Inequalities in cardiovascular disease mortality: the role of behavioural, physiological and social risk factors.
BACKGROUND
While the relationship between socio-economic disadvantage and cardiovascular disease (CVD) is well established, the role that traditional cardiovascular risk factors play in this association remains unclear. The authors examined the association between education attainment and CVD mortality and the extent to which behavioural, social and physiological factors explained this relationship.


METHODS
Adults (n=38,355) aged 40-69 years living in Melbourne, Australia were recruited in 1990-1994. Subjects with baseline CVD risk factor data ascertained through questionnaire and physical measurement were followed for an average of 9.4 years with CVD deaths verified by review of medical records and autopsy reports.


RESULTS
CVD mortality was higher for those with primary education only, compared with those who had completed tertiary education, with an HR of 1.66 (95% CI 1.10 to 2.49) after adjustment for age, country of birth and gender. Those from the lowest educated group had a more adverse cardiovascular risk factor profile compared with the highest educated group, and adjustment for these risk factors reduced the HR to 1.18 (95% CI 0.78 to 1.77). In analysis of individual risk factors, smoking and waist circumference explained most of the difference in CVD mortality between the highest and lowest education groups.


CONCLUSIONS
Most of the excess CVD mortality in lower socio-economic groups can be explained by known risk factors, particularly smoking and overweight. While targeting cardiovascular risk factors should not divert efforts from addressing the underlying determinants of health inequalities, it is essential that known risk factors are addressed effectively among lower socio-economic groups.
Beauchamp
Alison
A
Department of Epidemiology & Preventive Medicine, Monash University, Alfred Hospital, Melbourne 3004, Australia. alison.beauchamp@med.monash.edu.au
Peeters
Anna
A
Wolfe
Rory
R
Turrell
Gavin
G
Harriss
Linton R
LR
Giles
Graham G
GG
English
Dallas R
DR
McNeil
John
J
Magliano
Dianna
D
Harrap
Stephen
S
Liew
Danny
D
Hunt
David
D
Tonkin
Andrew
A
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001315:Australia / Q000453:epidemiology; D002318:Cardiovascular Diseases / Q000401:mortality* / Q000523:psychology; D004522:Educational Status; D005260:Female; D015438:Health Behavior; D006801:Humans; D008297:Male; D008875:Middle Aged; D050177:Overweight / Q000150:complications; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects