Income-related inequalities in cardiovascular disease from mid-life to old age in a Northern Swedish cohort: A decomposition analysis. (January 2016)

• Record Type: Journal Article
• Authors: Mosquera, Paola A.; San Sebastian, Miguel; Waenerlund, Anna-Karin; Ivarsson, Anneli; Weinehall, Lars; Gustafsson, Per E.
• Is Part Of: Social science & medicine. Volume 149(2016)
• Page Start: 135
• Page End: 144
• Publication Date: 2016-01
• Subjects: Cardiovascular disease -- Income inequality -- Concentration index -- Decomposition -- Life course -- Cohort design -- Sweden; Social medicine -- Periodicals; Medical anthropology -- Periodicals; Public health -- Periodicals; Psychology -- Periodicals; Medicine -- Periodicals; Medicine -- Periodicals; Médecine sociale -- Périodiques; Anthropologie médicale -- Périodiques; Santé publique -- Périodiques; Psychologie -- Périodiques; Médecine -- Périodiques; Electronic journals; 362.105
• DOI: 10.1016/j.socscimed.2015.12.017
• Languages: English
• ISSNs: 0277-9536

Abstract

Abstract: While the social determinants of cardiovascular disease (CVD) are fairly well-known, the determinants of socioeconomic inequalities in CVD are scarcely studied and almost completely based on cross-sectional designs in which the changing circumstances across the life course are not taken into account. The present study seeks to incorporate a life course approach to the social determinants of socioeconomic inequalities in CVD. The specific aims were to 1) examine how income-related inequalities in CVD change over two decades of the mid-late life course, and 2) identify the key social determinants of the inequalities at each time period. The cohort (N = 44, 039) comprised all individuals aged 40–60 years in 1990 who during 1990–2010 were enrolled in the county-wide preventive effort :"Västerbotten Intervention Program" (VIP). The cohort was followed over these two decades by Swedish population register data linked within the Umeå SIMSAM Lab micro data infrastructure. First-time hospitalization for CVD and mean earned income were used to calculate the concentration index (C) during four periods of 5–6 years. The C for each period was decomposed by sociodemographic factors, using Wagstaff-type decomposition analysis. Results suggest that inequalities in CVD increase gradually from mid-life to old age; from initially non-significant to particularly marked among the elderly. The decomposition showed that, from middle to old age, educational and employment inequalities underwent a transition from initially dominant to a moderate role in explaining the health inequalities, coupled with an increasing importance of age and a stable role of income. In conclusion, the study illustrates the need for incorporating a dynamic life course perspective into research, policy and practice concerned with equity in health. Highlights: Income inequalities in CVD increased gradually from mid-life to old age. The key factors explaining CVD inequalities underwent life-course transitions. Labour market factors successively gave way to age as a central determinant. Income inequalities remained a persistently key determinant across aging. A joint equity lens and life course approach may be needed to tackle inequities.