Social inequity in risk of coronary artery disease in Ontario.
OBJECTIVE
To examine the distribution of risk factors for coronary artery disease (CAD) by socioeconomic status; to quantify the impact of this distribution on disease incidence; and to estimate by socioeconomic status the proportion of new CAD cases attributable to either smoking or elevated cholesterol.


METHODS
The overall study population consisted of participants from the Ontario Heart Health Survey (n = 2532) aged 18 to 74 years. A subset of these participants (n = 1293) aged 30 to 74 years, who provided a fasting blood sample for lipid analysis, were used for estimating impact of socioeconomic status on CAD incidence.


METHODS
Frequency distributions of risk factors were calculated. The Framingham mathematical model was used to estimate the 10-year probability of developing CAD. Education was selected as the measure for socioeconomic status.


METHODS
Outcomes were prevalence of CAD risk factors, probability of developing CAD and proportion of new cases attributable to smoking and elevated blood cholesterol.


RESULTS
Having an elevated cholesterol level, high blood pressure, diabetes, being overweight or smoking was more prevalent among those with low socioeconomic status. The 10-year probability of CAD was about twice as high among persons with lower education (socioeconomic status) (0.099 low versus 0.055 high). Among males aged 30 to 44 with low socioeconomic status, 26% of the CAD cases were due to smoking versus 13% for those with high socioeconomic status. The values for elevated cholesterol were 19 and 13%, respectively.


CONCLUSIONS
Persons with low socioeconomic status are twice as likely to develop CAD because of their higher prevalence of smoking and elevated cholesterol.
Jaglal
S B
SB
Clinical Epidemiology Unit, Sunnybrook Health Science Centre, Toronto, Ontario.
Goel
V
V
D000293:Adolescent; D000328:Adult; D000368:Aged; D002784:Cholesterol / Q000097:blood; D003327:Coronary Disease / Q000453:epidemiology / Q000209:etiology*; D004522:Educational Status; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009864:Ontario / Q000453:epidemiology; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects; D012923:Social Class; D012959:Socioeconomic Factors
D002784:Cholesterol