title: The impact of social status inconsistency on cardiovascular risk factors, myocardial infarction and stroke in the EPIC-Heidelberg cohort.
abstract: BACKGROUND
  Social inequalities in cardiovascular diseases are well documented. Yet, the relation of social status inconsistency (having different ranks in two or more status indicators like education, occupational position or income) and medical conditions of heart or vessels is not clear. Status inconsistency (SI) is assumed to be stressful, and the association of psychosocial distress and health is well known. Therefore, we aimed to analyze the relationship between cardiovascular diseases (CVD) and status inconsistency. Another target was to assess the influence of behaviour related risk factors on this association.
  
  
  METHODS
  8960 men and 6070 women, aged 45-65 years, from the EPIC-Heidelberg cohort (European Prospective Investigation into Cancer and Nutrition) were included. Socio-economic status was assessed by education/vocational training and occupational position at recruitment. During a median follow-up of 8.7 years, information on CVD was collected.
  
  
  RESULTS
  Compared to status consistent subjects, men who were in a higher occupational position than could be expected given their educational attainment had a nearly two-fold increased incidence of CVD (Odds Ratio (OR) = 1.8, 95% Confidence Interval (CI) = 1.5; 2.4, adjusted for age). Smoking behaviour and BMI differed significantly between those who had adequate occupational positions and those who did not. Yet, these lifestyle factors, as opposed to age, did not contribute to the observed differences in CVD. No association of cardiovascular diseases and status inconsistency was found for women or in cases where education exceeded occupational position.
  
  
  CONCLUSIONS
  Status inconsistent men (occupational position > education) had a higher risk of cardiovascular diseases than status consistent men. However, harmful behaviour did not explain this relationship.
authors.affiliation: Ulm University, Institute of Epidemiology and Medical Biometry, Germany. stefanie.braig@uni-ulm.de
authors.forename: Stefanie
authors.initials: S
authors.lastname: Braig
authors.forename: Richard
authors.initials: R
authors.lastname: Peter
authors.forename: Gabriele
authors.initials: G
authors.lastname: Nagel
authors.forename: Silke
authors.initials: S
authors.lastname: Hermann
authors.forename: Sabine
authors.initials: S
authors.lastname: Rohrmann
authors.forename: Jakob
authors.initials: J
authors.lastname: Linseisen
mesh_terms: D000368:Aged; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000209:etiology; D015331:Cohort Studies; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology* / Q000209:etiology; D012307:Risk Factors; D012923:Social Class; D020521:Stroke / Q000453:epidemiology* / Q000209:etiology