title: Educational class inequalities in the incidence of coronary heart disease in Europe.
abstract: To estimate the burden of social inequalities in coronary heart disease (CHD) and to identify their major determinants in 15 European populations.
  
  
  
  The MORGAM (MOnica Risk, Genetics, Archiving and Monograph) study comprised 49 cohorts of middle-aged European adults free of CHD (110 928 individuals) recruited mostly in the mid-1980s and 1990s, with comparable assessment of baseline risk and follow-up procedures. We derived three educational classes accounting for birth cohorts and used regression-based inequality measures of absolute differences in CHD rates and HRs (ie, Relative Index of Inequality, RII) for the least versus the most educated individuals.
  
  
  
  N=6522 first CHD events occurred during a median follow-up of 12 years. Educational class inequalities accounted for 343 and 170 additional CHD events per 100 000 person-years in the least educated men and women compared with the most educated, respectively. These figures corresponded to 48% and 71% of the average event rates in each gender group. Inequalities in CHD mortality were mainly driven by incidence in the Nordic countries, Scotland and Lithuania, and by 28-day case-fatality in the remaining central/South European populations. The pooled RIIs were 1.6 (95% CI 1.4 to 1.8) in men and 2.0 (1.7 to 2.4) in women, consistently across population. Risk factors accounted for a third of inequalities in CHD incidence; smoking was the major mediator in men, and High-Density-Lipoprotein (HDL) cholesterol in women.
  
  
  
  Social inequalities in CHD are still widespread in Europe. Since the major determinants of inequalities followed geographical and gender-specific patterns, European-level interventions should be tailored across different European regions.
authors: Centro Ricerche EPIMED-Epidemiologia e Medicina Preventiva, Università degli Studi dell'Insubria, Varese, Italy.
authors: Giovanni
authors: 0000-0002-4119-6615
authors: G
authors: Veronesi
authors: Centro Ricerche EPIMED-Epidemiologia e Medicina Preventiva, Università degli Studi dell'Insubria, Varese, Italy.
authors: Marco M
authors: MM
authors: Ferrario
authors: THL-National Institute for Health and Welfare, Helsinki, Finland.
authors: Kari
authors: K
authors: Kuulasmaa
authors: Research Department of Epidemiology and Public Health, University College London, London, UK.
authors: Martin
authors: M
authors: Bobak
authors: Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
authors: Lloyd E
authors: LE
authors: Chambless
authors: THL-National Institute for Health and Welfare, Helsinki, Finland.
authors: Veikko
authors: V
authors: Salomaa
authors: Department of Public Health and Clinical Medicine, Cardiology and Heart Centre, Umeå University, Umeå, Sweden.
authors: Stefan
authors: S
authors: Soderberg
authors: Department of Epidemiology and Population Studies, Faculty of Health Sciences, Jagiellonian University Medical College, Kraków, Poland.
authors: Andrzej
authors: A
authors: Pajak
authors: Research Centre for Prevention and Health, Capital Region of Denmark, Denmark Department of Public Health, Faculty of Medical Science, University of Copenhagen, Copenhagen, Denmark Faculty of Medicine, Aalborg University, Denmark.
authors: Torben
authors: T
authors: Jørgensen
authors: Department of Epidemiology & Public Health, Pasteur Institute of Lille, Lille, France.
authors: Philippe
authors: P
authors: Amouyel
authors: Department of Epidemiology and Public Health, University of Strasbourg, Strasbourg, France.
authors: Dominique
authors: D
authors: Arveiler
authors: Department of Epidemiology, CVD Prevention and Health Promotion, National Institute of Cardiology, Warsaw, Poland.
authors: Wojciech
authors: W
authors: Drygas
authors: Department of Cardiology, Toulouse University School of Medicine, Toulouse, France.
authors: Jean
authors: J
authors: Ferrieres
authors: Istituto Superiore di Sanità, Rome, Italy.
authors: Simona
authors: S
authors: Giampaoli
authors: UKCRC Centre of Excellence for Public Health Research, Queen's University Belfast, Belfast, UK.
authors: Frank
authors: F
authors: Kee
authors: Department of Epidemiology and Prevention, IRCCS Istituto Neurologico Mediterraneo Neuromed, Pozzilli, Italy.
authors: Licia
authors: L
authors: Iacoviello
authors: The Institute of Internal and Preventive Medicine, Siberian Branch of Russian Academy of Medical Sciences, Novosibirsk, Russian Federation.
authors: Sofia
authors: S
authors: Malyutina
authors: Helmholtz Zentrum München-German Research Center for Environmental Health, Neuherberg, Germany.
authors: Annette
authors: A
authors: Peters
authors: Institute of Cardiology, Lithuanian University of Health Sciences, Kaunas, Lithuania.
authors: Abdonas
authors: A
authors: Tamosiunas
authors: Cardiovascular Epidemiology Unit, Institute of Cardiovascular Research, University of Dundee, Dundee, UK.
authors: Hugh
authors: H
authors: Tunstall-Pedoe
authors: Centro Studi e Ricerche in Sanità Pubblica (CESP), Università degli Studi di Milano-Bicocca, Monza, Italy.
authors: Giancarlo
authors: G
authors: Cesana
mesh_terms: D000328:Adult; D008076:Cholesterol, HDL / Q000097:blood; D003327:Coronary Disease / Q000175:diagnosis / Q000453:epidemiology* / Q000517:prevention & control; D050171:Dyslipidemias / Q000097:blood / Q000453:epidemiology; D004522:Educational Status; D005060:Europe / Q000453:epidemiology; D005260:Female; D054624:Health Status Disparities; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D065840:Protective Factors; D018570:Risk Assessment; D012307:Risk Factors; D017678:Sex Distribution; D012907:Smoking / Q000009:adverse effects / Q000453:epidemiology; D016540:Smoking Cessation; D000074606:Smoking Prevention; D013997:Time Factors
chemical_list: D008076:Cholesterol, HDL