Cardiovascular risk factors in relation to educational level in 36 000 men and women in the Netherlands

Hoeymans, Nancy; Smit, Henriëtte A.; Verkleij, Harry; Kromhout, Daan

doi:10.1093/oxfordjournals.eurheartj.a014903

Cited by 83 publications

(68 citation statements)

References 32 publications

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“…9 This was also the case in another survey, in a younger population in the same country. 16 The findings related to women are in keeping with previous reports in other countries: more women than men were in the lower occupational categories and health differences were more pronounced when educational level rather than occupational category is taken into an account. 17,18 Similarly, job strain has been observed to be a risk factor for high blood pressure in men, but not in women.…”

Section: Discussionsupporting

confidence: 89%

Socioeconomic Inequalities in Hypertension Prevalence and Care

et al. 2002

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Abstract-To analyze the health disparities relative to the prevalence of arterial hypertension and its therapeutic control in the active French population, in relation to occupational categories (OC), a population of 17 359 men and 12 267 women was assessed from January 1997 to April 1998. The initial phase was a cross-sectional analysis of a cohort study designed to assess the incidence of arterial hypertension in a French working population. Information was collected by the worksite physician during the annual examination. Blood pressure (BP) was measured using a validated automatic device. Among subjects with a BP Ն140/90 mm Hg, patients not treated with antihypertensive drugs were invited to have an additional BP measurement, 1 month later. Overall prevalence was 16.1% for men and 9.4% for women. Both prevalence and therapeutic control of high BP were related to OCs in this study. Prevalence of hypertension was higher and maintenance of therapeutic control lower among lower OCs. In contrast, awareness of high BP and the proportion of hypertensive subjects under current treatment were not related to OCs. Educational level and low OC were significantly related to prevalence of high BP after adjustment for obesity, excessive alcohol consumption, and sedentary lifestyle in women only. A poor BP control under treatment was related to high alcohol intake and low OC in men. In women only, however, low educational level was related to high prevalence of hypertension and poor BP control under antihypertensive treatment. Inequalities in hypertension prevalence persist, with prevalence being higher among lower OCs. Social disparities were not observed, however, in awareness of their condition among hypertensive subjects and among patients for receiving versus not receiving any treatment for hypertension. In contrast, BP control under antihypertensive treatment was lower among lower OCs. Key Words: hypertension, arterial Ⅲ blood pressure Ⅲ population Ⅲ obesity Ⅲ socioeconomic factors Ⅲ body mass index Ⅲ alcohol Ⅲ epidemiology A rterial hypertension is one of the important determinants of health inequalities of cardiovascular diseases, which have been observed to persist or increase in developed countries in the previous 20 years. 1,2 Higher prevalence of hypertension and poorer therapeutic control of hypertension care have been noted in populations in the low social classes. [3][4][5] Information regarding the continued presence and type of disparity (prevalence or therapeutic control) could provide guidance for the most efficient treatment activities for reducing the disparity. For example, differences in prevalence would stress the importance of primary prevention. Differences in therapeutic blood pressure control would emphasize the need for reinforcing secondary prevention. These questions are all the more important because insufficient therapeutic control of hypertension at the population level has been shown to be persistent. 6 The causality chain between socioeconomic factors and blood pressure is complex. Hypert...

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Section: Discussionsupporting

confidence: 89%

Socioeconomic Inequalities in Hypertension Prevalence and Care

et al. 2002

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“…In one study an inverse association was found and in two, no association was found Europe-outside UK: Inverse associations of SES with BP and hypertension have been reported in (Table 3). In the Kenyan Luo Migration study there was a positive correlation between years of edusome parts of Sweden 35-37 but not others, 38 in Norway, 39 Paris, 40 the Netherlands 41,42 and in Ireland. 43 cation and systolic and diastolic BP adjusted for age, 58 and in a Nigerian occupational cohort a direct In Finland the association among men was not present in 1972 but has emerged recently 4,44 and an association with hypertension prevalence was also found.…”

Section: Grade Occupation Ethnic Group Psycho-social Andmentioning

confidence: 92%

“…13 In the Health Survey for England with other variables. 19,28,30,34,39,42,46,49,51,57 The specific effect of alcohol adjustment was reported separ-(1994), obesity is considerably more prevalent in women of lower social class, although this is not ately in just one of these studies. Adjusting for alcohol alone approximately halved the SES gradient in true of males.…”

Section: Grade Occupation Ethnic Group Psycho-social Andmentioning

confidence: 95%

“…[11][12][13]15,17,18,25,27,28,30,34,36,39,42,49,57,70 In general the remaining ment for alcohol and other variables. 28,34,39,42 In INTERSALT adjusting for alcohol along with BMI, association between SES and BP is small and could simply be due to residual confounding as BMI is not smoking, sodium and potassium excretion halved the association between SES and BP in men so that a good measure of total body fat. Furthermore, BPs will appear spuriously high if too small a cuff has it was no longer statistically significant.…”

Section: Grade Occupation Ethnic Group Psycho-social Andmentioning

confidence: 99%

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Socio-economic status and blood pressure: an overview analysis

Colhoun

Hemingway²,

Poulter³

1998

J Hum Hypertens

347

269

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Background: Mortality rates from hypertension relatedThe finding of an SES gradient in BP, despite adjusting for treatment in some studies and the lack of consistent diseases such as coronary heart disease, hypertensive heart disease, stroke and end stage renal disease show SES differences in hypertension treatment rates, makes differential treatment an unlikely explanation for the SES an inverse association with socio-economic status (SES). gradient in BP. A substantial part of the SES gradient was accounted for by the SES gradient in body mass Objectives: To review the published literature in order to assess whether (i) there is an association between index. Alcohol consumption across SES groups accounted for part of the association in men though few SES and blood pressure (BP), and if so whether this is explained by (ii) SES differences in treatment rates, or studies examined this issue specifically. In contrast, in undeveloped or developing countries a direct associ-(iii) SES differences in established risk factors for hypertension, or (iv) psycho-social factors associated ation between SES and BP has often been found which may reflect a higher prevalence of obesity, and higher with SES. Method: A narrative systematic review of published artsalt and alcohol intakes among those of higher SES. The SES differences in BP were not detectable in most studicles identified from a MEDLINE search from 1966-1996 and manual searching of the retrieved articles' biblioies in children. There is little evidence that adverse psycho-social factors associated with low SES cause graphies. Results: Lower SES was associated with higher mean chronic elevations in BP. Conclusion: A major challenge in reducing the SES BPs in almost all studies in developed countries. This inverse gradient was both stronger and more consistgradient in BP is to understand and prevent the SES differences in obesity, which are particularly large in ently found in women than in men. The magnitude of the association varied but generally was quite small, women. Future research should be directed to this question. with age adjusted mean systolic BP differences of about 2-3 mm Hg between the highest and lowest SES groups.

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“…A large number of studies have documented a powerful association between CVD and socio-economic status (SES), whether measured by education, income or occupation [11][12][13][14][15][16][17][18]. However, only a few studies have reported on the relative importance of both biomedical and psycho-social factors as predictors of acute myocardial infarction (AMI) in the population.…”

Section: Introductionmentioning

confidence: 99%

Perceived health modifies the effect of biomedical risk factors in the prediction of acute myocardial infarction. An incident case–control study from northern Sweden

Weinehall¹,

Johnson²,

(Eva)³

et al. 1998

Journal of Internal Medicine

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Abstract. Weinehall L, Johnson O, Jansson J-H, Boman K, Huhtasaari F, Hallmans G, Dahlen GH, Wall S (Umeå University, Skellefteå County Hospital and Luleå-Boden Hospital, Umeå, Sweden). Perceived health modifies the effect of biomedical risk factors in the prediction of acute myocardial infarction. An incident case-control study from northern Sweden. J Intern Med 1998; 243: 99-107.Objectives. To assess the importance of biomedical risk factors, social factors and self-reported health in the prediction of the first event of acute myocardial infarction (AMI) in an apparently healthy middleaged population.Design. An incident case-control study. Setting. The study was nested within the Västerbotten Intervention Program and the Northern Sweden MONICA cohorts. Subjects. The study consists of 78 AMI cases with two randomly selected controls per case from the same study cohorts. Results. Significant odds ratios were found for history of diabetes, daily smoking, cholesterol, body-mass index, hypertension, lower education and perceived ill health. In multivariate logistic regression smoking, hypertension and cholesterol of Ն7.8 mmol L Ϫ1 remained significant. An interaction was observed between number of biomedical risk factors and perceived health. Conclusions. Smoking, hypertension and hypercholesterolaemia explain a major share of incident AMI events in a Swedish middle-aged population. The study further illustrates that perceived ill health negatively modifies the impact of these risk factors.

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Cardiovascular risk factors in relation to educational level in 36 000 men and women in the Netherlands

Cited by 83 publications

References 32 publications

Socioeconomic Inequalities in Hypertension Prevalence and Care

Socioeconomic Inequalities in Hypertension Prevalence and Care

Socio-economic status and blood pressure: an overview analysis

Perceived health modifies the effect of biomedical risk factors in the prediction of acute myocardial infarction. An incident case–control study from northern Sweden

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