The decline in ischemic heart disease mortality: prospective evidence from the Alameda County Study.
ABSTRACT The contribution of secular changes in the distribution of ischemic heart disease risk factors and medical care utilization to the decline in ischemic heart disease mortality was investigated using data collected on the nine-year ischemic heart disease mortality experience of two cohorts selected to be representative of Alameda County, California, in 1965 and 1974. With adjustment for age, sex, race, and baseline ischemic heart disease conditions and symptoms, there was a 45% decline in the nine-year odds of ischemic heart disease mortality between the two cohorts (1965/1974, odds ratio (OR) = 1.82, p = 0.0001). Further adjustment for cohort differences in the following ischemic heart disease risk factors did not explain the decline: smoking status, leisure-time physical activity, self-assessed physical activity, alcohol consumption, body mass index, or social network participation; neither did adjustment for measures of education, utilization of preventive medical care, availability of a regular physician or clinic, health insurance coverage, number of physician visits during the last 12 months, or occupation. There was no change in the estimated ischemic heart disease decline when all adjustment variables were included in a logistic model (1965/1974, OR = 1.81, p = 0.0002). These variables do not appear to explain the large decline in nine-year ischemic heart disease mortality between these two cohorts.
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ABSTRACT: It is perhaps ironic that an epidemiologist who has been working in the field of social epidemiology for over a quarter of a century, and who directs a center focused on social epidemiology, should coin a title suggesting that there is something "wrong" with social epidemiology. Perhaps it is even inopportune, as it could provide ammunition to those who believe that the practice of social epidemiology is misguided, unscientific, ideological, or too overreaching (1- 3). However, this title was chosen purposely with the hope that identifying some of the critical intellectual, methodolog- ical, and empirical lacunae and challenges in social epidemi- ology might promote continuing development of a social epidemiology that is both scientifically enlightening and useful, productive, and contributory to the public's health. Indeed, the hope is that the "social" in epidemiology will become so integral a part of epidemiology that the term can be dropped altogether. To assert that all epidemiology is social is not an attempt at intellectual hegemony—that the problems of disease and the distribution of disease in popu- lations over time and space can be understood from a social perspective only or that such information is in some sense more fundamental that other types of information about disease determinants. In the same way that our under- standing of the etiology of chronic and infectious diseases benefits from knowledge of the pathobiologic processes involved in such diseases, increased understanding of social factors, broadly considered, may shed light on processes every bit as integral to our understanding of the etiology of those diseases. There is no question that social epidemiology has come of age and that the term "social epidemiology" is being increas- ingly used to describe examination of the role of a broad array of social factors in the development and progression of many important health problems, and in the natural history of the risk factors for those diseases and conditions. While not all may agree with Geoffrey Rose's assertion that "the primary determinants of disease are mainly economic and social, and therefore its remedies must also be economic and social" (4, p. 129), there is no question that there has been enormous growth in the study of these economic and social forces on health and disease. Figure 1, which plots growth since 1966 in use of the term "social epidemiology" in article titles, abstracts, and keywords, graphically illustrates this increased interest. Beginning in the early 1980s, growth of such publications increased rapidly, well fit by an exponen- tial curve. In fact, this figure is likely to dramatically under- represent the growth of social epidemiologists' interest in the matter; a similar exponential growth pattern has been seen when studies examining socioeconomic position and health (5) and social capital and social relationships (6) were simi- larly totaled.Epidemiologic Reviews 02/2004; 26:124-35. · 9.27 Impact Factor
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ABSTRACT: We examined the ability of adult Canadians to recall cardiovascular disease risk factors to determine the associations between their ability to recall risk factors for cardiovascular disease and their socioeconomic status. This study used the database assembled by the Canadian Heart Health Surveys Research Group between 1986 and 1992--a stratified representative sample comprising 23,129 Canadian residents aged 18 to 74. Nurses administered a standard questionnaire asking respondents to list the major risk factors for cardiovascular disease: fat in food, smoking, lack of exercise, excess weight, elevated blood cholesterol and high blood pressure. Six logistic regressions examined the multivariate associations between ability to recall each risk factor with education, income adequacy, occupation, sex, age, marital status and province of residence. More people knew about the behaviour-related risk factors for cardiovascular disease than about the physiologic risk factors: 60% recalled fat in food, 52% smoking and 41% lack of exercise, but only 32% identified weight, 27% cholesterol and 22% high blood pressure. Education was the socioeconomic status indicator most strongly and consistently associated with the ability to recall risk factors for cardiovascular disease. The odds ratios of reporting an association of the risks between people with elementary education and those with university degrees varied between 0.16 (95% confidence interval 0.12 to 0.22) for lack of exercise to 0.55 (95% confidence interval 0.39 to 0.77) for smoking. People in categories at greater risk of cardiovascular disease, such as those aged 65 or more or those with only elementary education, are less able to recall important cardiovascular disease risk factors.Canadian Medical Association Journal 02/2000; 162(9 Suppl):S5-11. · 6.47 Impact Factor
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ABSTRACT: This study was designed to describe the distribution of risk factors for cardiovascular disease by socioeconomic status in adult men and women across Canada using the Canadian Heart Health Surveys Database. The data were derived from provincial cross-sectional surveys done between 1986 and 1992. Data were obtained through a home interview and a clinic visit using a probability sample of 29,855 men and women aged 18-74 years of whom 23,129 (77%) agreed to participate. The following risk factors for cardiovascular disease were considered: elevated total plasma cholesterol (greater than 5.2 mmol/L), regular current cigarette smoking (one or more daily), elevated diastolic or systolic blood pressure (140/90 mm Hg), overweight (body mass index and lack of leisure-time physical activity [less than once a week in the last month]). Education and income adequacy were used as measures of socioeconomic status and mother tongue as a measure of cultural affiliation. For most of the risk factors examined, the prevalence of the risk factors was inversely related to socioeconomic status, but the relationship was stronger and more consistent for education than for income. The inverse relationship between socioeconomic status and the prevalence of the risk factors was particularly strong for smoking and overweight, where a gradient was observed: 46% (standard error [SE] 1.4) of men and 42% (SE 4.3) of women who had not completed secondary school were regular smokers, but only 12% (SE 1.0) of men and 13% (SE 0.9) of women with a university degree were regular smokers. Thirty-nine percent (SE 1.4) of men and 19% (SE 3.8) of women who had not completed secondary school were overweight, compared with 26% (SE 2.6) of male and 19% of female university graduates. The prevalence of leisure-time physical inactivity and elevated cholesterol was highest in both men and women in the lowest socioeconomic category, particularly by level of education. The differences in the prevalence of risk factors for cardiovascular disease between socioeconomic groups are still important in Canada and should be considered in planning programs to reduce the morbidity and mortality from cardiovascular disease.Canadian Medical Association Journal 02/2000; 162(9 Suppl):S13-24. · 6.47 Impact Factor