Modifiable risk factors have an impact on socio-economic differences in coronary heart disease events.
OBJECTIVE
To investigate the association of socio-economic status, defined by occupational class, income and education, with coronary heart disease (CHD) morbidity and mortality, and further to analyse to which extent modifiable risk factors may explain socio-economic differences in CHD risk.


METHODS
A population-based prospective cohort study including 9,061 men and 10,211 women aged 35-64 at baseline who participated in a cardiovascular risk factor survey in 1982, 1987, 1992 or 1997 in Finland. The subjects were followed for CHD events up till the end of 2001. Cox's proportional hazards model was used in the analysis.


RESULTS
Male manual workers had a double risk of CHD death compared with upper-level employees (HR=2.00, 95% CI 1.35-2.97). This excess risk was reduced by 31% when adjusted for traditional cardiovascular risk factors and most of this reduction was due to smoking.


CONCLUSIONS
Modifiable risk factors explained about a third of the excess CHD mortality between manual workers and upper-level employees in men. Among women the differences between socio-economic groups were not statistically significant.
Harald
Kennet
K
National Public Health Institute, Helsinki, Finland. kennet.harald@ktl.fi
Pajunen
Pia
P
Jousilahti
Pekka
P
Koskinen
Seppo
S
Vartiainen
Erkki
E
Salomaa
Veikko
V
D000328:Adult; D015331:Cohort Studies; D003327:Coronary Disease / Q000191:economics / Q000453:epidemiology*; D004522:Educational Status; D005260:Female; D005387:Finland / Q000453:epidemiology; D006306:Health Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D009790:Occupations / Q000145:classification* / Q000706:statistics & numerical data; D016016:Proportional Hazards Models; D012307:Risk Factors; D012737:Sex Factors; D012907:Smoking / Q000453:epidemiology; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires