Social inequities in cardiovascular risk factors in women and men by autonomous regions in Spain

ObjectiveTo describe social inequities in cardiovascular risk factors in women and men by autonomous regions in Spain.MethodWe used data from 20,406 individuals aged 18 or older from the 2017 Spanish National Health Survey. We measured socioeconomic position using occupational social class and used data on self-reported cardiovascular risk factors: high cholesterol, diabetes, hypertension, obesity, and smoking. We estimated the relative risk of inequality using Poisson regression models. Analyses were stratified by men and women and by region (autonomous communities).ResultsOverall, the relative risk of inequality was 1.02, 1.13, 1.06, 1.17 and 1.09 for high cholesterol, diabetes, hypertension, obesity, and current smoking, respectively. Ocuupational social class inequities in diabetes, hypertension, and obesity was stronger for women. Results showed a large regional heterogeneity in these inequities; some regions (e.g. Asturias and Balearic Islands) presented wider social inequities in cardiovascular risk factors than others (e.g. Galicia, Navarra or Murcia).ConclusionIn Spain, we found marked social inequities in the prevalence of cardiovascular risk factors, with wide regional and women/men heterogeneity in these inequities. Education, social, economic and health policies at the regional level could reduce health inequities in cardiovascular risk factors and, thus, prevent cardiovascular disease.     

Social class and cardiovascular risk factors in Danish men.

During the last 25 years, a series of epidemiological studies in North-Western Europe and U.S.A. have demonstrated a negative association between social class and the incidence of cardiovascular disease (CVD), that is, an increasing incidence the lower the social class. In studies where possible explanations of this negative gradient have been analyzed, it was concluded that the traditional individual risk factors, such as elevated blood pressure, high serum cholesterol, and smoking, could explain about one half of the differences demonstrated. In a prospective study of a cohort of 504 men from the County of Copenhagen, the participants were examined when 40 and 51 years old. At both examinations the social class of the participants was recorded in addition to a number of cardiovascular risk factors. The latter included both the traditional risk factors and some not previously analyzed in relation to social class. At the 51-year examination we found statistically significant negative associations between social class and the following risk factors: plasma fibrinogen (p less than 0.001), short height (p less than 0.001), smoking (p less than 0.05), physical inactivity in leisure time (p less than 0.01), shift work (p less than 0.05), job strain (p less than 0.05), living alone (p less than 0.01), and having a poor social network (p less than 0.05). Two factors showed a significant opposite association with social class: Type A behaviour (p less than 0.001) and physical inactivity at work (p less than 0.001). In the last 10-15 years, a tendency has been demonstrated in many countries towards a strengthened association between social class and cardiovascular risk factors. This tendency was not found in our cohort. It has been discussed whether some of the social inequalities observed could be due to selection, so that people with a favourable cardiovascular risk profile socially were upward mobile. We found no support for such a selection hypothesis in our study.     

Relationship of social class characteristics and risk factors for coronary heart disease in West Germany

A cross-sectional analysis of the baseline survey of the German Cardiovascular Prevention Study was carried out to analyse the relationship between four different social class characteristics and major risk factors for coronary heart disease. 4,796 randomly selected German residents aged 25-69 years participated in the health survey between 1984 and 1986. The response rate was 66.2%. No significant association with social class variables was observed for prevalence of hypertension, hypercholesterolaemia or low high density lipoproteins. Multiple logistic regression analysis showed that obesity and lack of physical activity were significantly more prevalent in lower social classes for both sexes, while for cigarette smoking this relationship held for males only. The strongest social class gradient was found for lack of physical activity, adjusted odds ratio 4.75, P less than 0.001, comparing lowest social class by composite index to highest. The number of coronary heart disease risk factors per study subject increased strongly with decreasing social class. Education, measured as years of schooling, showed a stronger association with coronary heart disease risk factors than household income, occupational status, or a three-dimensional composite index of social class. These findings indicate the need to focus on lower social class population groups when carrying out community-based coronary heart disease primary prevention programmes, particularly with regard to smoking, obesity, and lack of physical activity.     

Shift work, risk factors and cardiovascular disease.

The literature on shift work, morbidity and mortality from cardiovascular disease, and changes in traditional risk factors is reviewed. Seventeen studies have dealt with shift work and cardiovascular disease risk. On balance, shift workers were found to have a 40% increase in risk. Causal mechanisms of this risk via known cardiovascular risk factors, in relation to circadian rhythms, disturbed sociotemporal patterns, social support, stress, behavior (smoking, diet, alcohol, exercise), and biochemical changes (cholesterol, triglycerides, etc) are discussed. The risk is probably multifactorial, but the literature has focused on the behavior of shift workers and has neglected other possible causal connections. In most studies methodological problems are present; these problems are related to selection bias, exposure classification, outcome classification, and the appropriateness of comparison groups. Suggestions for the direction of future research on this topic are proposed.     

Alcohol consumption and its relation to cardiovascular risk factors in Germany

OBJECTIVE: To analyse the association of alcohol consumption and blood lipids, haemostatic factors, and homocysteine in German adults by gender and age groups. DESIGN: Cross-sectional population-based survey. SETTING: Data from the German National Health Interview and Examination Survey 1998, representative for age, gender, community size, and federal state. SUBJECTS: From a sample of 7124 Germans between 18 and 79 y old, 2420 women and 2365 men were selected. Only individuals who were not currently receiving medical treatment or did not have disorders related to cardiovascular disease were selected for this study. RESULTS: Using analyses of variance, mean blood levels of total cholesterol, HDL cholesterol, HDL/total cholesterol ratio, total glycerides, fibrinogen, antithrombin III, and homocysteine adjusted for age, socioeconomic status, East/West Germany residence, body mass index, tobacco use, sports activity, and coffee consumption, if appropriate are presented by alcohol consumption groups (0, >0-10, >10-20, >20-30 and >30 g/day). The HDL/total cholesterol ratio increased with higher alcohol groups up to 10-20 g/day (+15%) for women and >30 g/day (+18%) for men, showing the strongest rise among men aged 55-79 y. Fibrinogen decreased with higher alcohol groups up to 10-20 g/day for women and 20-30 g/day for men. Among women, homocysteine levels showed a U-shaped curve with a minimum of 8.49 mmol/l at 10-20 g alcohol/day (-8%, reference: nondrinking), whereas an inverse association was observed for men. CONCLUSIONS: Moderate alcohol consumption is associated with favourable levels of several cardiovascular risk factors. The most favourable cardiovascular risk factor profile among women was observed among those drinking 10-20 g alcohol/day. Beneficial effects seem to be more pronounced among older men.     

Indoor risk factors for atopic eczema in school children from East Germany.

This study aimed to investigate the relation between environmental influences such as arsenic, cadmium, lead, and mercury, as well as environmental tobacco smoke, pet keeping, and heating systems on the prevalence of atopic eczema. Therefore, a multicenter cross-sectional study of school children aged 5-14 years, including a standardized questionnaire, blood and urine analyses, and a dermatological examination, was undertaken. A cases-control approach was chosen in order to identify relevant risk factors. A total of 2200 school children (response 79.1%) of two areas (Bitterfeld, Hettstedt) polluted by industrial activities and an agricultural control region (Zerbst) of the former German Democratic Republic were examined. Atopic eczema as identified by dermatological examination and history was the outcome variable of interest. Body burden of arsenic and heavy metals and questionnaire data on environmental tobacco smoke exposure, pet keeping, and heating system were investigated as potential risk factors.The overall prevalence of atopic eczema was 2.6%, with higher prevalences in the industrial areas (2.5 and 2.9%) compared to the control area (1.6%, not significant). Bivariate analyses did not reveal statistically significant associations between atopic eczema and tobacco smoke exposure or the body burden of arsenic and heavy metals. According to multiple logistic regression analysis, atopic eczema was significantly more frequent in predisposed families and those who reported keeping guinea pigs (OR=4.37, CI 2.15-8.91), but not other pets, like dogs, cats, and hamsters. In comparison to a distant heating system, a decreased risk was observed in households with central heating system (OR=0.30, CI 0.10-0.90), whereas the presence of a gas heater with an exhaust pipe connection to the wall was associated with a significantly elevated risk for eczema (OR=8.22, CI 2.44-27.66).The heating system and exposure to certain animal allergens are related to the manifestation of atopic eczema. Further studies are needed to clarify how far a causal relationship is reflected by these findings.     

Clustering of cardiovascular disease risk factors

In a population-based cardiovascular disease study we analyzed the associations among five risk factors—cholesterol, triglycerides, blood pressure, obesity, and cigarette smoking. Two methods were used: standard correlation analysis, and a percentile analysis method limited to associations at higher levels of these risk factors. The study population, 4,839 men and women aged 30–89, showed significantly positive standard and age-adjusted correlation coefficients for all comparisons between any two risk factors except for those comparisons involving smoking. In the percentile analysis, subjects with moderate or greater (?70th percentile) or high (?90th percentile) levels on one of these risk factors showed clustering of elevations in other risk factors in that observed/expected ratios were generally greater than unity, again excepting smoking comparisons. Clustering was strongest in subjects at the highest levels of these risk factors, a phenomenon which has not, to our knowledge, previously been reported. Because of the particularly high risk of subjects with several risk factors, this finding should caution clinicians who identify a patient with an elevation of one of these risk factors to evaluate the patient carefully for elevations of other risk factors.     

军队干部心血管疾病危险因素和临界危险因素调查分析

目的了解军队干部心血管疾病危险因素和临界危险因素的流行现状,为下一步实施有效个体化干预提供数据资料。方法采用心血管疾病流行病学调查表,整群调查陆军机关、院校、野战部队干部809人,分析军队干部心血管疾病危险因素及临界危险因素的流行现状。结果军队干部多数存在不健康生活方式,其中摄盐过多者为43.0%,喜欢食肉者为58.59%,不喜欢运动者为53.89%。心血管疾病危险因素患病率为43.51%,临界危险因素患病率为74.29%,17.06%的人无任何危险因素。其中心血管疾病危险因素患病率位居前3位的分别是吸烟(29.42%)、肥胖(10.38%)、高血压(10.01%);临界危险因素患病率位居前三位的分别是超重(50.56%)、临界高血脂(40.67%)、临界高血压(34.73%)。分组研究结果显示,心血管疾病危险因素,年龄每增加10岁就有显著性增多(P<0.05);临界危险因素,在50岁之前,年龄每增加10岁就有显著性增多(P<0.05),然后进入一个平台期。结论军队干部心血管疾病危险因素患病率明显低于社会普通人群,但临界危险因素存在现象较为普遍。     

Determinants of avoidable deaths from ischemic heart disease in East and West Germany

Objective  

Within Germany, a significant decrease in avoidable mortality from ischemic heart disease (IHD) has been observed since the early 1990s. The objective of this paper is to identify the specific reasons that have led to the decrease in the number of avoidable deaths from IHD in West and East Germany from 1996 to 2004.     

Socio-demographic variations in perspectives on cardiovascular disease and associated risk factors.

Coronary heart disease (CHD) rates in Ireland are very high but little is known about attitudes to the disease. Qualitative attitudinal data were collected in focus group settings from 74 individuals across socio-demographic categories in order to assess knowledge of and attitudes to CHD and associated risk factors. Focus group questions were derived from group deconstruction of constructs from the Health Belief Model, Theory of Planned Behaviour, Protection Motivation Theory and Social Learning Theory. Participants were drawn from the personnel lists of local government and a health authority hospital. Eight types of groups were constructed according to the various permutations of the three variables: age, gender and occupational group. Analyses revealed good knowledge levels about risk factors among participants. However, participants exhibited mixed loci of control and low motivation to change behaviours. Men generally were less motivated to change than women; older men thought it too late and younger ones too soon. Though white and blue collar groups' views were similar, the discussion in white collar groups was more varied. Participants were sceptical about apparently contradictory medical advice which undermined motivation to change. The data complement earlier work and suggest preventative initiatives should be more focused.     

Shiftwork and metabolic risk factors of cardiovascular disease

We conducted this study to examine the relationship between shift work duration and the metabolic risk factors of cardiovascular disease among shift workers. The study population consisted of 226 female hospital nurses and 134 male workers at a firm manufacturing diapers and feminine hygiene materials, whose mean ages were 28.5 yr for the nurses and 29.1 yr for the male workers. The fasting blood sugar level, serum cholesterol, blood pressure, height and weight, waist and hip circumferences (only for the nurses), and numbers of walks during work (as a measure of physical activity) were measured. Using the Karasek's job contents questionnaire, job stress was assessed. Information about the years of work, shift work duration, past medical and behavioral history, including smoking, was obtained by a self-administered questionnaire. With definitions of hypertension as systolic blood pressure (SBP) > or =160 or diastolic blood pressure (DBP) > or =90 mmHg occurring at least once, hypercholesterolemia as serum total cholesterol > or =240 mg/dl, obesity as body mass index (BMI) > or =25 kg/m(2) and as waist to hip ratio (WHR) > or =0.85, we examined the prevalences of metabolic risk factors among subjects. Regression analyses to show the relationships between shift work duration and metabolic risk factors were performed using simple and multivariate models stratified by age, and adjusted for smoking, drinking, job strain and physical activity. Duration of shift work was significantly associated with SBP or cholesterol level among male workers aged 30 or more. Among female nurses, it was inversely associated with DBP (in those who were below 30 yr old) and cholesterol (in those who were aged 30 or more). BMI was non-significantly associated with the duration of shift work in both male workers and female nurses who were 30 yr old or more. WHR in female nurses increased slightly according to increasing duration of shift work. Fasting blood sugar was not significantly associated with the duration of shift work in either sex regardless of age-group. These results suggest an association between shift work duration and the metabolic risk factors of cardiovascular disease.     

居民社会经济状况与心血管病危险因素的关系

目的 探讨居民社会经济状况(Socioeconomic Status，SES)和心血管病危险因素之间的关系，为干预的重点人群的确定提供科学依据。方法 利用1997年及1998年广东省糖尿病流行病学调查资料分析社会经济状况和心血管病危险因素之间的关系。结果 男性的社会经济状况指标优于女性。调整年龄、职业性体力活动、休闲体力活动和饮酒后，SES对心血管病危险因素仍有影响，其中受教育程度和居住地区的影响较大，其关联在男女不同。结论 社会经济状况是心血管病危险因素的重要影响因子，对社会经济状况好的女性施加干预可能会取得更好的效果。