Is the association between socioeconomic position and coronary heart disease stronger in women than in men?

Department of Society, Human Development, and Health, Harvard School of Public Health, Boston, MA 02215, USA .
American Journal of Epidemiology (Impact Factor: 4.98). 08/2005; 162(1):57-65. DOI: 10.1093/aje/kwi159
Source: PubMed

ABSTRACT The association between socioeconomic position and health is generally believed to be weaker among women than men. However, gender differences in the relation between socioeconomic position and coronary heart disease have not been evaluated in a representative sample of the US population. The authors examined this association in the First National Health and Nutrition Examination Survey (1971-1993), a longitudinal, representative study of the US population (n = 6,913). Information on educational attainment, household income, and covariates was derived from the baseline interview, and that on incident coronary heart disease was obtained from hospital records/death certificates over 22 years of follow-up. Cox's proportional hazards models showed that education and income were inversely associated with incident coronary heart disease in age-only and multivariate models. Risk associated with education varied by gender (p = 0.01), with less than high school education associated with stronger risk of coronary heart disease in women (relative risk = 2.15, 95% confidence interval: 1.46, 3.17) than in men (relative risk = 1.58, 95% confidence interval: 1.18, 2.12) in age-adjusted models. Low education was associated with greater social and psychological risks for women than men; however, metabolic risks largely explained gender differences in the educational gradient in coronary heart disease.

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    ABSTRACT: Background-No previous studies have examined the interplay among socioeconomic status, sex, and race with the risk of atrial fibrillation (AF). Methods and Results-We prospectively followed 14 352 persons (25% black, 75% white, 55% women, mean age 54 years) who were free of AF and participating in the Atherosclerosis Risk in Communities (ARIC) study. Socioeconomic status was assessed at baseline (1987-1989) through educational level and total family income. Incident AF through 2009 was ascertained from electrocardiograms, hospitalizations, and death certificates. Cox regression was used to estimate hazard ratios and 95% CIs of AF for education and family income. Interactions were tested between socioeconomic status and age, race, or sex. Over a median follow-up of 20.6 years, 1794 AF cases occurred. Lower family income was associated with higher AF risk (hazard ratio 1.45, 95% CI 1.27 to 1.67 in those with income less than $25 000 per year compared with those with $50 000 or more per year). The association between education and AF risk varied by sex (P=0.01), with the lowest education group associated with higher AF risk in women (hazard ratio 1.88, 95% CI 1.55 to 2.28) but not in men (hazard ratio 1.15, 95% CI 0.97 to 1.36) compared with the highest education group. Adjustment for cardiovascular risk factors attenuated the associations. There were no interactions with race or age. Blacks had lower AF risk than whites in all income and education groups. Conclusions-Lower family income was associated with a higher AF risk overall, whereas the impact of education on AF risk was present only in women. Differences in socioeconomic status do not explain the lower risk of AF in blacks compared with whites.
    Journal of the American Heart Association 06/2014; 3(4). DOI:10.1161/JAHA.114.001159 · 2.88 Impact Factor
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    ABSTRACT: This study investigates how unemployment and income influence the length of time an individual remains in good health. This is a complex relationship since unemployment or low income deteriorates health but poor health can become a barrier to obtaining higher income or gaining re-employment. Data are from the British Household Panel Survey, using two measures of physical health: an index of mobility problems and a measure of self-assessed health. The results show that unemployment, low income and poor education adversely affect the time that people remain in good health. These results have important implications for public policy, particularly in an age of austerity when social protection mechanisms are under threat. In fact, the results suggest that to improve health and reduce health inequality, more investment needs to be directed at policies that enhance labour force participation, improve education and reduce income inequality.
    Review of Social Economy 01/2015; 73(1). DOI:10.1080/00346764.2014.986969
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