Socioeconomic inequalities in cardiovascular disease mortality. An international study

Mackenbach, Johan P.; Cavelaars, Adriënne E J M; Kunst, Anton E.; Groenhof, Feikje

doi:10.1053/euhj.1999.1990

Cited by 317 publications

(228 citation statements)

References 41 publications

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“…The educational inequalities observed in gestational hypertension may represent an early manifestation of the socioeconomic differences in morbidity and mortality from cardiovascular disease in women. 13 Strategies to reduce educational inequalities in gestational hypertension should be aimed primarily at reducing the burden of overweight and obesity in lower socioeconomic groups.…”

Section: Implications and Conclusionmentioning

confidence: 99%

“…2,9 In some studies, smoking during pregnancy has been associated with a lower risk of gestational hypertension. 10,11 Because low socioeconomic status is a marked risk factor for obesity, metabolic syndrome, hypertension and cardiovascular disease, [12][13][14] socioeconomic status is also likely to be associated with gestational hypertension. As early as the 1950s, researchers described associations between measures of socioeconomic status and hypertension during pregnancy.…”

Section: Introductionmentioning

confidence: 99%

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Maternal educational level and risk of gestational hypertension: the Generation R Study

et al. 2008

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We examined whether maternal educational level as an indicator of socioeconomic status is associated with gestational hypertension. We also examined the extent to which the effect of education is mediated by maternal substance use (that is smoking, alcohol consumption and illegal drug use), pre-existing diabetes, anthropometrics (that is height and body mass index (BMI)) and blood pressure at enrolment. This was studied in 3262 Dutch pregnant women participating in the Generation R Study, a population-based cohort study. Level of maternal education was established by questionnaire at enrolment, and categorized into high, mid-high, mid-low and low. Diagnosis of gestational hypertension was retrieved from medical records using standard criteria. Odds ratios (OR) of gestational hypertension for educational levels were calculated, adjusted for potential confounders and additionally adjusted for potential mediators. Adjusted for age and gravidity, women with mid-low (OR: 1.52; 95% CI: 1.02, 2.27) and low education (OR: 1.30; 95% CI: 0.80, 2.12) had a higher risk of gestational hypertension than women with high education. Additional adjustment for substance use, pre-existing diabetes, anthropometrics and blood pressure at enrolment attenuated these ORs to 1.09 (95% CI: 0.70, 1.69) and 0.89 (95% CI: 0.50, 1.58), respectively. These attenuations were largely due to the effects of BMI and blood pressure at enrolment. Women with relatively low educational levels have a higher risk of gestational hypertension, which is largely due to higher BMI and blood pressure levels from early pregnancy. The higher risk of gestational hypertension in these women is probably caused by pre-existing hypertensive tendencies that manifested themselves during pregnancy.

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Section: Implications and Conclusionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Maternal educational level and risk of gestational hypertension: the Generation R Study

et al. 2008

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“…Thus, lower socioeconomic status and general disadvantage are associated 42 with higher levels of CVD (Kanjilal et al, 2006;Clark et al, 2009) or increased exposure to CVD risk 43 factors, such as smoking or low levels of physical activity (Gupta et al, 2012). A review of CVD 44 mortality in the US and 11 western European countries found that risk increased with decreasing 45 occupational class and lower levels of educational attainment, as well as factors such as smoking uptake 46 and alcohol consumption (Mackenbach et al, 2000). 47…”

mentioning

confidence: 99%

To move or not to move? Exploring the relationship between residential mobility, risk of cardiovascular disease and ethnicity in New Zealand

Darlington‐Pollock

Norman

Lee

et al. 2016

Social Science & Medicine

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3Residential mobility can have negative impacts on health, with some studies finding that residential 4 mobility can contribute to widening health gradients in the population. However, ethnically 5 differentiated experiences of residential mobility and the relationship with health are neglected in the 6 literature. To examine the relationship between residential mobility, risk of cardiovascular disease 7 (CVD) and ethnicity, we constructed a cohort of 2,077,470 participants aged 30+ resident in New 8Zealand using encrypted National Health Index (eNHI) numbers linked to individual level routinely 9 recorded data. Using binary logistic regression, we model the risk of CVD for the population stratified 10 by ethnic group according to mover status, baseline deprivation and transitions between deprivation 11 statuses. We show that the relationship between residential mobility and CVD varies between ethnic 12 groups and is strongly influenced by the inter-relationship between residential mobility and deprivation 13 mobility. Whilst residential mobility is an important determinant of CVD, much of the variation 14 between ethnic groups is explained by contrasting deprivation experiences. To reduce inequalities in 15 CVD within New Zealand, policies must focus on residentially mobile M ori, Pacific and South Asian 16 populations who already have a heightened risk of CVD living in more deprived areas. 17 Key words 18New Zealand; CVD; Ethnicity; Inequalities; Mobility; Migration; Deprivation; Record Linkage 19 Introduction 20Cardiovascular disease (CVD) and associated morbidities are among the leading causes of global deaths 21 (World Health Organisation, 2014). In New Zealand (NZ) there are marked variations between ethnic 22 groups in the prevalence of CVD (Blakely et al., 2004;Riddell et al., 2007;Jatrana and Blakely, 2008; 23 Kerr et al., 2008; Grey et al., 2010; Mehta et al., 2011; Perumal et al., 2012; Ker et al., 2015; Mehta et 24 al., 2014;Exeter et al., 2015;Wells et al., 2015). Between 1980 and 1999, while all ethnic groups 25 experienced reductions in CVD mortality, M ori and Pacific populations saw markedly smaller 26 2 reductions than non-M ori non-Pacific (nMnP) groups (Blakely et al., 2005). By 2007, these disparities 27 had not disappeared: M ori males and females almost invariably had the highest age-specific prevalence 28 of CVD across all age groups, as well as the highest age-standardised prevalence of CVD (7.41 29 compared to NZ's total population at 4.77, and 5.68 for the Pacific group) (Cheuk Chan et al., 2008). 30Stark differences in risk of CVD and CVD mortality between ethnic groups are not restricted to NZ. 31For example, rates of ischaemic heart disease amongst South Asian males are 30 to 40% higher than 32 rates amongst the UK's general population (Department of Health, 2001). In the US in 2013, Black 33 groups had 30% higher mortality from CVD than Whites, increasing to 113% higher CVD mortality 34 than Asians and Pacific Islanders (Singh et al., 2015). 35Exploring why ethnic in...

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“…Recent migration of people from West Africa to western and southern European Union (EU) countries offers the opportunity to examine the influence of different social environments on cardiovascular disease in Africans. Cardiovascular health is strongly patterned by socio-economic factors in western, developed countries [6], but the extent to which differences in the social distribution of risk contribute to ethnic disparities is still debated.…”

Section: Introductionmentioning

confidence: 99%

All cause and cardiovascular mortality in African migrants living in Portugal: evidence of large social inequalities

Harding

Teyhan

Rosato

et al. 2008

European Journal of Cardiovascular Prevention & Rehabilitat

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Aim To examine cardiovascular mortality of African migrants in Portugal in relation to socio-economic status. Method Data from death registrations, 1998-2002, and the 2001 Census were used to derive standardized death rates by country of birth and occupational class/marital status. Results Compared with native Portuguese, African migrants had higher mortality for all causes, circulatory disease, coronary heart disease and stroke. There was considerable heterogeneity among Africans with Cape Verdeans having higher mortality than Angolans or Mozambiquans. Class differences in mortality were generally greater for African than for Portuguese men. Although the coronary heart disease mortality rate among Africans in a manual class was twice that of those in a nonmanual class, there was no class difference for Portuguese men. Marital status was associated with 2-3-fold differences in mortality rates in both Africans and Portuguese. A larger proportion of Africans were not married which accounted for some of the excess mortality. Conclusion Adverse cardiovascular mortality experience of African migrants is associated with socio-environmental factors. Investigating how best to achieve risk reduction in Africans should be a public health priority in

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Socioeconomic inequalities in cardiovascular disease mortality. An international study

Cited by 317 publications

References 41 publications

Maternal educational level and risk of gestational hypertension: the Generation R Study

Maternal educational level and risk of gestational hypertension: the Generation R Study

To move or not to move? Exploring the relationship between residential mobility, risk of cardiovascular disease and ethnicity in New Zealand

All cause and cardiovascular mortality in African migrants living in Portugal: evidence of large social inequalities

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