College London, London, United Kingdom
| | - Neophytos Stylianou
- Department of Primary Care and Public Health, Imperial College London, London, United Kingdom
| | - Kirsten Bibbins-Domingo
- Departments of Medicine, Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, United States of America
| | - Utz J. Pape
- Department of Primary Care and Public Health, Imperial College London, London, United Kingdom
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Cho CM, Lee YM. The relationship between cardiovascular disease risk factors and gender. Health (London) 2012. [DOI: 10.4236/health.2012.46051] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Page A, Lane A, Taylor R, Dobson A. Trends in socioeconomic inequalities in mortality from ischaemic heart disease and stroke in Australia, 1979–2006. Eur J Prev Cardiol 2011; 19:1281-9. [DOI: 10.1177/1741826711427505] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Andrew Page
- School of Population Health, University of Queensland, Herston, Australia
| | - Amanda Lane
- School of Population Health, University of Queensland, Herston, Australia
| | - Richard Taylor
- School of Public Health and Community Medicine, University of New South Wales, Randwick, Australia
| | - Annette Dobson
- School of Population Health, University of Queensland, Herston, Australia
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Harper S, Lynch J, Smith GD. Social Determinants and the Decline of Cardiovascular Diseases: Understanding the Links. Annu Rev Public Health 2011; 32:39-69. [DOI: 10.1146/annurev-publhealth-031210-101234] [Citation(s) in RCA: 107] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Sam Harper
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC H3A 1A2, Canada;
| | - John Lynch
- Sansom Institute for Health Research, Division of Health Sciences, University of South Australia, Adelaide SA 5001; School of Population Health and Clinical Practice, University of Adelaide, SA 5005 Australia;
- School of Community and Social Medicine, University of Bristol, Bristol BS8 2BN, United Kingdom
| | - George Davey Smith
- School of Community and Social Medicine, University of Bristol, Bristol BS8 2BN, United Kingdom
- MRC Center for Causal Analyses in Translational Epidemiology, University of Bristol, Bristol BS8 2BN, United Kingdom;
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Trends in the prevalence, awareness, treatment, and control of cardiovascular risk factors across educational level in the 1995-2005 period. Ann Epidemiol 2011; 21:555-63. [PMID: 21435903 DOI: 10.1016/j.annepidem.2011.02.008] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2010] [Revised: 02/04/2011] [Accepted: 02/07/2011] [Indexed: 11/20/2022]
Abstract
PURPOSE To determine the differences and trends in the prevalence, awareness, treatment and control of cardiovascular risk factors and lifestyle variables across educational level in the 1995-2005 period in a country with a universal free health care system. METHODS Data from three consecutive independent population-based surveys were used. Cardiovascular risk factors, lifestyle variables, and self-reported educational level were collected in 9646 individuals ages 35-74 years throughout the decade. RESULTS The prevalence of hypertension and diabetes was inversely associated with education. An increase in the proportion of hypertension and dyslipidemia awareness, treatment, and control in all educational level groups was observed. This increase was greater among the lowest education group, reducing the disparities between groups. The prevalence of lifestyle-related risk factors decreased in the greatest but increased in the lowest education group, widening the disparities between groups. CONCLUSIONS A universal free health care system is effective in avoiding inequalities in the diagnosis, treatment, and control of cardiovascular risk factors. However, other social determinants seem to explain the social inequalities in the prevalence of these risk factors and in the adoption of healthy lifestyles.
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Kim K, Hong SA, Kim MK. Trends in nutritional inequality by educational level: a case of South Korea. Nutrition 2009; 26:791-8. [PMID: 19963353 DOI: 10.1016/j.nut.2009.07.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2009] [Revised: 07/13/2009] [Accepted: 07/14/2009] [Indexed: 10/20/2022]
Abstract
OBJECTIVE There is much evidence of a cross-sectional relation between socioeconomic position and dietary intakes but the trend of this relation is little studied. This study aimed to examine the extent and trend of nutritional inequality by educational level based on the prevalence of inadequate nutrient intakes. METHODS Three cross-sectional nationwide surveys (1998, 2001, 2005) of the Korean National Health and Nutrition Examination Survey were used. A total of 20 777 participants > or = 20 y old were included. The socioeconomic position indicator was educational level. Dietary nutrient intakes were assessed by a 24-h recall and inadequacy of intake for nutrients was assessed on the basis of the percentage of attainment of the dietary reference intakes for Koreans. To assess nutritional inequality by educational level, the prevalence ratio, relative index of inequality, and slope index of inequality were used. RESULTS Poorer dietary intakes and higher estimated prevalence of nutrient inadequacy were more apparent in the lower education group than the higher education group for both genders and each survey year. Graded patterns of inequalities in nutrient intakes by educational level were generally clear at each survey year. The trend of the relative nutritional inequalities in Korean men and women remained unchanged from 1998 to 2005, with some exceptions. CONCLUSION The inequality in nutrient intakes by educational level was persistently apparent for both genders in the Korean adult population, although the relative inequalities did not increase over time.
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Affiliation(s)
- Kirang Kim
- Department of Preventive Medicine, Hanyang University, College of Medicine, Seoul, Korea
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Seppänen-Nuijten E, Lahti-Koski M, Männistö S, Knekt P, Rissanen H, Aromaa A, Heliövaara M. Fat free mass and obesity in relation to educational level. BMC Public Health 2009; 9:448. [PMID: 19961589 PMCID: PMC2801678 DOI: 10.1186/1471-2458-9-448] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2009] [Accepted: 12/04/2009] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND The aim of the study was to describe the body composition of Finnish adults, especially by education, and to investigate whether fat-free mass (FFM) can explain educational gradients relating to body mass index (BMI) and waist-to-hip ratio (WHR). METHODS Data for this cross-sectional study were based on data collected in 2000-2001 for the Health 2000 Survey. Of the nationally representative sample of 8,028 Finnish men and women aged 30 years and older, 6,300 (78.5%) were included in the study. Body composition measurements were carried out in the health examination, where FFM was assessed with eight-polar bioelectrical impedance analysis. Questions on education were included in the health interview. RESULTS The mean FFM varied by education in older (>or= 65 y.) men only. In the middle-aged group (30-64 y.), highly educated men were less likely to belong to the lowest quintile of FFM (OR 0.67, 95%CI 0.48-0.93) compared with the least educated subjects. The level of education was inversely associated with the prevalence of high BMI and WHR in middle-aged men. In women, the respective associations were found both in middle-aged women and their older counterparts. Adjustment for FFM slightly strengthened the associations of education with BMI and WHR. CONCLUSIONS The association between education and FFM is weak. Educational gradients of high BMI and high WHR cannot be explained by FFM.
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Affiliation(s)
| | - Marjaana Lahti-Koski
- National Institute for Health and Welfare, Mannerheimintie 166, 00300 Helsinki, Finland
- Finnish Heart Association, Oltermannintie 8, P.O.Box 50, 00621 Helsinki, Finland
| | - Satu Männistö
- National Institute for Health and Welfare, Mannerheimintie 166, 00300 Helsinki, Finland
| | - Paul Knekt
- National Institute for Health and Welfare, Mannerheimintie 166, 00300 Helsinki, Finland
| | - Harri Rissanen
- National Institute for Health and Welfare, Mannerheimintie 166, 00300 Helsinki, Finland
| | - Arpo Aromaa
- National Institute for Health and Welfare, Mannerheimintie 166, 00300 Helsinki, Finland
| | - Markku Heliövaara
- National Institute for Health and Welfare, Mannerheimintie 166, 00300 Helsinki, Finland
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Peach HG, Bath NE. PREVENTING FRACTURES IN LARGE RURAL CENTRES: SOCIODEMOGRAPHIC SUB-GROUPS AT RISK OF OSTEOPOROSIS FROM THEIR LIFESTYLE. Aust J Rural Health 2008. [DOI: 10.1111/j.1440-1584.2000.tb00374.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Paxton SJ, Sculthorpe A. Weight and health locus of control beliefs in an australian community sample. Psychol Health 2007. [DOI: 10.1080/08870449908407338] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Strand BH, Tverdal A. Trends in educational inequalities in cardiovascular risk factors: a longitudinal study among 48,000 middle-aged Norwegian men and women. Eur J Epidemiol 2006; 21:731-9. [PMID: 17106763 DOI: 10.1007/s10654-006-9046-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2006] [Indexed: 11/29/2022]
Abstract
The aim of the study was to compare educational and gender specific trends in the classical cardiovascular risk factors body mass index (BMI), cholesterol, systolic blood pressure and smoking in a Norwegian population during a period when the coronary heart disease mortality had just reached its peak in the late 1970s and 1980s. We used The Norwegian Counties study: a longitudinal study with three screenings on the same individuals in Oppland, Sogn og Fjordane and Finnmark counties in Norway in the period 1974-1988. All residents aged 35-49 were invited and 48,422 participated (89%) in the baseline screening. To estimate the cardiovascular risk factor change in individuals over time longitudinal statistical methods were used. BMI, cholesterol and blood pressure levels increased with age, while the amount of daily smokers decreased. The higher the educational level the lower the level of BMI, blood pressure, smoking and cholesterol. This pattern persisted through the whole study period. In men, however, the educational gradient in cholesterol diminished in the last screening. Among women there was an increase in inequality in systolic blood pressure, and for smoking there was a steeper decrease for men than women across all educational groups. The educational differences in classical cardiovascular risk factors persisted, except for BMI, cholesterol and daily smokers in men which tended to decrease.
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Affiliation(s)
- Bjørn Heine Strand
- Division of Epidemiology, Norwegian Institute of Public Health, P.O. Box 4404, NO-0403, Nydalen, Oslo, Norway.
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Khang YH, Cho HJ. Socioeconomic inequality in cigarette smoking: trends by gender, age, and socioeconomic position in South Korea, 1989-2003. Prev Med 2006; 42:415-22. [PMID: 16580714 DOI: 10.1016/j.ypmed.2006.02.010] [Citation(s) in RCA: 92] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2005] [Revised: 02/14/2006] [Accepted: 02/21/2006] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The aim of this study was to examine trends of socioeconomic differentials in smoking rates by gender, age, and socioeconomic position in South Korea. METHODS We used data from five Social Statistical Surveys of Korea National Statistical Office from 1989 to 2003. This study included 344,969 men and women aged 20 or over. Socioeconomic position indicators were education and occupation. RESULTS Age-standardized smoking rates decreased in all age groups of men and women aged 45+ between 1989 and 2003, while smoking rates among women aged 20-44 did not decrease. Education was inversely associated with smoking in both genders. Those with manual occupations had greater smoking rates than those who performed non-manual labor. Based on the relative index of inequality, unfavorable inequality trends toward low education were detected in both genders aged 20-44. However, these trends were not found at ages 45-64. For occupational class, the relative inequality in smoking measured by odds ratios remained stable among men and women between 1995 and 2003. CONCLUSIONS Continuous and progressive anti-smoking policy measures should be directed toward South Korean men whose smoking rates are still high. Policy efforts to reduce socioeconomic inequality in smoking, especially among young adult men and women, should be exercised. In addition, additional anti-smoking policy measures toward young women's smoking habits need to be developed in South Korea.
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Affiliation(s)
- Young-Ho Khang
- Department of Preventive Medicine, University of Ulsan College of Medicine, Seoul, 138-736 Korea.
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Braaten T, Weiderpass E, Kumle M, Lund E. Explaining the Socioeconomic Variation in Cancer Risk in the Norwegian Women and Cancer Study. Cancer Epidemiol Biomarkers Prev 2005; 14:2591-7. [PMID: 16284383 DOI: 10.1158/1055-9965.epi-05-0345] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Associations between level of education and cancer risk is well supported by scientific evidence, but previous studies could only partly adjust for relevant confounding factors. In this article, we examined how risk of cancer varies with level of education and identified factors that explain this variation using data from a prospective cohort study, including 93,638 Norwegian women who responded to an extensive questionnaire in 1991/1992 or 1996/1997. A total of 3,259 incident primary invasive cancer cases were diagnosed during follow-up, which ended in December 2001. We used Cox proportional hazards model to calculate relative risks (RR) with 95% confidence intervals (95% CI). Besides a similar overall risk of female cancers by level of education, we observed differing risks between educational groups for cancers of the lung, breast, cervix, kidney, and skin melanoma. Women with >16 years of education had an increased risk of breast cancer (RR, 1.46; 95% CI, 1.19-1.79) and a decreased risk of lung cancer (RR, 0.30; 95% CI, 0.13-0.70) and cervical cancer (RR, 0.38; 95% CI, 0.17-0.85) compared with the lowest educated women (7-9 years). The middle educated (13-16 years) had the lowest risk of kidney cancer (RR, 0.24; 95% CI, 0.08-0.71), whereas the risk of skin melanoma was highest among women with 10 to 12 years of education (RR, 1.53; 95% CI, 1.05-2.24) compared with the lowest educated women. After multivariate adjustment for potential confounders related to level of education, the variation in cancer risk according to educational levels declined into nonsignificance for all these sites.
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Affiliation(s)
- Tonje Braaten
- Institute of Community Medicine, University of Tromsø, N-9037 Tromsø, Norway.
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Jackson SL, Peterson GM, House M, Bartlett T. Point-of-care monitoring of anticoagulant therapy by rural community pharmacists: description of successful outcomes. Aust J Rural Health 2005; 12:197-200. [PMID: 15588262 DOI: 10.1111/j.1440-1854.2004.00604.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Warfarin is a recognised high-risk drug for adverse events. Patients from rural and remote regions are at increased risk of these events because of problems of access to health care providers and services, and there is some reluctance to prescribe warfarin to patients in rural areas because of the difficulties in monitoring anticoagulated patients. The availability of portable international normalised ratio (INR) monitors is particularly attractive in rural or remote settings because of the lack of access to pathology services. Pharmacists and other health professionals in rural areas are ideally placed to assist general practitioners in the management of their anticoagulated patients through the use of portable INR monitors. The present article describes three cases of successful outcomes of pharmacist-assisted anticoagulation monitoring in the rural setting. Innovative service delivery models like these are needed to meet the needs of the increasing number of rural Australians requiring warfarin therapy.
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Affiliation(s)
- Shane L Jackson
- Tasmanian School of Pharmacy, University of Tasmania, Hobart, Tasmania 7001, Australia
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Zhao Y, Guthridge S, Magnus A, Vos T. Burden of disease and injury in Aboriginal and non‐Aboriginal populations in the Northern Territory. Med J Aust 2004; 180:498-502. [PMID: 15139825 DOI: 10.5694/j.1326-5377.2004.tb06051.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2003] [Accepted: 03/22/2004] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To quantify the burden of disease and injury for the Aboriginal and non-Aboriginal populations in the Northern Territory. DESIGN AND SETTING Analysis of Northern Territory data for 1 January 1994 to 30 December 1998 from multiple sources. MAIN OUTCOME MEASURES Disability-adjusted life-years (DALYs), by age, sex, cause and Aboriginality. RESULTS Cardiovascular disease was the leading contributor (14.9%) to the total burden of disease and injury in the NT, followed by mental disorders (14.5%) and malignant neoplasms (11.2%). There was also a substantial contribution from unintentional injury (10.4%) and intentional injury (4.9%). Overall, the NT Aboriginal population had a rate of burden of disease 2.5 times higher than the non-Aboriginal population; in the 35-54-year age group their DALY rate was 4.1 times higher. The leading causes of disease burden were cardiovascular disease for both Aboriginal men (19.1%) and women (15.7%) and mental disorders for both non-Aboriginal men (16.7%) and women (22.3%). CONCLUSIONS A comprehensive assessment of fatal and non-fatal conditions is important in describing differentials in health status of the NT population. Our study provides comparative data to identify health priorities and facilitate a more equitable distribution of health funding.
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Affiliation(s)
- Yuejen Zhao
- Health Gains Planning, Northern Territory Department of Health and Community Services, Casuarina, NT.
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Sekuri C, Eser E, Akpinar G, Cakir H, Sitti I, Gulomur O, Ozcan C. Cardiovascular Disease Risk Factors in Post-Menopausal Women in West Anatolia. ACTA ACUST UNITED AC 2004; 45:119-31. [PMID: 14973357 DOI: 10.1536/jhj.45.119] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Cardiovascular risk factors are important causes of morbidity and mortality in postmenopausal women. The aim of this cross-sectional study was to evaluate the cardiovascular risk factors in 207 postmenopausal Turkish women over 45 years old in a rural district of West Anatolia, Manisa Muradiye district. A questionnaire on socioeconomic and sociodemographic characteristics was conducted in the women followed by the measurement of blood pressure, fasting blood glucose, cholesterol levels, and waist-hip ratio along with an electrocardiogram (ECG). The European Cardiology Society risk index was used for cardiovascular risk evaluation. The results showed that 86% percent of the women will be carrying more than a 5% probability of developing a cardiovascular risk in the next 10 years. Moreover, the results proved 7% of the women are at high risk for a cardiovascular condition. Hypertension, hypercholesterolemia, and impaired glucose tolerance, were observed in 62%, 35.3%, and 13.5% of the women, respectively. Seven percent had smoked for at least six months. Fourteen cases had complained of exercise angina and pathologic ECG signs were diagnosed in one-third of these 14 cases. The waist-hip ratio measured 0.8 or more in 66.2% of the cases, with a range of 68-147 cm (mean; 95.6 +/- 11.55). The results indicate that the risk of a cardiovascular condition developing is extremely high in postmenopausal West Anatolian women and increases with age. Morever, the prevalance of hypertension increased with age and was very closely related with low socioeconomic levels. These hazardous cardiovascular disease risk factors should be considered as high priority health problems in rural and low socioeconomic areas of developing communities. Intervention to modify the cardiovascular risk factors should be included in routine primary health care programs.
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Affiliation(s)
- Cevad Sekuri
- Cardiology Department, Celal Bayar University, Manisa, Turkey
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Gilman SE, Abrams DB, Buka SL. Socioeconomic status over the life course and stages of cigarette use: initiation, regular use, and cessation. J Epidemiol Community Health 2003; 57:802-8. [PMID: 14573586 PMCID: PMC1732304 DOI: 10.1136/jech.57.10.802] [Citation(s) in RCA: 221] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
STUDY OBJECTIVE To investigate the association between multiple indicators of socioeconomic status (SES) over the life course and three stages of cigarette use: initiation, regular use, and cessation. DESIGN Prospective birth cohort study. SETTING Providence, Rhode Island. PARTICIPANTS Subjects (n=657) aged 30 to 39 were offspring of participants in the Brown University cohort of the United States National Collaborative Perinatal Project started in 1959. MAIN RESULTS A significantly increased risk of smoking initiation was observed among people from lower socioeconomic backgrounds. Low SES in childhood also increased the risk for progression to regular smoking, and was associated with a reduced likelihood of smoking cessation. Progression to regular smoking and smoking persistence were also associated with lower adult SES. CONCLUSIONS Socioeconomic conditions over the life course accumulate to produce increased rates of smoking uptake and reduced rates of cessation among lower SES people. Addressing SES gradients in smoking will require persistent and extended intervention over multiple life stages.
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Affiliation(s)
- S E Gilman
- Centers for Behavioral and Preventive Medicine, Brown Medical School and The Miriam Hospital, CORO Building Suite 500, 1 Hoppin Street, Providence, RI 02903, USA.
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Archer SL, Hilner JE, Dyer AR, Greenlund KJ, Colangelo LA, Kiefe CI, Liu K. Association of education with dietary intake among young adults in the bi-ethnic Coronary Artery Risk Development in Young Adults (CARDIA) cohort. Public Health Nutr 2003; 6:689-95. [PMID: 14552670 DOI: 10.1079/phn2003488] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To examine associations of changes in dietary intake with education in young black and white men and women. DESIGN The Coronary Artery Risk Development in Young Adults (CARDIA) study, a multi-centre population-based prospective study. Dietary intake data at baseline and year 7 were obtained from an extensive nutritionist-administered diet history questionnaire with 700 items developed for CARDIA. SETTING Participants were recruited in 1985-1986 from four sites: Birmingham, Alabama; Chicago, Illinois; Minneapolis, Minnesota; and Oakland, California. SUBJECTS Participants were from a general community sample of 703 black men (BM), 1006 black women (BW), 963 white men (WM) and 1054 white women (WW) who were aged 18-30 years at baseline. Analyses here include data for baseline (1985-1986) and year 7 (1992-1993). RESULTS Most changes in dietary intake were observed among those with high education (>or=12 years) at both examinations. There was a significant decrease in intake of energy from saturated fat and cholesterol and a significant increase in energy from starch for each race-gender group (P<0.001). Regardless of education, taste was considered an important influence on food choice. CONCLUSION The inverse relationship of education with changes in saturated fat and cholesterol intakes suggests that national public health campaigns may have a greater impact among those with more education.
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Affiliation(s)
- S L Archer
- Department of Preventive Medicine, Northwestern University, Feinberg School of Medicine, 680 N. Lake Shore Drive, #1102, Chicago, IL 60611, USA.
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Kobetz E, Daniel M, Earp JA. Neighborhood poverty and self-reported health among low-income, rural women, 50 years and older. Health Place 2003; 9:263-71. [PMID: 12810333 DOI: 10.1016/s1353-8292(02)00058-8] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We examined the relationship between neighborhood socioeconomic context and self-reported health among low-income, rural women aged 50+ years, without a history of breast cancer. Tract-level census data were linked to individual level data from the baseline survey of a community trial to increase breast cancer screening rates. Generalized estimating equations were used to analyze data for 1988 women and 56 census tracts. Neighborhood poverty was associated with a greater likelihood of poor self-reported health, adjusted for age, race and socioeconomic status (OR=1.35, 95% CI=1.08-1.68). This effect was greatest for individuals with incomes below the median neighborhood income.
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Affiliation(s)
- E Kobetz
- Department of Health Behavior and Health Education, School of Public Health, The University of North Carolina at Chapel Hill, C.B. #7440, Rosenau Hall, Chapel Hill, NC 27599-7440, USA.
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Galobardes B, Costanza MC, Bernstein MS, Delhumeau C, Morabia A. Trends in risk factors for lifestyle-related diseases by socioeconomic position in Geneva, Switzerland, 1993-2000: health inequalities persist. Am J Public Health 2003; 93:1302-9. [PMID: 12893619 PMCID: PMC1447961 DOI: 10.2105/ajph.93.8.1302] [Citation(s) in RCA: 73] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We report on trends in risk factors for lifestyle-related diseases among socioeconomic position (SEP) groups. METHODS We continuously surveyed the adult population of Geneva, Switzerland, for 8 years (1993-2000) with independent, cross-sectional surveys of representative samples (4207 men and 3987 women aged 35-74 years). Age-adjusted linear regression slopes estimated annual risk factor trends. Interaction terms were tested for trend differences between SEP groups. RESULTS Overall, low-SEP persons had the worst risk factor profiles. Eight-year trends indicate that (1) number of pack-years smoked decreased by half a pack-year among high-SEP female current smokers only; (2) obesity prevalence more than doubled from 5% to 11% among high-SEP men only; (3) systolic and diastolic blood pressures decreased similarly in all SEP groups; (4) unsaturated-to-saturated dietary fat ratio declined in the low-SEP group only; and (5) physical inactivity and current/former cigarette smoking prevalences remained unchanged in all SEP groups. CONCLUSIONS Smoking, obesity, high blood pressure, and physical inactivity are more prevalent among low-SEP persons. Most socioeconomic risk factor differences remained stable in the 1990s. Thus, social inequalities in chronic disease morbidity and mortality will persist in the next decades.
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Affiliation(s)
- Bruna Galobardes
- Division of Clinical Epidemiology, Geneva University Hospitals, Switzerland
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Ferrie JE, Shipley MJ, Stansfeld SA, Smith GD, Marmot M. Future uncertainty and socioeconomic inequalities in health: the Whitehall II study. Soc Sci Med 2003; 57:637-46. [PMID: 12821012 DOI: 10.1016/s0277-9536(02)00406-9] [Citation(s) in RCA: 75] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Over the past 20 years, socioeconomic inequalities in mortality have widened, while job security and financial security have decreased. This paper examines the Whitehall II study, a longitudinal study of white-collar British civil servants. In the Whitehall II cohort socioeconomic gradients in morbidity and cardiovascular risk factors at Phase 5 (1997-99) were generally steeper than at Phase 1 (1985-88). We examine the contribution of job and financial insecurity to these at Phase 5 in 6770 women and men, all of whom were white-collar civil servants at Phase 1. Steep, inverse employment grade gradients were observed for all health measures at Phase 5, except cholesterol and systolic blood pressure in women. Gradients in the sub-population of non-employed participants tended to be steeper than gradients for participants in employment, although, with the exception of self-rated health and General Health Questionnaire (GHQ) score in men, differences were non-significant. Steep gradients in job insecurity were observed among employed participants (p<or=0.01), and in financial insecurity among both employed and non-employed participants (p<or=0.001), particularly non-employed men. With the exception of depression, adjustment for job insecurity had little effect on the employment grade gradients in morbidity. However, financial insecurity contributed substantially to gradients in self-rated health, longstanding illness, and depression in both employed and non-employed men, and additionally to GHQ score and diastolic blood pressure in the latter. Adjustment for financial insecurity in non-employed women substantially attenuated gradients in self-rated health, GHQ score and depression. These findings imply that the specific effects of job insecurity in this cohort may be less important than the more general effects of financial insecurity in determining inequalities in health.
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Affiliation(s)
- Jane E Ferrie
- Department of Epidemiology and Public Health, University College London Medical School, London, UK.
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Ferrie JE, Shipley MJ, Davey Smith G, Stansfeld SA, Marmot MG. Change in health inequalities among British civil servants: the Whitehall II study. J Epidemiol Community Health 2002; 56:922-6. [PMID: 12461113 PMCID: PMC1757010 DOI: 10.1136/jech.56.12.922] [Citation(s) in RCA: 64] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
STUDY OBJECTIVE Despite an overall decline in mortality rates, the social gradient in mortality has increased over the past two decades. However, evidence on trends in morbidity and cardiovascular risk factors indicates that socioeconomic differences are static or narrowing. The objective of this study was to investigate morbidity and cardiovascular risk factor trends in white collar British civil servants. DESIGN Self rated health, longstanding illness, minor psychiatric morbidity (General Health Questionnaire (GHQ) 30 score, GHQ caseness and GHQ depression subscale), cholesterol, diastolic and systolic blood pressure, body mass index, alcohol over the recommended limits, and smoking were collected at baseline screening (1985-88) and twice during follow up (mean length of follow up 5.3 and 11.1 years). Employment grade gradients in these measures at each phase were compared. SETTING Whitehall II, prospective cohort study. PARTICIPANTS White collar women and men aged 35-55, employed in 20 departments at baseline screening. Analyses included 6770 participants who responded to all three phases. RESULTS Steep employment grade gradients were observed for most measures at second follow up. In general, there was little evidence that employment grade gradients have increased over the 11.1 years of follow up, but marked increases in the gradient were observed for GHQ score (p<0.001) and depression (p=0.05) in both sexes and for cholesterol in men (p=0.01). CONCLUSIONS There is little evidence of an increase in inequality for most measures of morbidity and cardiovascular risk factors in white collar civil servants over the 11.1 years to 1998. Inequalities have increased significantly for minor psychiatric morbidity in both sexes and for cholesterol in men.
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Affiliation(s)
- J E Ferrie
- International Centre for Health and Society, Department of Epidemiology and Public Health, University College London Medical School, London, UK.
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Abstract
OBJECTIVES To examine the relationship between socio-economic position and height in early adulthood. METHOD A representative probability sample of Australian households (part of the 1995 National Health Survey). Data were collected by face-to-face interviews. Socio-economic position was measured using occupation and family income. Participants comprised 9,577 Australian-born males and females aged 20-24 (n = 3,186), 25-29 (n = 3,184), and 30-34 (n = 3,207). Height was self-reported and operationalised in terms of mean height and 'short' stature (defined as 1 SD below mean height for each sex-age subgroup). RESULTS Graded, positive associations were found between occupation, family income, and height for males and females in each age cohort. Among males, mean height differences between blue-collar employees and professionals were 1.1 cm to 1.5 cm (depending on age-cohort), and for females, 1.6 cm to 2.1 cm. The corresponding height differences for males and females living in the least and most affluent families were 1.6 cm to 2.3 cm, and 1.0 cm to 2.5 cm, respectively. Persons in blue-collar jobs and those in low-income families were more likely to be classified as 'short'. CONCLUSIONS AND IMPLICATIONS Estimates of mortality risk associated with short stature suggest that these height differences translate to about a 2-5% increased risk of death for the most disadvantaged groups. Given that socioeconomic height differences in adulthood have their genesis in the formative stages of biological and social development, public health intervention efforts need to focus on early life exposures and environments. The greatest reduction in height inequalities, and by extension health inequalities, is likely to flow from macro-level public policies to alleviate poverty and minimise the social and economic divide.
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Affiliation(s)
- Gavin Turrell
- School of Public Health, Queensland University of Technology, Kelvin Grove.
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Yu Z, Nissinen A, Vartiainen E, Hu G, Tian H, Guo Z. Socio-economic status and serum lipids: a cross-sectional study in a Chinese urban population. J Clin Epidemiol 2002; 55:143-9. [PMID: 11809352 DOI: 10.1016/s0895-4356(01)00451-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Socio-economic status and serum lipids are important factors in the progression of cardiovascular disease. We studied the association between socio-economic status and serum lipids in a Chinese urban population. In all, 4,541 respondents (2,231 men and 2,310 women) between 25-64 years of age participated in a cross-sectional population survey carried out in Tianjin, China, and provided blood samples. Three socio-economic indicators (education, occupation, and income), total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and triglycerides were determined. People in higher socio-economic groups had a more unfavorable serum lipid profile compared with those in lower socio-economic groups. This significant association was especially apparent in men. Education seemed to be the most important predictor of serum lipids in the three socio-economic indicators. The direction of the association between high socio-economic status and poor serum lipid profiles appears to be opposite to those observed in the developed countries.
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Affiliation(s)
- Zhijie Yu
- Department of Public Health and General Practice, University of Kuopio, Kuopio, Finland
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Ferrario M, Sega R, Chatenoud L, Mancia G, Mocarelli P, Crespi C, Cesana G. Time trends of major coronary risk factors in a northern Italian population (1986–1994). How remarkable are socioeconomic differences in an industrialized low CHD incidence country? Int J Epidemiol 2001; 30:285-97. [PMID: 11369728 DOI: 10.1093/ije/30.2.285] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The goals are to estimate time trends (1986-1994) of major coronary risk factors in an industrialized low CHD incidence population and to assess education class (EC) differences in risk factor prevalence and in time trends. METHODS Three population surveys were conducted in 1986-1987, 1989-1990 and 1993- 1994 on independent and two-stage age- and gender-stratified random samples (1906 men and 1941 women) of 35-64 year old residents of Brianza, an affluent region of northern Italy. The protocol for data collection, clinical measurements and biochemical determinations adhered to the WHO MONICA manual and underwent repeated quality control assessments. EC were identified according to gender- and 5-year birth-cohort specific tertiles. RESULTS In the initial, middle and final surveys 1258, 1259 and 1330 subjects were enrolled, corresponding to participation rates of 70.1%, 70.3% and 74.3%, respectively. Over the 8-year period, in men systolic blood pressure and smoking habits declined, body mass index and serum total cholesterol increased. In women systolic blood pressure showed a constant reduction, total cholesterol and BMI increased and the prevalence of smokers remained stable. Overall inverse associations with EC were found for body mass index, for prevalence of cigarette smokers in men and for systolic blood pressure in women. Decreases in blood pressure were more evident in the lowest EC. Cigarette smoking was on the decline in the higher EC in men. BMI and total cholesterol increased in all EC with the notable exception of the 'low' EC in women. CONCLUSIONS Favourable changes of the risk factor profile in the low socio-economic classes may have contributed to reduce CHD rates in this population. Specific policies oriented to lowest socio-economic classes are needed to continue to combat the smoking epidemic.
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Affiliation(s)
- M Ferrario
- Research Centre for Chronic Degenerative Diseases and Department of Internal Medicine and Prevention and Health Biotechnology, University of Milan-Bicocca, Milan, Italy.
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Wardle J, Griffith J. Socioeconomic status and weight control practices in British adults. J Epidemiol Community Health 2001; 55:185-90. [PMID: 11160173 PMCID: PMC1731844 DOI: 10.1136/jech.55.3.185] [Citation(s) in RCA: 151] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
STUDY OBJECTIVE Attitudes and practices concerning weight control in British adults were examined to test the hypothesis that variation in concern about weight and deliberate weight control might partly explain the socioeconomic status (SES) gradient in obesity. Higher SES groups were hypothesised to show more weight concern and higher levels of dieting. SETTING Data were collected as part of the monthly Omnibus Survey of the Office of National Statistics in March 1999. PARTICIPANTS A stratified, probability sample of 2690 households was selected by random sampling of addresses in Britain. One randomly selected person in each household was interviewed at their home. MAIN RESULTS As predicted, higher SES men and women had higher levels of perceived overweight, monitored their weight more closely, and were more likely to be trying to lose weight. Higher SES groups also reported more restrictive dietary practices and more vigorous physical activity. CONCLUSIONS The results are consistent with the idea that part of the protection against weight gain in higher SES groups could be a higher frequency of weight monitoring, a lower threshold for defining themselves as overweight, and a greater likelihood of deliberate efforts at weight control.
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Affiliation(s)
- J Wardle
- ICRF Health Behaviour Unit, Department of Epidemiology and Public Health, University College London, 2-16 Torrington Place, London WC1E 6BT, UK.
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41
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Peach HG, Bath NE. Preventing fractures in large rural centres: sociodemographic sub-groups at risk of osteoporosis from their lifestyle. Aust J Rural Health 2000; 8:299-304. [PMID: 11894788 DOI: 10.1046/j.1440-1584.2000.00324.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Middle-aged people living in non-metropolitan Victoria have higher hospitalisation rates from osteoporotic fractures than those in metropolitan areas. This may reflect a higher prevalence of lifestyle risk factors for osteoporosis. One-fifth of Victoria's non-metropolitan population live in 'large rural centres'. The aim of the present study was to identify the sociodemographic sub-groups in a 'large rural centre' at risk of osteoporosis because of their lifestyle. Adults on Ballarat's electoral rolls were invited to complete a questionnaire and have their height and weight measured. A total of 335 eligible people participated in the present study (67% response). The sub-groups at risk of osteoporosis were identified using logistic regression analyses. Among women, being single/separated/divorced/widowed was associated with being underweight and having low dietary calcium. A lack of exercise was associated with not completing high school and smoking with being aged 25-44 years. Among men, low dietary calcium was associated with not completing high school and smoking was associated with being employed in a non-professional/non-managerial occupation. These sub-groups must be considered when planning preventative strategies for people in 'large rural centres'.
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Affiliation(s)
- H G Peach
- University of Melbourne, Ballarat Health Services Base Hospital, PO Box 577, Ballarat, Victoria 3353, Australia
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Abstract
BACKGROUND International research indicates that blue-collar employees typically exhibit lower rates of leisure-time physical activity. While "lack of time" and "work demands" are commonly reported barriers to activity, the extent to which time-at-work mediates the relationship between occupation and leisure-time physical activity is unclear. This study investigated the association between occupation, time spent in paid employment, and participation in leisure-time physical activity. METHODS This was a secondary analysis of cross-sectional data from the 1995 Australian Health Survey, focusing on employed persons ages 18-64 years (n = 24, 454). Occupation was coded as per the Australian Standard Classification of Occupations and collapsed into three categories (professional, white-collar, blue-collar). Hours worked was categorized into eight levels, ranging from 1-14 to more than 50 h per week. Participation in leisure-time physical activity was categorized as either insufficient or sufficient for health, consistent with recommended levels of energy expenditure (1600 METS-min/fortnight). The relationship between occupation, hours worked, and leisure-time physical activity was examined using logistic regression. Analyses were conducted separately for male and female, and the results are presented as a series of models that successively adjust for a range of potential covariates: age, living arrangement, smoking status, body mass index, and self-reported health. RESULTS Individuals in blue-collar occupations were approximately 50% more likely to be classified as insufficiently active. This occupational variability in leisure-time physical activity was not explained by hours worked. There was a suggested relationship between hours worked and leisure-time physical activity; however, this differed between men and women, and was difficult to interpret. CONCLUSIONS Occupational variability in leisure-time physical activity cannot be explained by hours worked. Therefore, reports that work constitutes a barrier to participation should be explored further. Identification of the factors contributing to occupational variability in leisure-time physical activity will add to our understanding of why population subgroups differ in their health risk profiles, and assist in the development of health promotion strategies to reduce rates of sedentariness and health inequalities.
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Affiliation(s)
- N W Burton
- School of Public Health, Queensland University of Technology, Victoria Park Road, Kelvin Grove, Queensland, 4059, Australia.
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Borrell C, Rue M, Pasarín MI, Rohlfs I, Ferrando J, Fernandez E. Trends in social class inequalities in health status, health-related behaviors, and health services utilization in a Southern European urban area (1983-1994). Prev Med 2000; 31:691-701. [PMID: 11133336 DOI: 10.1006/pmed.2000.0751] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND The objective of this study was to describe the evolution of social class inequalities in Barcelona (Spain) residents in perceived health status, health-related behaviors, and utilization of health services between 1983 and 1994. METHODS The information was obtained from the Health Interview Surveys conducted in 1983, 1986, 1992, and 1994 in Barcelona. In this study we included noninstitutionalized people ages >14 years. Social class was obtained from the Spanish adaptation of the British Registrar General classification. We studied health status, health-related behaviors, and health services utilization variables. Age-adjusted percentages and the relative index of inequality were obtained. RESULTS Of the health status variables, having been confined to bed and acute restriction of activity in the 2 weeks prior to the interview showed an increase in inequalities by social class in 1994. The pattern of chronic conditions by social class in men did not change between 1983 and 1994. Women had a higher prevalence of chronic conditions and the inequalities among social classes had increased. In men there were no social class inequalities in smoking in 1983. In 1992 and 1994 smoking was more prevalent in men of social classes IV and V. In women, smoking was more prevalent in social classes I and II in 1983 than in social classes IV and V, something that had changed by 1994. Lack of usual physical activity in men was always more prevalent in social classes I and II, and this difference increased since more people of advantaged classes moved into inactivity. Health services utilization showed no inequalities in the years studied. CONCLUSION The changing pattern according to social class of smoking and physical activity practice needs to be taken into account by policy-makers and public health workers.
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Affiliation(s)
- C Borrell
- Institut Municipal de Salut Pública de Barcelona, Spain.
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Abstract
OBJECTIVES This study employs a sample population of older workers to estimate an empirical model of leisure exercise activity. Alternative theories relating work and leisure attitudes relevant for understanding the exercise behavior of older workers are tested empirically. METHODS Responses of 6,433 full-time older workers (51 to 61 years old) from the 1992 Health and Retirement Study (HRS) are grouped into two white-collar and blue-collar worker categories and are analyzed to test whether self-reported levels of regular physical activity are associated with the physical demands and stress associated with one's job. RESULTS Although the white-collar workers, whose jobs involve more physical efforts, are more likely to do light physical activity, the blue-collar workers, whose jobs are more physically demanding, tend to engage in more vigorous exercise. DISCUSSION The empirical results are most supportive of the generalization theory, and they also illustrate the complexity of relationships between work and leisure physical activity.
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Affiliation(s)
- B Wu
- Center for Health Economics Research, Waltham, MA, USA.
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Bartley M, Fitzpatrick R, Firth D, Marmot M. Social distribution of cardiovascular disease risk factors: change among men in England 1984-1993. J Epidemiol Community Health 2000; 54:806-14. [PMID: 11027193 PMCID: PMC1731575 DOI: 10.1136/jech.54.11.806] [Citation(s) in RCA: 64] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To investigate change in the social distribution of some of the main risk factors for cardiovascular disease in men in England during a period when inequality in cardiovascular disease mortality widened DESIGN Age standardised comparison of the social distribution of seven known risk factors for cardiovascular disease (body mass index, waist to hip ratio, systolic and diastolic blood pressure, consumption of fresh green vegetables, leisure time exercise, cigarette smoking and levels of social support) in two large cross sectional representative samples of the English population. SUBJECTS Men aged 20-64 years in the 1984 Health and Lifestyle Survey (excluding Scotland and Wales) first sweep and the 1993 Health Survey for England. MAIN OUTCOME MEASURES Mean values of continuous variables; age adjusted proportions of categorical variables; change in the relative index of inequality for each risk factor. RESULTS The overall prevalence of cardiovascular disease risk factors improved during the period in which cardiovascular disease mortality was falling. The social distribution of cardiovascular disease risk factors, in contrast, did not become more extreme. Increases in the relative index of inequality for angina from 1.75 to 1.86, for eating vegetables less than once a day from 1.76 in 1984 to 1.96 in 1993, and an apparently larger increase in inequality of social support, from 1.92 to 2.53 were not statistically significant. In most cases the degree of inequality in risk factors tended to narrow non-significantly: for example the relative index of inequality fell from 5.02 in 1984 to 3.07 in 1993 for systolic blood pressure, from 5.60 to 4.29 for current smoking and from 6.24 to 4.19 for eating other than wholemeal bread as the main form of bread in the diet. The two statistically significant changes in inequality were in the direction of narrowing inequality: from a relative index of inequality of 2.12 to 0.90 for diastolic blood pressure (p<0.01) and from 19.3 to 0.87 (p<0.01) for psychological distress as indicated by the General Health Questionnaire. CONCLUSIONS Healthier lifestyle options have not been adopted at a significantly faster rate by middle class than working class people over this time period. At the population level the change in risk factors is consistent with falling cardiovascular mortality. The change in the social distribution of risk factors within the population, however, shows little or no relation to the pattern of widening inequality in cardiovascular mortality. This may be because the effect is lagged, or because the adoption of healthier behaviour confers greater benefits on those in higher socioeconomic status groups.
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Affiliation(s)
- M Bartley
- Department of Epidemiology and Public Health, University College London WC1E 6BT, UK.
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Forsén T, Eriksson J, Qiao Q, Tervahauta M, Nissinen A, Tuomilehto J. Short stature and coronary heart disease: a 35-year follow-up of the Finnish cohorts of The Seven Countries Study. J Intern Med 2000; 248:326-32. [PMID: 11086644 DOI: 10.1046/j.1365-2796.2000.00747.x] [Citation(s) in RCA: 64] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To examine whether short stature is associated with an increased risk of coronary heart disease. DESIGN Follow-up study. SETTING Two geographically defined areas in eastern and western Finland. SUBJECTS A total of 1441 men who were free of coronary heart disease at the start of the follow-up. MAIN OUTCOME MEASURES Hazard ratios for fatal and non-fatal coronary heart disease RESULTS Height was inversely related to fatal coronary heart disease and incident non-fatal coronary heart disease during the follow-up. These relationships persisted after adjusting for other major cardiovascular risk factors. Comparing the high-risk area in eastern Finland with the low-risk area in south-western Finland, no difference in fatal coronary heart disease and cumulative incidence of non-fatal coronary heart disease was seen in tall men. The increase in risk of coronary heart disease death was 19% for a 10 cm decrease in height (OR = 0.81, 95% CI = 0.68-0.95). CONCLUSIONS Our results show that short stature is an independent risk factor for coronary heart disease. Differences in stature partly explain the Finnish east-west difference in the incidence of coronary heart disease.
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Affiliation(s)
- T Forsén
- Department of Epidemiology and Health Promotion, National Public Health Institute, Helsinki, Finland
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Yu Z, Nissinen A, Vartiainen E, Song G, Guo Z, Tian H. Changes in cardiovascular risk factors in different socioeconomic groups: seven year trends in a Chinese urban population. J Epidemiol Community Health 2000; 54:692-6. [PMID: 10942449 PMCID: PMC1731753 DOI: 10.1136/jech.54.9.692] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
STUDY OBJECTIVE To analyse trends in socioeconomic differences in cardiovascular disease risk factors among an urban Chinese population using educational attainment as the socioeconomic indicator. DESIGN Population surveys with randomly selected independent samples were carried out in 1989 and in 1996. Educational attainment, blood pressure, body mass index, cigarette smoking and lack of leisure time physical activity were determined. SETTING Urban areas of the city of Tianjin, China. PARTICIPANTS A total of 14 275 respondents aged 25-64 years. MAIN RESULTS Diastolic blood pressure increased and the proportion of people without leisure time physical activity decreased in both sexes during the study period. The prevalence of smoking and the number of cigarettes smoked daily increased significantly among men. Smoking decreased in the least educated men and increased in those who had studied at least to college level. Body mass index decreased across all educational strata in women, but blood pressure increased in women with at least college level education. CONCLUSIONS These data reveal a different picture in trends in the association of education and cardiovascular risk factors from those depicted in developed countries. This highlights the need for an effective intervention programme in the study population.
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Affiliation(s)
- Z Yu
- Department of Public Health and General Practice, University of Kuopio, PO Box 1627, 70211 Kuopio, Finland.
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Abstract
Consistent with international evidence, the findings of Australian research show that socioeconomically disadvantaged groups experience significantly higher mortality and morbidity rates. Despite marked improvements in the health of all segments of the Australian population in recent decades, during this same period there has also been an increase in socioeconomically related mortality inequalities for some conditions. Socioeconomically disadvantaged groups are more likely to engage in health-damaging behaviours, experience poorer psychosocial health, make less use of the healthcare system for preventive purposes, and have a more adverse risk factor profile. These are the main contributing factors to the poorer physiological health of low socioeconomic groups. At present, our knowledge of how socioeconomic status and health are related is limited. A necessary step in improving our understanding of this issue is to draw together all the empirical evidence and use it as the basis for developing a theory of socioeconomic health inequalities. We present a conceptual framework to facilitate this process.
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Affiliation(s)
- G Turrell
- School of Public Health, Queensland University of Technology
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Salmon J, Owen N, Bauman A, Schmitz MK, Booth M. Leisure-time, occupational, and household physical activity among professional, skilled, and less-skilled workers and homemakers. Prev Med 2000; 30:191-9. [PMID: 10684742 DOI: 10.1006/pmed.1999.0619] [Citation(s) in RCA: 142] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Adults in lower status occupations are at higher risk of premature cardiovascular disease, for which physical inactivity is a major risk factor. While lower rates of leisure-time physical activity have been found to be associated consistently with lower income and education levels, the association between occupational and home-based physical activity with membership of different occupational categories is not well understood. METHODS An urban-representative population data set derived from a self-completion questionnaire was used to examine both self-reported leisure-time physical activity and a combined measure of occupational/home-based physical activity of adult less-skilled, skilled, and professional workers and homemakers (3795 males; 4140 females). chi(2) analyses, ANOVA, and logistic regressions were used to examine the associations between occupational group membership and physical activity. RESULTS After adjustment for age, body mass index, education, country of birth, marital status, and smoking, less-skilled workers were less likely to report any form of leisure-time physical activity. However, occupational category was not a strong predictor of participation in combined vigorous occupational/home physical activity. Homemakers and those in lower status occupations were less likely to report participation in vigorous leisure-time physical activity sufficient for cardiorespiratory fitness. With the inclusion of time spent in combined vigorous occupational/home physical activity, there was no longer an association of activity with occupational status for males. However, for females the association remained. CONCLUSIONS The assessment of occupational and household physical activity in addition to leisure-time activity may be important for understanding associations between occupational categories, physical activity, and increased levels of health risk and for the development of physical activity promotion strategies.
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Affiliation(s)
- J Salmon
- School of Health Sciences, Deakin University, Burwood, Victoria, 3125, Australia.
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Osler M, Gerdes LU, Davidsen M, Brønnum-Hansen H, Madsen M, Jørgensen T, Schroll M. Socioeconomic status and trends in risk factors for cardiovascular diseases in the Danish MONICA population, 1982-1992. J Epidemiol Community Health 2000; 54:108-13. [PMID: 10715743 PMCID: PMC1731611 DOI: 10.1136/jech.54.2.108] [Citation(s) in RCA: 83] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
STUDY OBJECTIVE The decline in cardiovascular mortality in Denmark during the 1980s has been greatest in the highest socioeconomic groups of the population. This study examines whether the increased social inequality in cardiovascular mortality has been accompanied by a different trend in cardiovascular risk factors in different educational groups. DESIGN Data from three cross sectional WHO MONICA surveys conducted in 1982-84, 1987, and 1991-92, were analysed to estimate trends in biological (weight, height, body mass index, blood pressure, and serum lipids) and behavioural (smoking, physical activity during leisure, and eating habits) risk factors in relation to educational status. SETTING County of Copenhagen, Denmark. PARTICIPANTS 6695 Danish men and women of ages 30, 40, 50, and 60 years. MAIN RESULTS The prevalence of smoking and heavy smoking decreased during the study but only in the most educated groups. In fact, the prevalence of heavy smoking increased in the least educated women. There was no significant interaction for the remaining biological and behavioural risk factors between time of examination and educational level, indicating that the trend was the same in the different educational groups. However, a summary index based on seven cardiovascular risk factors improved, and this development was only seen in the most educated men and women. CONCLUSION The difference between educational groups in prevalence of smoking increased during the 1980s, and this accounted for widening of an existing social difference in the total cardiovascular risk.
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Affiliation(s)
- M Osler
- Danish Institute of Clinical Epidemiology, Copenhagen O, Denmark
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