Educational class inequalities in the incidence of coronary heart disease in Europe. Issue 12 (5th February 2016)

• Record Type: Journal Article
• Authors: Veronesi, Giovanni; Ferrario, Marco M; Kuulasmaa, Kari; Bobak, Martin; Chambless, Lloyd E; Salomaa, Veikko; Soderberg, Stefan; Pajak, Andrzej; Jørgensen, Torben; Amouyel, Philippe; Arveiler, Dominique; Drygas, Wojciech; Ferrieres, Jean; Giampaoli, Simona; Kee, Frank; Iacoviello, Licia; Malyutina, Sofia; Peters, Annette; Tamosiunas, Abdonas; Tunstall-Pedoe, Hugh; Cesana, Giancarlo
• Is Part Of: Heart. Volume 102:Issue 12(2016)
• Page Start: 958
• Page End: 965
• Publication Date: 2016-02-05
• Subjects: Heart -- Diseases -- Treatment -- Periodicals; Cardiology -- Periodicals; 616.12
• DOI: 10.1136/heartjnl-2015-308909
• Languages: English
• ISSNs: 1355-6037

Abstract

Abstract : Objective: To estimate the burden of social inequalities in coronary heart disease (CHD) and to identify their major determinants in 15 European populations. Methods: The MORGAM (MOnica Risk, Genetics, Archiving and Monograph) study comprised 49 cohorts of middle-aged European adults free of CHD (110 928 individuals) recruited mostly in the mid-1980s and 1990s, with comparable assessment of baseline risk and follow-up procedures. We derived three educational classes accounting for birth cohorts and used regression-based inequality measures of absolute differences in CHD rates and HRs (ie, Relative Index of Inequality, RII) for the least versus the most educated individuals. Results: N=6522 first CHD events occurred during a median follow-up of 12 years. Educational class inequalities accounted for 343 and 170 additional CHD events per 100 000 person-years in the least educated men and women compared with the most educated, respectively. These figures corresponded to 48% and 71% of the average event rates in each gender group. Inequalities in CHD mortality were mainly driven by incidence in the Nordic countries, Scotland and Lithuania, and by 28-day case-fatality in the remaining central/South European populations. The pooled RIIs were 1.6 (95% CI 1.4 to 1.8) in men and 2.0 (1.7 to 2.4) in women, consistently across population. Risk factors accounted for a third of inequalities in CHD incidence; smoking was the major mediator in men, and High-Density-Lipoprotein (HDL) cholesterol in women. Conclusions: Social inequalities in CHD are still widespread in Europe. Since the major determinants of inequalities followed geographical and gender-specific patterns, European-level interventions should be tailored across different European regions.