Temporal trends in socioeconomic inequality in mortality in France between 1968 and 1996. Study of educational differences by cause of death

BackgroundLittle information is available on temporal trends in socioeconomic inequalities in mortality by cause of death in France. The aim of this paper was to study educational differences in mortality in France by cause of death and their temporal trend.MethodsWe used a representative sample of 1% of the French population and compared four periods (1968–1974, 1975–1981, 1982–1988, 1990–1996). Causes of death were obtained from the French national death registry. Education was measured at the beginning of each period, and educational disparities in mortality were studied among men and women aged 30–64 at the beginning of each period. Analyses were conducted for all deaths and for the following causes of death: all cancers, lung cancer (in men), head and neck cancers (in men), breast cancer (in women), colorectal cancer, other cancers, cardiovascular diseases, ischemic heart diseases, cerebrovascular diseases, other cardiovascular diseases, external causes, and other causes of death. Socioeconomic inequalities were quantified with relative risk and relative index of inequality (RII). The RII measures socioeconomic inequalities across the population and can be interpreted as the ratio of mortality rates of those with the lowest to those with the highest socioeconomic status.ResultsAnalyses showed an increase in educational differences in all-cause mortality among men (the RII increased from 1.96 to 2.77 from the first to the last period) and among women (the RII increased from 1.87 to 2.53). Socioeconomic inequalities increased for all causes of death studied among women, and for cancer and cardiovascular diseases among men. The contribution of cancer mortality to the difference in overall mortality between the lowest and the highest levels of education sharply increased over the entire study period, especially for women.ConclusionThis study shows that large socioeconomic inequalities in mortality exist in France, and that they have increased over time in both men and women.     

Socioeconomic inequalities in mortality among elderly people in 11 European populations

STUDY OBJECTIVE: To describe mortality inequalities related to education and housing tenure in 11 European populations and to describe the age pattern of relative and absolute socioeconomic inequalities in mortality in the elderly European population. DESIGN AND METHODS: Data from mortality registries linked with population census data of 11 countries and regions of Europe were acquired for the beginning of the 1990s. Indicators of socioeconomic status were educational level and housing tenure. The study determined mortality rate ratios, relative indices of inequality (RII), and mortality rate differences. The age range was 30 to 90+ years. Analyses were performed on the pooled European data, including all populations, and on the data of populations separately. Data were included from Finland, Norway, Denmark, England and Wales, Belgium, France, Austria, Switzerland, Barcelona, Madrid, and Turin. MAIN RESULTS: In Europe (populations pooled) relative inequalities in mortality decreased with increasing age, but persisted. Absolute educational mortality differences increased until the ages 90+. In some of the populations, relative inequalities among older women were as large as those among middle aged women. The decline of relative educational inequalities was largest in Norway (men and women) and Austria (men). Relative educational inequalities did not decrease, or hardly decreased with age in England and Wales (men), Belgium, Switzerland, Austria, and Turin (women). CONCLUSIONS: Socioeconomic inequalities in mortality among older men and women were found to persist in each country, sometimes of similar magnitude as those among the middle aged. Mortality inequalities among older populations are an important public health problem in Europe.     

Trends of socioeconomic differences in daily vegetable consumption, 1979-2002

BACKGROUND: Studies from different time periods have shown that consumption of vegetables is more common in higher socioeconomic groups and among women. However, there are only few studies of changes of socioeconomic differences in vegetable consumption over time. Our aim was to determine whether socioeconomic differences, measured by educational level and household income, in daily vegetable consumption have increased, decreased or been stable over the last two decades among Finnish men and women. METHODS: Data on daily consumption of fresh vegetables were derived from repeated annual cross-sectional surveys performed among representative samples of Finnish working aged (15-64 years) population. Data from the years 1979-2002 were linked with data on education and household income from Statistics Finland. Those under 25 years and all students were excluded, giving a total of 69 383 respondents. The main analyses were conducted with logistic regression. RESULTS: Daily consumption of fresh vegetables became overall more prevalent during the study period. Daily consumption of fresh vegetables was more common among those with higher education and higher income during the whole study period. Both educational level and household income differences in daily vegetable consumption slightly narrowed since 1979 among men and women. CONCLUSIONS: Women with high socioeconomic position have been initial trend setters, but the prevalence of daily consumers of vegetables in these groups has not increased since the early 1990s. The prevalence of daily consumption of fresh vegetables has increased more in lower educational and income groups during the 1980s and 1990s along with narrowing socioeconomic differences.     

Trends in socioeconomic health inequalities in the Netherlands, 1981-1999

STUDY OBJECTIVE: To determine changes in socioeconomic inequalities in self reported health in both the 1980s and the 1990s in the Netherlands. DESIGN: Analysis of trends in socioeconomic health inequalities during the last decades of the 20th century were made using data from the Health Interview Survey (Nethhis) and the subsequent Permanent Survey on Living Conditions (POLS) from Statistics Netherlands. Socioeconomic inequalities in self assessed health, short-term disabilities during the past 14 days, long term health problems and chronic diseases were studied in relation to both educational level and household income. Trends from 1981 to 1999 were studied using summary indices for both the relative and absolute size of socioeconomic inequalities in health. SETTING: The Netherlands. PARTICIPANTS: For the period 1981-1999 per year a random sample of about 7000 respondents of 18 years and older from the non-institutionalised population. MAIN RESULTS: Socioeconomic inequalities in self assessed health showed a fairly consistent increase over time. Socioeconomic inequalities in the other health indicators were more or less stable over time. In no case did socioeconomic inequalities in health seemed to have decreased over time. Socioeconomic inequalities in self assessed health increased both in the 1980s and the 1990s. This increase was more pronounced for income (as compared with education) and for women (as compared with men). CONCLUSION: There are several possible explanations for the fact that, in addition to stable health inequalities in general, income related inequalities in some health indicators increased in the Netherlands, especially in the early 1990s. Most influential were perhaps selection effects, related to changing labour market policies in the Netherlands. The fact that the health inequalities did not decrease over recent years underscores the necessity of policies that explicitly aim to tackle these inequalities.     

甘肃榆中地区健康公平性及其相对变化

目的：研究甘肃省榆中地区1993年与2001年健康公平性状况及其相对变化。方法：按照教育程度把人群分为4组，以半年患病率作为健康指标，利用Logistic模型和以回归为基础的不平等相对指数（RII）对1993年和2001年不同人群的健康差异情况及其相对改变进行分析。结果：该地区普遍存在健康差异现象，教育程度较低的人群患病率较高。1993年男性RII为0．76，女性RII为0．32；而到2001年则分别增大到0．75和0．17，女性健康差异大于男性，并且女性的增长幅度也更大。结论：教育在健康差异中起着重要作用，特别是对于女性。要减小健康不公平现象，在改善其他条件的同时，也应该加强该地区的教育工作。     

Trends in alcohol intake by education and marital status in urban population in Russia between the mid 1980s and the mid 1990s

AIMS: We investigated changes in the distribution of alcohol consumption by education and marital status in Russia during the period of societal transformation after 1990. Such changes would indicate the potential role of alcohol in the rising social inequalities in mortality. METHODS: We analysed data from three surveys in random population samples conducted in Novosibirsk as part of the WHO MONICA project in 1985/86 (1533 men, 1292 women), 1988/89 (1700 men, no women) and 1994/95 (1526 men, 1510 women), coinciding with the period of societal transformation. Four measures of drinking were examined in relation to education and marital status: prevalence of drinking at least twice a week; the mean intake in the last week; the mean intake per drinking occasion; and the prevalence of binge drinking (>80 g ethanol for men and >60 g for women) at least once a month. RESULTS: Among men, those with university education had the lowest levels of all measures of drinking. Drinking indices increased over time in all educational groups but most sharply in men with high education, thus leading to a smaller education-related difference in the last survey. With respect to marital status, divorced and widowed men tended to drink most, but the pattern was inconsistent, and the difference between divorced and married men also narrowed over time. Among women, alcohol intake increased between the first and last survey. Differences by education and marital status in women were smaller than in men, and binge drinking was inversely related to education. CONCLUSIONS: All indices of alcohol consumption in men increased between the mid 1980s and the mid 1990s. The increase in alcohol intake among men was proportionally similar across categories of education and marital status but the absolute differences increased. The contribution of alcohol to the increase in social differentials in mortality in the 1990s was probably modest.     

Changing social disparities and mortality in France (1968-1996): cause of death analysis by educational level

BACKGROUND: Little information is available on temporal trend in socioeconomic inequalities in cause of death mortality in France. The aim of this paper was to study educational differences in mortality in France by cause of death and their temporal trend. METHODS: We used a representative sample of 1% of the French population and compared four periods (1968-1974, 1975-1981, 1982-1988, 1990-1996). Causes of death were obtained by direct linkage with the French national death registry. Education was measured at the beginning of each period, and educational disparities in mortality were studied among men and women aged 30-64 at the beginning of each period. Analyses were conducted for all deaths and for the following causes of death: all cancers, lung cancer (among men), upper aerodigestive tract cancers (among men), breast cancer (among women), colorectal cancer, other cancers, cardiovascular diseases, ischaemic heart diseases, cerebrovascular diseases, other cardiovascular diseases, external causes, other causes of death. Socioeconomic inequalities were quantified with relative risks and relative indices of inequality. The relative indices of inequality measures socioeconomic inequalities across the population and can be interpreted as the ratio of mortality rates of those with the lowest to those with the highest socioeconomic status. RESULTS: Analyses showed an increase in educational differences in all cause mortality among men (the relative indices of inequality increased from 1.96 to 2.77 from the first to the last period) and among women (the relative indices of inequality increased from 1.87 to 2.53). Socioeconomic inequalities increased for all cause of death studied among women, and for cancer and cardiovascular diseases among men. The contribution of cancer mortality to difference in overall mortality between the lowest and the highest levels of education increased strongly over the whole study period, especially among women. CONCLUSION: This study shows that large socioeconomic inequalities in mortality are observed in France, and that they increase over time among men and women.     

Trends in socioeconomic inequalities in self-assessed health in 10 European countries

BACKGROUND: Changes over time in inequalities in self-reported health are studied for increasingly more countries, but a comprehensive overview encompassing several countries is still lacking. The general aim of this article is to determine whether inequalities in self-assessed health in 10 European countries showed a general tendency either to increase or to decrease between the 1980s and the 1990s and whether trends varied among countries. METHODS: Data were obtained from nationally representative interview surveys held in Finland, Sweden, Norway, Denmark, England, The Netherlands, West Germany, Austria, Italy, and Spain. The proportion of respondents with self-assessed health less than 'good' was measured in relation to educational level and income level. Inequalities were measured by means of age-standardized prevalence rates and odds ratios (ORs). RESULTS: Socioeconomic inequalities in self-assessed health showed a high degree of stability in European countries. For all countries together, the ORs comparing low with high educational levels remained stable for men (2.61 in the 1980s and 2.54 in the 1990s) but increased slightly for women (from 2.48 to 2.70). The ORs comparing extreme income quintiles increased from 3.13 to 3.37 for men and from 2.43 to 2.86 for women. Increases could be demonstrated most clearly for Italian and Spanish men and women, and for Dutch women, whereas inequalities in health in the Nordic countries showed no tendency to increase. CONCLUSIONS: The results underscore the persistent nature of socioeconomic inequalities in health in modern societies. The relatively favourable trends in the Nordic countries suggest that these countries' welfare states were able to buffer many of the adverse effects of economic crises on the health of disadvantaged groups.     

Income differences in mortality: a register-based follow-up study of three million men and women

OBJECTIVES: We analyse whether the relationship between net household income and mortality form a continuous linear gradient or is curvilinear, assess the attenuation of this association after adjusting for confounding and reverse causality, and assess the strength of the association by age and cause of death. DESIGN AND SETTING: Prospective study of mortality in Finland among all men and women over 30 years old. Information on household income and sociodemographic factors was from the records of the Finnish tax authorities and the 1990 census. Income data were available for more than 95% of the cohort. Follow-up was by record linkage to death certificates in 1991-1996; altogether about 261 000 deaths. RESULTS: The all-cause mortality ratio between the lowest and the highest household income decile is 2.37 (95% CI : 2.30-2.44) among men and 1.73 (95% CI : 1.67-1.80) among women. Adjusting for household structure, spouse's economic activity, social class, education and own economic activity attenuates the relationship by 61% among men and 52% among women. The association between income and mortality is mainly linear before and after adjusting for confounding, and the association is strong for all 5-year age groups below 60-64 years, after which it declines rapidly in strength. CONCLUSIONS: The mainly linear nature of the relationship and the strong attenuation after adjustment for other socioeconomic factors and economic activity status, and the age pattern of the relationship indicate that a large part of the relationship is unlikely to be due to direct causal effects of poverty and material hardship. Rather, income seems to be related to accumulation of factors that increase mortality over the whole range of incomes.     

Are Mortality Differences and Trends by Education Any Better or Worse in New Zealand? A Comparison Study with Norway,Denmark and Finland, 1980–1990s

During the 1980s and early 1990s New Zealand experienced major social and economic change, decreasing all-cause mortality rates for the majority ethnic group, and high (but falling) cardiovascular disease (CVD) mortality rates. This paper explores whether inequalities in mortality by education were greater, and increased more, in New Zealand than in Nordic countries (Denmark, Finland, Norway), and determines the contribution of CVD to these differences and trends. Methods: We used mortality rates for 30–59 year olds by education, and slope (SII) and relative (RII) indices of inequality, calculated from comparable linked census mortality data. Results: Mortality inequalities in New Zealand were at the high end of the Nordic range when standardised by age only, but were mid-range when also standardised by ethnicity. Over time, relative inequalities in all-cause mortality increased similarly in all countries. In New Zealand a large increase in inequality for cardiovascular disease (CVD) mortality was the major contributor. In contrast both CVD and other causes of death were important drivers of increasing inequalities in Nordic countries. Absolute inequalities in all-cause mortality were stable over time among males across all countries, and increased modestly among females. The contribution of CVD to absolute inequality was stable or decreasing over time in all countries. Conclusion: Overall, inequalities in mortality in New Zealand did not widen more rapidly than in northern European countries. However, rapid social and economic change may have affected trends in CVD mortality among low educated men and women, and especially the ethnic minority groups.     

Socioeconomic status and mortality in Dutch elderly people: The Rotterdam study

Background: The aim of the study was to describe the relationshipbetween socioeconomic status and mortality in Dutch elderlypeople. Methods: A prospective follow-up study was performedamong 4,878 women and 3,105 men aged 55 years and over livingin Ommoord, a district of Rotterdam, The Netherlands. At baseline,data on education, occupation and income were collected. Dataon mortality were obtained from the municipal population registryand general practitioners. Relative risks of mortality by indicatorsof socioeconomic status were estimated after an average follow-upperiod of 4.1 years. Separate age-adjusted analyses were performedfor men and women. Results: The findings in this study indicatethat for men (mean age at baseline of 69 ± 9 years),differences in mortality exist for all three indicators of socioeconomicstatus. Mortality risks were higher for lower educated men,unskilled manual workers and those with a lower equivalent householdincome. For women (mean age 72 ± 10 years), the relativerisks of mortality were also higher for lower educated groups,but lower equivalent household income and occupational statusappeared not to be related to mortality. Conclusions: In elderlyDutch people, there are clear differences in mortality acrossgroups of different socioeconomic status. The mechanisms forexplaining the apparent inequalities in health among older subjectsrequire further research.     

Evolution of educational inequalities in mortality among young adults in an urban setting

Objectives

To gain insight into the evolution in educational inequalities in adolescent and young adult all-cause and cause-specific mortality in the urban setting of the Brussels-Capital Region.

Methods

Data were derived from record linkage between the censuses of 1991 and 2001 and register data on all-cause and cause-specific mortality and emigration in the respective periods of 1st October 1991 to 1st January 1996 and 1st October 2001 to 1st January 2006. Both directly and indirectly standardised mortality rates and the relative index of inequality (RII) were computed.

Results

Mortality rates among adolescents and young adults have dropped significantly, especially infections and traffic accidents. However, educational inequalities among men have slightly increased: men with a maximum primary education are four times more likely to die than those who are higher educated [RII = 4.09 (2.78–6.03)]. Among women, no social gradient is observed in either period, but a clear split between the lowest educated and other educational groups is apparent in the 2000s.

Conclusions

There is a positive evolution towards lower mortality among adolescents and young adults, but educational inequalities remain a public health concern.     

The association between self-rated health and mortality in different socioeconomic groups in the GAZEL cohort study

OBJECTIVES: Self-rated health (SRH) is considered a valid measure of health status as it has been shown to predict mortality in several studies. We examine whether SRH predicts mortality equally well in different socioeconomic groups. METHODS: Data (14 879 men and 5525 women) are drawn from GAZEL, a prospective cohort study of French public utility workers. Data on SRH and the socioeconomic measures (education, occupational position and income) were taken from the baseline questionnaire (1989), when the average age of individuals was 44.2 years (SD = 3.5). Mortality follow-up was available for a mean of 17.2 years and analysed over the first 10 years and over the entire follow-up period. Associations between SRH and mortality were assessed using Cox regression models using the relative index of inequality (RII) to summarize associations. RESULTS: The RII for the association between SRH and mortality over the first 10 years was 6.78 [95% confidence interval (CI) = 3.33-13.81] in the lowest occupational group and 2.10 (95% CI = 0.97-4.54) in the highest. For income, the RIIs were 8.82 (95% CI = 4.70-16.54) for the lowest and 1.80 (95% CI = 0.86-3.80) for the highest groups respectively. Findings over the full follow-up period were similar. The association between SRH and mortality was weaker in the high occupation and income groups, both in the short and the long term. The results for education were similar but generally weaker than for the other socioeconomic measures. CONCLUSIONS: The predictive ability of SRH for mortality weakens with increasing socioeconomic advantage among middle-aged individuals. Thus SRH appears not to measure 'true' health status in a similar way across socioeconomic categories.     

Mortality by education in German speaking Switzerland, 1990-1997: results from the Swiss National Cohort

BACKGROUND: The aim of this paper is to show for the first time mortality differentials by level of education for Swiss men and women. This work is of interest to public health efforts in Switzerland as well as for co-operative international research into the determinants of socioeconomic differentials in health and mortality. METHODS: This study is based on a longitudinal data set from the Swiss National Cohort, currently incorporating a probabilistic record linkage of the 1990 Swiss census, and all subsequent deaths until the end of 1997. The study population covers all Swiss nationals aged >/=25 years living in German speaking Switzerland, with 19.7 million person-years and 296 929 deaths observed. Educational gradients were analysed using standardized mortality ratios, multiple logistic regression, and the Relative Index of Inequality (RII). RESULTS: There were sizeable gradients in mortality by education for all age groups and both sexes. The mortality odds ratio decreased by 7.2% (95% CI: 7.0-7.5%) per additional year of education for men, and by 6.0% (95% CI: 5.6-6.3%) for women. In men, we found a steady decrease of the gradient from 13.1% (95% CI: 11.9-14.4%) in the age group 25-39 to 4.5% (95% CI: 4.0-5.0%) in the age group >/=75 years. For women in the age groups under 65 the gradients were smaller; over the age of 40 there was no decrease with increasing age. These results were fairly insensitive to variations in the parameters of record linkage. CONCLUSIONS: Despite a comparatively low overall mortality, Swiss men in the 1990s show larger relative gradients in mortality by education than men in other European countries in the 1980s, with the possible exception of younger men in Italy. In Switzerland there is a sizeable potential for further increasing overall life expectancy by reducing the mortality of those with a lower educational level. The results presented contribute to a reliable assessment of socioeconomic mortality differentials in Europe.     

Twenty-year trends in physical activity among Canadian adults

OBJECTIVE: Physical inactivity is associated with increased risk of mortality and chronic diseases, yet trend information is lacking in most countries. This investigation examines physical activity levels of Canadian adults aged 18 years and older. METHODS: Data were collected in six national surveys between 1981 and 2000. Sample sizes ranged from 2,500 to 18,000. Prevalences were tested using Chi-square and Student's t-tests. Socio-demographic correlates were examined using odds ratios adjusted for age, sex, education and income. RESULTS: Physical activity increased in the 1980s and 1990s among men and women and for all age, education and income groups (p<0.01). Although education differentials narrowed over the period, age differentials widened and income differentials emerged. DISCUSSION: The positive trend in Canada is consistent with Finland, but contrary to recent trends for Australia, England and the United States. Despite increases, sedentary living remains a public health issue particularly among women, older adults and lower income groups.     

Inequalities in the prevalence of smoking in the European Union: comparing education and income

BACKGROUND: The aim of the study was to determine whether education or income was more strongly related to smoking in the European Union at large, and within the individual countries of the EU, at the end of the 1990s. METHODS: We related smoking prevalence to education and income level by analyzing cross-sectional data on a total of 48,694 men and 52,618 women aged 16 and over from 11 countries of the European Union in 1998. RESULTS: Both education and income were related to smoking within the European Union at large. After adjustment of the other socioeconomic indicator, education remained related to smoking in the EU at large, but income only remained so among men. Educational inequalities were larger than income-related inequalities among younger and middle-aged men and women. Educational inequalities were larger than income-related inequalities among men in all individual countries, and among women in Northern Europe. For women from Southern European countries, the magnitude of education- and income-related inequalities was similar. CONCLUSIONS: Education is a strong predictor of smoking in Europe. Interventions should aim to prevent addiction to smoking among the lower educated, by price policies, school-based programs, and smoking cessation support for young adults.     

Trends in income-related health inequalities in self-assessed health in Korea, 1998–2011

This study assesses income-related health inequalities in self-assessed health (SAH) and its trend from 1998 to 2011 in Korea that covers important time periods of financial crisis and post-crisis. Data came from the Korean National Health and Nutrition Examination Survey from 1998 to 2011. A population-representative sample aged 46 years and older was analysed. SAH was used as an indicator of health status, with household equivalence income as a proxy for socio-economic position. Age-adjusted prevalence rates of SAH were analysed to estimate both absolute and relative measures of health inequalities and the trend over time by the relative index of inequality (RII) and the slope index of inequality (SII). Results indicated that the highest level of health inequalities was found among men aged 46–59 years, especially in 2001 and 2005. For men, there was no clear, consistent pattern of increase or decrease in the trend over time. On the other hand, increasing trends in the RII and SII were found for women, except for women aged 46–59 years who reported a decreasing trend in the SII. Trends in health inequalities over time were influenced by economic crisis, demonstrating the need for macro-level economic policies as well as health policies addressing health gaps.     

Socioeconomic position in childhood and adulthood and weight gain over 34 years: the Alameda County Study

PURPOSE: Socioeconomic position (SEP) has been shown to be related to obesity and weight gain, especially among women. It is unclear how different measures of socioeconomic position may impact weight gain over long periods of time, and whether the effect of different measures vary by gender and age group. We examined the effect of childhood socioeconomic position, education, occupation, and log household income on a measure of weight gain using individual growth mixed regression models and Alameda County Study data collected over thirty four years(1965-1999). METHODS: Analyses were performed in four groups stratified by gender and age at baseline: women, 17-30 years (n = 945) and 31-40 years (n = 712); men, 17-30 years (n = 766) and 31-40 years (n = 608). RESULTS: Low childhood SEP was associated with increased weight gain among women 17-30 (0.13 kg/year, p < 0.001). Low educational status was associated with increased weight gain among women 17-30 (0.14 kg/year, p = 0.030), 31-40 (0.14 kg/year, p = 0.014), and men 17-30 (0.20 kg/year, p = 0.001). CONCLUSION: Log household income was inversely associated with weight gain among men 31-40 (-0.10 kg/yr, p = 0.16). Long-term weight gain in adulthood is associated with childhood SEP and education in women and education and income in men.     

Waist circumference as a measurement of obesity in the Netherlands Antilles; associations with hypertension and diabetes mellitus

OBJECTIVES: To evaluate waist circumference (WC) as a screening tool for obesity in a Caribbean population. To identify risk groups with a high prevalence of (central) obesity in a Caribbean population, and to evaluate associations between (central) obesity and self-reported hypertension and diabetes mellitus. DESIGN: Cross-sectional. SETTING: Population-based study. SUBJECTS: A random sample of adults (18 y or older) was selected from the Population Registries of three islands of the Netherlands Antilles. Response was over 80%. Complete data were available for 2025 subjects. INTERVENTION: A questionnaire and measurements of weight, height, waist and hip. MAIN OUTCOME MEASUREMENT: Central obesity indicator (WC > or =102 cm men, > or =88 cm women). RESULTS: WC was positively associated with age (65-74 y vs 18-24 y) in men (OR=7.7, 95% CI 3.4-17.4) and women (OR=6.4, 95% CI 3.2-12.7). Women with a low education had a higher prevalence of central obesity than women with a high education (OR=0.5, 95% CI 0.3-0.7). However, men with a high income had a higher prevalence of a central obesity than men with a low income (OR=1.7, 95% CI=1.1-2.6). WC was the strongest independent obesity indicator associated with self-reported hypertension (OR=1.7, 95% CI 1.4-2.0) and diabetes mellitus (OR=1.6, 95% CI 1.3-1.9). CONCLUSIONS: The identified risk groups were women aged 55-74 y, women with a low educational level and men with a high income. WC appears to be the major obesity indicator associated with hypertension and diabetes mellitus. SPONSORSHIP: Island Governments of Saba, St Eustatius and Bonaire, the Federal Government of the Netherlands Antilles, Dutch Directorate for Kingdom relationships.     

Is the association between socioeconomic position and coronary heart disease stronger in women than in men?

The association between socioeconomic position and health is generally believed to be weaker among women than men. However, gender differences in the relation between socioeconomic position and coronary heart disease have not been evaluated in a representative sample of the US population. The authors examined this association in the First National Health and Nutrition Examination Survey (1971-1993), a longitudinal, representative study of the US population (n = 6,913). Information on educational attainment, household income, and covariates was derived from the baseline interview, and that on incident coronary heart disease was obtained from hospital records/death certificates over 22 years of follow-up. Cox's proportional hazards models showed that education and income were inversely associated with incident coronary heart disease in age-only and multivariate models. Risk associated with education varied by gender (p = 0.01), with less than high school education associated with stronger risk of coronary heart disease in women (relative risk = 2.15, 95% confidence interval: 1.46, 3.17) than in men (relative risk = 1.58, 95% confidence interval: 1.18, 2.12) in age-adjusted models. Low education was associated with greater social and psychological risks for women than men; however, metabolic risks largely explained gender differences in the educational gradient in coronary heart disease.