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Socioeconomic Aspects of Cardiovascular Health

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Interdisciplinary Concepts in Cardiovascular Health

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Abstract

Extensive epidemiological evidence has demonstrated the socioeconomic ­gradient in cardiovascular health, with the most disadvantaged individuals at greatest risk of developing and dying from cardiovascular disease (CVD). Large-scale studies, beginning in the 1960s, reported significant associations between coronary mortality and occupation grade, income, and education. Individuals with low socioeconomic status (SES) additionally have a poorer prognosis post-myocardial infarction. Explanatory mechanisms explored here include differential access to medical care, differences in risk factor profiles, health literacy, and psychological and environmental factors. The influence of neighborhood SES is examined, beyond individual socioeconomic profile, as well as SES trajectory throughout life, and the relative importance of childhood versus adult SES in the development of CVD. Finally methodological factors are considered, examining the limitations of SES research, measurement issues, and risk prediction. It is proposed that SES should be considered in cardiovascular risk assessment, and that policy changes have the potential to minimize socioeconomic inequalities in cardiovascular health.

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References

  • Alter DA, Naylor CD, Austin P, Tu JV (1999) Effects of socioeconomic status on access to invasive cardiac procedures and on mortality after acute myocardial infarction. N Engl J Med 341(18):1359–1367

    Article  PubMed  CAS  Google Scholar 

  • Alter DA, Chong A, Austin PC, Mustard C, Iron K, Williams JI, Morgan CD, Tu JV, Irvine J, Naylor CD, SESAMI Study Group (2006) Socioeconomic status and mortality after acute myocardial infarction. Ann Intern Med 144(2):82–93

    Article  PubMed  Google Scholar 

  • Baker DW, Wolf MS, Feinglass J, Thompson JA, Gazmararian JA, Huang J (2007) Health literacy and mortality among elderly persons. Arch Intern Med 167(14):1503–1509

    Article  PubMed  Google Scholar 

  • Barker DJ, Gelow J, Thornburg K, Osmond C, Kajantie E, Eriksson JG (2010) The early origins of chronic heart failure: impaired placental growth and initiation of insulin resistance in childhood. Eur J Heart Fail 12(8):819–825

    Article  PubMed  Google Scholar 

  • Barnett TA, Gauvin L, Craig CL, Katzmarzyk PT (2008) Distinct trajectories of leisure time physical activity and predictors of trajectory class membership: a 22 year cohort study. Int J Behav Nutr Phys Act 5:57–64

    Article  PubMed  Google Scholar 

  • Beebe-Dimmer J, Lynch JW, Turrell G, Lustgarten S, Raghunathan T, Kaplan GA (2004) Childhood and adult socioeconomic conditions and 31-year mortality risk in women. Am J Epidemiol 159(5):481–490

    Article  PubMed  Google Scholar 

  • Bostock S, Steptoe A (2012) Association between low functional health literacy and mortality in older adults: longitudinal cohort study. BMJ 344:e1602

    Google Scholar 

  • Braveman PA, Cubbin C, Egerter S, Chideya S, Marchi KS, Metzler M, Posner S (2005) Socioeconomic status in health research: one size does not fit all. JAMA 294(22):2879–2888

    Article  PubMed  CAS  Google Scholar 

  • Cesana G, Sega R, Ferrario M, Chiodini P, Corrao G, Mancia G (2003) Job strain and blood pressure in employed men and women: a pooled analysis of four northern Italian population samples. Psychosom Med 65(4):558–563

    Article  PubMed  Google Scholar 

  • Cirera L, Tormo MJ, Chirlaque MD, Navarro C (1998) Cardiovascular risk factors and educational attainment in Southern Spain: a study of a random sample of 3091 adults. Eur J Epidemiol 14(8):755–763

    Article  PubMed  CAS  Google Scholar 

  • Cirino PT, Chin CE, Sevcik RA, Wolf M, Lovett M, Morris RD (2002) Measuring socioeconomic status: reliability and preliminary validity for different approaches. Assessment 9(2):145–155

    Article  PubMed  Google Scholar 

  • Cooper AF, Jackson G, Weinman J, Horne R (2002) Factors associated with cardiac rehabilitation attendance: a systematic review of the literature. Clin Rehabil 16(5):541–552

    Article  PubMed  CAS  Google Scholar 

  • Davey Smith G, Hart C, Hole D, MacKinnon P, Gillis C, Watt G, Blane D, Hawthorne V (1998) Education and occupational social class: which is the more important indicator of mortality risk? J Epidemiol Community Health 52(3):153–160

    Article  PubMed  CAS  Google Scholar 

  • Diez-Roux AV (1998) Bringing context back into epidemiology: variables and fallacies in multilevel analysis. Am J Public Health 88(2):216–222

    Article  PubMed  CAS  Google Scholar 

  • Diez-Roux AV, Nieto FJ, Muntaner C, Tyroler HA, Comstock GW, Shahar E, Cooper LS, Watson RL, Szklo M (1997) Neighborhood environments and coronary heart disease: a multilevel analysis. Am J Epidemiol 146(1):48–63

    Article  PubMed  CAS  Google Scholar 

  • Diez-Roux AV, Merkin SS, Arnett D, Chambless L, Massing M, Nieto FJ, Sorlie P, Szklo M, Tyroler HA, Watson RL (2001) Neighborhood of residence and incidence of coronary heart disease. N Engl J Med 345(2):99–106

    Article  PubMed  CAS  Google Scholar 

  • Ebrahim S, Montaner D, Lawlor DA (2004) Clustering of risk factors and social class in childhood and adulthood in British women’s heart and health study: cross sectional analysis. BMJ 328(7444):861

    Article  PubMed  Google Scholar 

  • Elovainio M, Ferrie JE, Singh-Manoux A, Shipley M, Batty GD, Head J, Hamer M, Jokela M, Virtanen M, Brunner E, Marmot MG, Kivimäki M (2011) Socioeconomic differences in cardiometabolic factors: social causation or health-related selection? Evidence from the Whitehall II Cohort Study, 1991-2004. Am J Epidemiol 174(7):779–789

    Article  PubMed  Google Scholar 

  • Estabrooks PA, Lee RE, Gyurcsik NC (2003) Resources for physical activity participation: does availability and accessibility differ by neighborhood socioeconomic status? Ann Behav Med 25(2):100–104

    Article  PubMed  Google Scholar 

  • Filion KB, Steffen LM, Duval S, Jacobs DR Jr, Blackburn H, Luepker RV (2012) Trends in ­smoking among adults from 1980 to 2009: the Minnesota heart survey. Am J Public Health 102(4):705–713

    Article  PubMed  Google Scholar 

  • Gerber Y, Goldbourt U, Drory Y (2008) Interaction between income and education in predicting long-term survival after acute myocardial infarction. Eur J Cardiovasc Prev Rehabil 15(5):526–532

    Article  PubMed  Google Scholar 

  • Gerber Y, Benyamini Y, Goldbourt U, Drory Y, Israel Study Group on First Acute Myocardial Infarction (2010) Neighbourhood socioeconomic context and long-term survival after myocardial infarction. Circulation 121:375–383

    Article  PubMed  Google Scholar 

  • Gerber Y, Koren-Morag N, Myers V, Benyamini Y, Goldbourt U, Drory Y, Israel Study Group on First Acute Myocardial Infarction (2011a) Long-term predictors of smoking cessation in a cohort of myocardial infarction survivors: a longitudinal study. Eur J Cardiovasc Prev Rehabil 18(3):533–541

    Article  PubMed  Google Scholar 

  • Gerber Y, Myers V, Goldbourt U, Benyamini Y, Drory Y, Israel Study Group on First Acute Myocardial Infarction (2011b) Neighborhood socioeconomic status and leisure-time physical activity after myocardial infarction: a longitudinal study. Am J Prev Med 41(3):266–273

    Article  PubMed  Google Scholar 

  • Geronimus AT, Bound J (1998) Use of census-based aggregate variables to proxy for socioeconomic group: evidence from national samples. Am J Epidemiol 148(5):475–486

    Article  PubMed  CAS  Google Scholar 

  • Greenwald HP, Polissar NL, Borgatta EF, McCorkle R (1994) Detecting survival effects of socioeconomic status: problems in the use of aggregate measures. J Clin Epidemiol 47(8):903–909

    Article  PubMed  CAS  Google Scholar 

  • Hollingshead AB (1975) Four factor index of social status. Yale University, New Haven

    Google Scholar 

  • Hotchkiss JW, Davies C, Gray L, Bromley C, Capewell S, Leyland AH (2011) Trends in adult cardiovascular disease risk factors and their socio-economic patterning in the Scottish population 1995-2008: cross-sectional surveys. BMJ Open 1(1):e000176

    Article  PubMed  Google Scholar 

  • Jacobsen BK, Thelle DS (1988) Risk factors for coronary heart disease and level of education. The Tromso Heart Study. Am J Epidemiol 127(5):923–932

    PubMed  CAS  Google Scholar 

  • Johnson JL, Heineman EF, Heiss G, Hames CG, Tyroler HA (1986) Cardiovascular disease risk factors and mortality among black women and white women aged 40-64 years in Evans County, Georgia. Am J Epidemiol 123(2):209–220

    PubMed  CAS  Google Scholar 

  • Kaplan GA, Keil JE (1993) Socioeconomic factors and cardiovascular disease: a review of the literature. Circulation 88(4 Pt 1):1973–1998

    Article  PubMed  CAS  Google Scholar 

  • Karasek R (1990) Lower health risk with increased job control among white collar workers. J Organ Behav 11:171–185

    Article  Google Scholar 

  • Kivimäki M, Virtanen M, Elovainio M, Kouvonen A, Väänänen A, Vahtera J (2006) Work stress in the etiology of coronary heart disease: a meta-analysis. Scand J Work Environ Health 32(6):431–442

    Article  PubMed  Google Scholar 

  • Lee RE, Cubbin C, Winkleby M (2007) Contribution of neighbourhood socioeconomic status and physical activity among women. J Epidemiol Community Health 61:882–890

    Article  PubMed  Google Scholar 

  • Liberatos P, Link BG, Kelsey JL (1988) The measurement of social class in epidemiology. Epidemiol Rev 10:87–121

    PubMed  CAS  Google Scholar 

  • Lorant V, Deliège D, Eaton W, Robert A, Philippot P, Ansseau M (2003) Socioeconomic inequalities in depression: a meta-analysis. Am J Epidemiol 157(2):98–112

    Article  PubMed  CAS  Google Scholar 

  • Lynch JW, Kaplan GA, Cohen RD, Tuomilehto J, Salonen JT (1996) Do cardiovascular risk factors explain the relation between socioeconomic status, risk of all-cause mortality, cardiovascular mortality, and acute myocardial infarction? Am J Epidemiol 144(10):934–942

    Article  PubMed  CAS  Google Scholar 

  • Macintyre S (1994) Understanding the social patterning of health: the role of the social sciences. J Public Health Med 16(1):53–59

    PubMed  CAS  Google Scholar 

  • Manrique-Garcia E, Sidorchuk A, Hallqvist J, Moradi T (2011) Socioeconomic position and incidence of acute myocardial infarction: a meta-analysis. J Epidemiol Community Health 65(4):301–309

    Article  PubMed  Google Scholar 

  • Marmot MG, Smith GD, Stansfeld S, Patel C, North F, Head J, White I, Brunner E, Feeney A (1991) Health inequalities among British civil servants: the Whitehall II study. Lancet 337(8754):1387–1393

    Article  PubMed  CAS  Google Scholar 

  • Meijer A, Conradi HJ, Bos EH, Thombs BD, van Melle JP, de Jonge P (2011) Prognostic ­association of depression following myocardial infarction with mortality and cardiovascular events: a meta-analysis of 25 years of research. Gen Hosp Psychiatry 33(3):203–216

    Article  PubMed  Google Scholar 

  • Melchior M, Berkman LF, Kawachi I, Krieger N, Zins M, Bonenfant S, Goldberg M (2006) Lifelong socioeconomic trajectory and premature mortality (35-65 years) in France: findings from the GAZEL Cohort Study. J Epidemiol Community Health 60(11):937–944

    Article  PubMed  CAS  Google Scholar 

  • Mendis S (2010) The contribution of the Framingham Heart Study to the prevention of cardiovascular disease: a global perspective. Prog Cardiovasc Dis 53(1):10–14

    Article  PubMed  Google Scholar 

  • Molshatzki N, Drory Y, Myers V, Goldbourt U, Benyamini Y, Steinberg DM, Gerber Y (2011) Role of socioeconomic status measures in long-term mortality risk prediction after myocardial infarction. Med Care 49(7):673–678

    Article  PubMed  Google Scholar 

  • Morrow D, Clark D, Tu W, Wu J, Weiner M, Steinley D, Murray MD (2006) Correlates of health literacy in patients with chronic heart failure. Gerontologist 46(5):669–676

    Article  PubMed  Google Scholar 

  • Myers V, Gerber Y, Benyamini Y, Goldbourt U, Drory Y (2012) Post-myocardial infarction depression: increased hospital admissions and reduced adoption of secondary prevention measures – a longitudinal study. J Psychosom Res 72(1):5–10

    Article  PubMed  Google Scholar 

  • Naska A, Katsoulis M, Trichopoulos D, Trichopoulou A (2012) The root causes of socioeconomic differentials in cancer and cardiovascular mortality in Greece. Eur J Cancer Prev 21(5):490–496

    Article  PubMed  Google Scholar 

  • Nielsen KM, Faergeman O, Foldspang A, Larsen ML (2008) Cardiac rehabilitation: health characteristics and socio-economic status among those who do not attend. Eur J Public Health 18(5):479–483

    Article  PubMed  Google Scholar 

  • Nietert PJ, Sutherland SE, Keil JE, Bachman DL (2006) Demographic and biologic influences on survival in whites and blacks: 40 years of follow-up in the Charleston Heart Study. Int J Equity Health 5:8

    Article  PubMed  Google Scholar 

  • Pappas G, Queen S, Hadden W, Fisher G (1993) The increasing disparity in mortality between socioeconomic groups in the United States, 1960 and 1986. N Engl J Med 329(2):103–109

    Article  PubMed  CAS  Google Scholar 

  • Philbin EF, McCullough PA, DiSalvo TG, Dec GW, Jenkins PL, Weaver WD (2000) Socioeconomic status is an important determinant of the use of invasive procedures after acute myocardial infarction in New York State. Circulation 102(19 Suppl 3):III107–III115

    PubMed  CAS  Google Scholar 

  • Pickett KE, Pearl M (2001) Multilevel analyses of neighbourhood socioeconomic context and health outcomes: a critical review. J Epidemiol Community Health 55(2):111–122

    Article  PubMed  CAS  Google Scholar 

  • Ramsay SE, Morris RW, Whincup PH, Papacosta AO, Thomas MC, Wannamethee SG (2011) Prediction of coronary heart disease risk by Framingham and SCORE risk assessments varies by socioeconomic position: results from a study in British men. Eur J Cardiovasc Prev Rehabil 18(2):186–193

    Article  PubMed  Google Scholar 

  • Rao SV, Kaul P, Newby LK, Lincoff AM, Hochman J, Harrington RA, Mark DB, Peterson ED (2003) Poverty, process of care, and outcome in acute coronary syndromes. J Am Coll Cardiol 41(11):1948–1954

    Article  PubMed  Google Scholar 

  • Rao SV, Schulman KA, Curtis LH, Gersh BJ, Jollis JG (2004) Socioeconomic status and outcome following acute myocardial infarction in elderly patients. Arch Intern Med 164(10):1128–1133

    Article  PubMed  Google Scholar 

  • Rathore SS, Berger AK, Weinfurt KP, Feinleib M, Oetgen WJ, Gersh BJ, Schulman KA (2000) Race, sex, poverty, and the medical treatment of acute myocardial infarction in the elderly. Circulation 102(6):642–648

    Article  PubMed  CAS  Google Scholar 

  • Rose G, Marmot MG (1981) Social class and coronary heart disease. Br Heart J 45(1):13–19

    Article  PubMed  CAS  Google Scholar 

  • Ross CE, Mirowsky J (1999) Refining the association between education and health: the effects of quantity, credential, and selectivity. Demography 36(4):445–460

    Article  PubMed  CAS  Google Scholar 

  • Salomaa V, Miettinen H, Niemelä M, Ketonen M, Mähönen M, Immonen-Räihä P, Lehto S, Vuorenmaa T, Koskinen S, Palomäki P, Mustaniemi H, Kaarsalo E, Arstila M, Torppa J, Kuulasmaa K, Puska P, Pyörälä K, Tuomilehto J (2001) Relation of socioeconomic position to the case fatality, prognosis and treatment of myocardial infarction events: the FINMONICA MI Register Study. J Epidemiol Community Health 55:475–482

    Article  PubMed  CAS  Google Scholar 

  • Smith GD, Bartley M, Blane D (1990) The Black report on socioeconomic inequalities in health 10 years on. BMJ 301(6748):373–377

    Article  PubMed  CAS  Google Scholar 

  • Steptoe A, Willemsen G, Owen N, Flower L, Mohamed-Ali V (2001) Acute mental stress elicits delayed increases in circulating inflammatory cytokine levels. Clin Sci (Lond) 101(2):185–192

    Article  CAS  Google Scholar 

  • Steptoe A, Feldman PJ, Kunz S, Owen N, Willemsen G, Marmot M (2002) Stress responsivity and socioeconomic status: a mechanism for increased cardiovascular disease risk? Eur Heart J 23(22):1757–1763

    Article  PubMed  CAS  Google Scholar 

  • Steptoe A, Molloy GJ, Messerly-Bürgy N, Wikman A, Randall G, Perkins-Porras L, Kaski JC (2011) Emotional triggering and low socio-economic status as determinants of depression following acute coronary syndrome. Psychol Med 41(9):1857–1866

    Article  PubMed  CAS  Google Scholar 

  • Sundquist K, Winkleby M, Ahlen H, Johansson SE (2004) Neighborhood socioeconomic environment and incidence of coronary heart disease: a follow-up study of 25,319 women and men in Sweden. Am J Epidemiol 159(7):655–662

    Article  PubMed  Google Scholar 

  • Thurston RC, Kubzansky LD, Kawachi I, Berkman LF (2005) Is the association between socioeconomic position and coronary heart disease stronger in women than in men? Am J Epidemiol 162(1):57–65

    Article  PubMed  Google Scholar 

  • Tiikkaja S, Hemstrom O, Vagero D (2009) Intergenerational class mobility and cardiovascular mortality among Swedish women: a population-based register study. Soc Sci Med 68(4):733–739

    Article  PubMed  Google Scholar 

  • Tofler GH, Muller JE, Stone PH, Davies G, Davis VG, Braunwald E (1993) Comparison of long-term outcome after acute myocardial infarction in patients never graduated from high school with that in more educated patients. Multicenter Investigation of the Limitation of Infarct Size (MILIS). Am J Cardiol 71(12):1031–1035

    Article  PubMed  CAS  Google Scholar 

  • Tonne C, Schwartz J, Mittleman M, Melly S, Suh H, Goldberg R (2005) Long-term survival after acute myocardial infarction is lower in more deprived neighbourhoods. Circulation 111:3063–3070

    Article  PubMed  Google Scholar 

  • Tunstall-Pedoe H, Woodward M (2006) By neglecting deprivation, cardiovascular risk scoring will exacerbate social gradients in disease. Heart 92(3):307–310

    Article  PubMed  CAS  Google Scholar 

  • van Melle JP, de Jonge P, Spijkerman TA, Tijssen JG, Ormel J, van Veldhuisen DJ, van den Brink RH, van den Berg MP (2004) Prognostic association of depression following myocardial infarction with mortality and cardiovascular events: a meta-analysis. Psychosom Med 66(6):814–822

    Article  PubMed  Google Scholar 

  • van Rossum CT, Shipley MJ, van de Mheen H, Grobbee DE, Marmot MG (2000) Employment grade differences in cause specific mortality. A 25 year follow up of civil servants from the first Whitehall study. J Epidemiol Community Health 54(3):178–184

    Article  PubMed  Google Scholar 

  • Wang Y, Beydoun MA (2007) The obesity epidemic in the United States – gender, age, socioeconomic, racial/ethnic, and geographic characteristics: a systematic review and meta-regression analysis. Epidemiol Rev 29:6–28

    Article  PubMed  CAS  Google Scholar 

  • Wilson TW, Kaplan GA, Kauhanen J, Cohen RD, Wu M, Salonen R, Salonen JT (1993) Association between plasma fibrinogen concentration and five socioeconomic indices in the Kuopio Ischemic Heart Disease Risk Factor Study. Am J Epidemiol 137(3):292–300

    PubMed  CAS  Google Scholar 

  • Winkleby M, Sundquist K, Cubbin C (2007) Inequities in CHD incidence and case fatality by neighborhood deprivation. Am J Prev Med 32(2):97–106

    Article  PubMed  Google Scholar 

  • Yen IH, Kaplan GA (1998) Poverty area residence and changes in physical activity level: evidence from the Alameda County Study. Am J Public Health 88:1709–1712

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Sackler Faculty of Medicine, Department of Epidemiology and Preventive Medicine, Tel Aviv University, Tel Aviv, Israel

    Vicki Myers MSc

  2. Sackler Faculty of Medicine, Department of Epidemiology and Preventive Medicine, School of Public Health, Tel Aviv University, Ramat Aviv, Tel Aviv, 69978, Israel

    Yariv Gerber PhD

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  1. Vicki Myers MSc
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  2. Yariv Gerber PhD
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Correspondence to Yariv Gerber PhD .

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  1. Department of Environmental and Preventi, Hyogo College of Medicine, Hyogo, Japan

    Ichiro Wakabayashi

  2. Institute of Biophysics, Medical University of Graz Center for Physiological Medicine, Graz, Austria

    Klaus Groschner

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Myers, V., Gerber, Y. (2013). Socioeconomic Aspects of Cardiovascular Health. In: Wakabayashi, I., Groschner, K. (eds) Interdisciplinary Concepts in Cardiovascular Health. Springer, Vienna. https://doi.org/10.1007/978-3-7091-1334-9_9

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