Sex differences in the relationship between socioeconomic status and cardiovascular disease: a systematic review and meta-analysis

Backholer, Kathryn; Peters, Sanne A.E.; Bots, Sophie H.; Peeters, Anna; Huxley, Rachel R.; Woodward, Mark

doi:10.1136/jech-2016-207890

Cited by 160 publications

(146 citation statements)

References 38 publications

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“…We were not able to corroborate the results of a recent review that revealed an overall stronger relationship between SES and cardiovascular outcomes among women compared with men 7. In the present study, the association was positive but weaker (not significant) among women compared with men.…”

Section: Discussioncontrasting

confidence: 99%

“…Income and education are often used interchangeably, although they can tap into different proximate determinants of health 5 6. The relationship between SES and cardiovascular outcomes has also been reported to vary according to sex 7. Compared with cardiovascular disease in general, only a few studies have focused on the association between SES and survival after OHCA.…”

Section: Introductionmentioning

confidence: 99%

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Survival after out-of-hospital cardiac arrest is associated with area-level socioeconomic status

Jonsson

Härkönen

Ljungman

et al. 2018

Heart

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ObjectiveOut-of-hospital cardiac arrest (OHCA) is a major cause of death in the Western world. In this study we aimed to investigate the relationship between area-level socioeconomic status (SES) and 30-day survival after OHCA. We hypothesised that high SES at an area level is associated with an improved chance of 30-day survival.MethodsPatients with OHCA in Stockholm County between 1 January 2006 and 31 December 2015 were analysed retrospectively. To quantify area-level SES, we linked the patient’s home address to 250 × 250/1000 × 1000 meter grids with aggregated information about income and education. We constructed multivariable logistic regression models in which area-level SES measures were adjusted for age, sex, emergency medical services response time, witnessed status, initial rhythm, aetiology, location and year of cardiac arrest.ResultsWe included 7431 OHCAs. There was significantly greater 30-day survival (p=0.003) in areas with a high proportion of university-educated people. No statistically significant association was seen between median disposable income and 30-day survival. The adjusted OR for 30-day survival among patients in the highest educational quintile was 1.70 (95% CI 1.15 to 2.51) compared with patients in the lowest educational quintile. We found no significant interaction for sex. Positive trend with increasing area-level education was seen in both men and women but the trend was only statistically significant among men (p=0.012)ConclusionsSurvival to 30 days after OHCA is positively associated with the average educational level of the residential area. Area-level income does not independently predict 30-day survival after OHCA.

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Section: Discussioncontrasting

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Survival after out-of-hospital cardiac arrest is associated with area-level socioeconomic status

Jonsson

Härkönen

Ljungman

et al. 2018

Heart

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“…Comorbid health conditions in conjunction with depressive symptoms were significantly associated with perceived stress. Psychosocial stressors hypothesized to increase CVD risk in women, particularly middle aged and older women include low socioeconomic status, inadequate social support and financial insecurity (21–23). …”

Section: Introductionmentioning

confidence: 99%

Cumulative psychological stress and cardiovascular disease risk in middle aged and older women: Rationale, design, and baseline characteristics

Albert

Durazo

Slopen

et al. 2017

American Heart Journal

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Although a growing body of evidence indicates strong links between psychological stress (stress) and untoward cardiovascular disease (CVD) outcomes, comprehensive examination of these effects remains lacking. The “Cumulative Psychological Stress and Cardiovascular Disease Risk in Middle Aged and Older Women” study is embedded within the landmark Women’s Health Study (WHS) follow-up cohort and seeks to evaluate the individual and joint effects of stressors (cumulative stress) on incident CVD risk, including myocardial infarction, stroke, coronary revascularization and CVD death. GWAS data will be used for exploratory analyses to identify any genes associated with stress and CVD. This study prospectively follows 25,335 women (mean age 72.2 ± 6.04 years) without CVD who returned a short mailed stress questionnaire at baseline and 3 years of follow-up inquiring about their experiences with stress including perceived stress, work stress, work-family spillover, financial stress, traumatic and major life events, discrimination and neighborhood environment/stressors. Other domains ascertained were sleep, anger, cynical hostility, depression, anxiety, social support, intimate partner relations, volunteer and social activities. Higher levels of cumulative stress were associated with younger age and black race/ethnicity, divorced or separated marital status, increased prevalence of obesity, smoking, diabetes, depression and anxiety (p<0.001 for each). Findings from this study will provide clinically important, new information about associations of cumulative stress, environmental, lifestyle and genetic factors with incident CVD risk in aging women.

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“…The higher response rate of males in the current study, secondary to the larger proportion of males invited, may reflect public opinion that CVD is a predominantly male disease despite also being the leading cause of death in females [5, 40]. Previous studies assessing participation in trials of those who already have CVD [41, 42], and in a survey regarding cardiovascular risk factors [43], also found lower response in females.…”

Section: Discussionmentioning

confidence: 62%

“…Modifiable risk factors for CVD include tobacco use, physical inactivity, obesity and raised low-density lipoprotein (LDL) cholesterol [2–4]. Those most at risk are older males, of south Asian ethnic background, with lower educational attainment and lower socioeconomic status [5, 6]. Lifestyle intervention trials for primary prevention of CVD are a research priority [7–9], but previous trials have reported low participation rates [10, 11].…”

Section: Introductionmentioning

confidence: 99%

Response bias to a randomised controlled trial of a lifestyle intervention in people at high risk of cardiovascular disease: a cross-sectional analysis

et al. 2018

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BackgroundResearch evaluating lifestyle interventions for prevention of cardiovascular disease (CVD) may not reach those most at risk. We compared the response rate to a randomised controlled trial (RCT) of a lifestyle intervention by CVD risk, ethnicity and level of deprivation.MethodsPrimary care patients with a QRisk2 score ≥ 20% were invited to participate in a RCT of an intensive lifestyle intervention versus usual care. This cross-sectional analysis compares anonymised data of responders and non-responders with multiple logistic regression, using adjusted odds ratios (AORs) for QRisk2 score, ethnicity, Index of Multiple Deprivation (IMD 2010) quintile, age and sex.ResultsFrom 60 general practices, 8902 patients were invited and 1489 responded. The mean age was 67.3 years and 21.0% were female. Of all patients invited, 69.9% were of white ethnic background, 13.9% ethnic minority backgrounds and 16.2% had no ethnicity data recorded in their medical records. Likelihood of response decreased as QRisk2 score increased (AOR 0.82 per 5 percentage points, 95% CI 0.77–0.88). Black African or Caribbean patients (AOR 0.67; 95% CI 0.45–0.98) and those with missing ethnicity data (AOR 0.55; 95% CI 0.46–0.66) were less likely to respond compared to participants of white ethnicity, but there was no difference in the response rates between south Asian and white ethnicity (AOR 1.08; 95% CI 0.84–1.38). Patients residing in the fourth (AOR 0.70; 95% CI 0.56–0.87) and fifth (AOR 0.52; 95% CI 0.40–0.68) most deprived IMD quintile were less likely to respond compared to the least deprived quintile.ConclusionsEvaluations of interventions intended for those at high risk of CVD may fail to reach those at highest risk. Hard to reach patient groups may require different recruitment strategies to maximise participation in future trials. Improvements in primary care ethnicity data recording is required to aid understanding of how successfully study samples represent the target population.Trial registrationISRCTN, ISRCTN84864870. Registered 15 May 2012, 10.1186/ISRCTN84864870.Electronic supplementary materialThe online version of this article (10.1186/s12889-018-5939-y) contains supplementary material, which is available to authorized users.

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Sex differences in the relationship between socioeconomic status and cardiovascular disease: a systematic review and meta-analysis

Abstract: Reduction of socioeconomic inequalities in CHD and CVD outcomes might require different approaches for men and women.

Cited by 160 publications

References 38 publications

Survival after out-of-hospital cardiac arrest is associated with area-level socioeconomic status

Survival after out-of-hospital cardiac arrest is associated with area-level socioeconomic status

Cumulative psychological stress and cardiovascular disease risk in middle aged and older women: Rationale, design, and baseline characteristics

Response bias to a randomised controlled trial of a lifestyle intervention in people at high risk of cardiovascular disease: a cross-sectional analysis

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