Socioeconomic status and cardiovascular disease among men: the Korean national health service prospective cohort study.
OBJECTIVE
We examined the association between socioeconomic status (SES) and myocardial infarction and stroke subtypes, including the possible mediating influence of cardiovascular risk factors.


METHODS
We evaluated data on 578756 Korean male public servants aged 30 to 58 years from August 1, 1990, to July 31, 2001.


RESULTS
SES had inverse associations with mortality because of myocardial infarction and stroke subtypes, which were not changed by an adjustment for, or stratification by, cardiovascular risk factors. For nonfatal events, SES had positive, null, and inverse associations with myocardial infarction, ischemic stroke, and hemorrhagic stroke, respectively. The association between SES and nonfatal myocardial infarction depended on the presence of risk factors and was positive only among men who had cardiovascular risk factors. Case-fatality after hospital admission for cardiovascular diagnoses was significantly lower among higher SES groups, even after risk factor adjustment.


CONCLUSIONS
Inverse SES associations with cardiovascular diseases were not mediated by cardiovascular risk factors among men who were undergoing economic transition. Socioeconomically patterned access to medical care may partly explain these socioeconomic gradients.
Song
Yun-Mi
YM
Dept of Family Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Irwondong 50, Gangnamgu, Seoul, Korea, 135-710. ymsong@smc.samsung.co.kr.
Ferrer
Robert L
RL
Cho
Sung-il
SI
Sung
Joohon
J
Ebrahim
Shah
S
Davey Smith
George
G
D000328:Adult; D006801:Humans; D007723:Korea / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology* / Q000401:mortality; D011446:Prospective Studies; D012307:Risk Factors; D012959:Socioeconomic Factors; D020521:Stroke / Q000453:epidemiology* / Q000401:mortality