title: Income-related inequalities in cardiovascular disease from mid-life to old age in a Northern Swedish cohort: A decomposition analysis.
abstract: While the social determinants of cardiovascular disease (CVD) are fairly well-known, the determinants of socioeconomic inequalities in CVD are scarcely studied and almost completely based on cross-sectional designs in which the changing circumstances across the life course are not taken into account. The present study seeks to incorporate a life course approach to the social determinants of socioeconomic inequalities in CVD. The specific aims were to 1) examine how income-related inequalities in CVD change over two decades of the mid-late life course, and 2) identify the key social determinants of the inequalities at each time period. The cohort (N = 44,039) comprised all individuals aged 40-60 years in 1990 who during 1990-2010 were enrolled in the county-wide preventive effort :"Västerbotten Intervention Program" (VIP). The cohort was followed over these two decades by Swedish population register data linked within the Umeå SIMSAM Lab micro data infrastructure. First-time hospitalization for CVD and mean earned income were used to calculate the concentration index (C) during four periods of 5-6 years. The C for each period was decomposed by sociodemographic factors, using Wagstaff-type decomposition analysis. Results suggest that inequalities in CVD increase gradually from mid-life to old age; from initially non-significant to particularly marked among the elderly. The decomposition showed that, from middle to old age, educational and employment inequalities underwent a transition from initially dominant to a moderate role in explaining the health inequalities, coupled with an increasing importance of age and a stable role of income. In conclusion, the study illustrates the need for incorporating a dynamic life course perspective into research, policy and practice concerned with equity in health.
authors.affiliation: Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, 901 87 Umeå, Sweden. Electronic address: paolamosquera@gmail.com.
authors.forename: Paola A
authors.initials: PA
authors.lastname: Mosquera
authors.affiliation: Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, 901 87 Umeå, Sweden. Electronic address: miguel.sansebastian@umu.se.
authors.forename: Miguel
authors.initials: M
authors.lastname: San Sebastian
authors.affiliation: Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, 901 87 Umeå, Sweden. Electronic address: anna-karin.waenerlund@umu.se.
authors.forename: Anna-Karin
authors.initials: AK
authors.lastname: Waenerlund
authors.affiliation: Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, 901 87 Umeå, Sweden. Electronic address: anneli.ivarsson@umu.se.
authors.forename: Anneli
authors.initials: A
authors.lastname: Ivarsson
authors.affiliation: Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, 901 87 Umeå, Sweden. Electronic address: lars.weinehall@umu.se.
authors.forename: Lars
authors.initials: L
authors.lastname: Weinehall
authors.affiliation: Social Medicine, Department of Public Health and Clinical Medicine, Umeå University, 901 87 Umeå, Sweden. Electronic address: per.e.gustafsson@umu.se.
authors.forename: Per E
authors.initials: PE
authors.lastname: Gustafsson
mesh_terms: D000328:Adult; D017677:Age Distribution; D002318:Cardiovascular Diseases / Q000453:epidemiology*; D015331:Cohort Studies; D054624:Health Status Disparities; D006801:Humans; D007182:Income / Q000706:statistics & numerical data*; D008875:Middle Aged; D012959:Socioeconomic Factors; D013548:Sweden / Q000453:epidemiology
keywords: Cardiovascular disease; Cohort design; Concentration index; Decomposition; Income inequality; Life course; Sweden