Unfavourable life-course social gradient of coronary heart disease within Spain: a low-incidence welfare-state country.
OBJECTIVE
Social position has yet to be established as a risk factor of coronary heart disease (CHD). Our aim was to investigate an individual life-course social position gradient link with CHD incidence in the EPIC-Spain cohort.


METHODS
41,066 participants, mostly 30-65 years old, and free of cardiovascular disease at baseline (1992-1996) were followed up for a mean of 10.4 years. A combined score of paternal occupation in childhood and own adult education was used to assess individual life-course risk accumulation. Hazard ratios of CHD were estimated using Cox models, stratifying by centre, and age, and adjusting for cardiovascular risk factors.


RESULTS
583 participants (80 % men) developed a definite CHD event. Paternal occupational class IV was associated with CHD in all models in men. The educational gradient remained significant after adjusting for diet and physical activity (p = 0.01). All adjusted risk of incident CHD rose by 23 % (95 % CI 6-42 %) per category increase of life-course social position score in men. No significant associations were found in women.


CONCLUSIONS
Individual life-course social position gradient was adversely related to incident CHD in Spanish men.
Department of Epidemiology, Regional Health Council, Ronda de Levante 11, 30008 Murcia, Spain. Lluis.Cirera@carm.es
Lluís
L
Cirera
José María
JM
Huerta
María Dolores
MD
Chirlaque
Genevieve
G
Buckland
Nerea
N
Larrañaga
María José
MJ
Sánchez
Antonio
A
Agudo
Pilar
P
Amiano
José Ramón
JR
Quirós
Eva
E
Ardanaz
Larraitz
L
Arriola
Esther
E
Molina
Miren
M
Dorronsoro
Aurelio
A
Barricarte
Carlos A
CA
González
Concepción
C
Moreno-Iribas
Carmen
C
Navarro
D000328:Adult; D000368:Aged; D015331:Cohort Studies; D003327:Coronary Disease / Q000453:epidemiology*; D004032:Diet; D004522:Educational Status; D004651:Employment; D005260:Female; D006801:Humans; D015994:Incidence; D008019:Life Style; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D012737:Sex Factors; D012923:Social Class; D013030:Spain / Q000453:epidemiology; D055105:Waist Circumference