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Unfavourable life-course social gradient of coronary heart disease within Spain: a low-incidence welfare-state country
Authors:Lluís Cirera  José María Huerta  María Dolores Chirlaque  Genevieve Buckland  Nerea Larrañaga  María José Sánchez  Antonio Agudo  Pilar Amiano  José Ramón Quirós  Eva Ardanaz  Larraitz Arriola  Esther Molina  Miren Dorronsoro  Aurelio Barricarte  Carlos A González  Concepción Moreno-Iribas  Carmen Navarro
Institution:1. Department of Epidemiology, Regional Health Council, Ronda de Levante, 11, 30008, Murcia, Spain
2. CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
3. Unit of Nutrition, Environment and Cancer, Cancer Epidemiology Research Program, Catalan Institute of Oncology (ICO-IDIBELL), Barcelona, Spain
4. Public Health Department of Gipuzkoa, Basque Government, San Sebastián, Spain
5. Andalusian School of Public Health, Granada, Spain
6. Public Health and Health Planning Directorate, Oviedo, Spain
7. Public Health Institute of Navarra, Pamplona, Spain
8. Department of Preventive Medicine, Universidad Autónoma de Barcelona, Barcelona, Spain
9. Department of Public Health and Preventive Medicine, University of Murcia, Murcia, Spain
Abstract:

Objective

Social position has yet to be established as a risk factor of coronary heart disease (CHD). Our aim was to investigate an individual life-course social position gradient link with CHD incidence in the EPIC-Spain cohort.

Methods

41,066 participants, mostly 30–65 years old, and free of cardiovascular disease at baseline (1992–1996) were followed up for a mean of 10.4 years. A combined score of paternal occupation in childhood and own adult education was used to assess individual life-course risk accumulation. Hazard ratios of CHD were estimated using Cox models, stratifying by centre, and age, and adjusting for cardiovascular risk factors.

Results

583 participants (80 % men) developed a definite CHD event. Paternal occupational class IV was associated with CHD in all models in men. The educational gradient remained significant after adjusting for diet and physical activity (p = 0.01). All adjusted risk of incident CHD rose by 23 % (95 % CI 6–42 %) per category increase of life-course social position score in men. No significant associations were found in women.

Conclusions

Individual life-course social position gradient was adversely related to incident CHD in Spanish men.
Keywords:
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