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: 5.23). 08/2005; 162(1):57-65. DOI: 10.1093/aje/kwi159
Source: PubMed


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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    • "Low income was defined as annual household income <$35,000, a threshold established to be meaningful for CHD outcomes in a prior REGARDS study[17], and low education was defined as less than a high school education. Previous studies have reported significantly higher CHD risk for those with less than a high school education compared with high school graduates[28]. These two variables were combined into four exposure groups: 1) high education and high income, 2) high education and low income, 3) low education and high income, and 4) low education and low income. "
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    ABSTRACT: Background We investigated the association between income-education groups and incident coronary heart disease (CHD) in a national prospective cohort study. Methods The REasons for Geographic And Racial Differences in Stroke study recruited 30,239 black and white community-dwelling adults between 2003 and 2007 and collected participant-reported and in-home physiologic variables at baseline, with expert adjudicated CHD endpoints during follow-up. Mutually exclusive income-education groups were: low income (annual household income <$35,000)/low education (< high school), low income/high education, high income/low education, and high income/high education. Cox models estimated hazard ratios (HR) for incident CHD for each exposure group, examining differences by age group. Results At baseline, 24,461 participants free of CHD experienced 809 incident CHD events through December 31, 2011 (median follow-up 6.0 years; interquartile range 4.5–7.3 years). Those with low income/low education had the highest incidence of CHD (10.1 [95 % CI 8.4–12.1]/1000 person-years). After full adjustment, those with low income/low education had higher risk of incident CHD (HR 1.42 [95 % CI: 1.14–1.76]) than those with high income/high education, but findings varied by age. Among those aged <65 years, compared with those reporting high income/high education, risk of incident CHD was significantly higher for those reporting low income/low education and low income/high education (adjusted HR 2.07 [95 % CI 1.42–3.01] and 1.69 [95 % CI 1.30–2.20], respectively). Those aged ≥65 years, risk of incident CHD was similar across income-education groups after full adjustment. Conclusion For younger individuals, low income, regardless of education, was associated with higher risk of CHD, but not observed for ≥65 years. Findings suggest that for younger participants, education attainment may not overcome the disadvantage conferred by low income in terms of CHD risk, whereas among those ≥65 years, the independent effects of income and education are less pronounced.
    Full-text · Article · Dec 2015 · BMC Public Health
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    • "For example, obesity was reported to be stigmatized more highly in women than men, and obesity may limit upward social mobility more so in women than men [98]. Furthermore, findings demonstrate that women with low education level have additional psychosocial risks (including high depressive symptoms, income under the poverty threshold, unemployment, and single parenting) than men with low education [56]. This greater psychosocial burden in low socioeconomic position women may be associated in turn with poorer metabolic outcomes, as suggested in other studies that showed a relation between depression and metabolic syndrome [99, 100] and income and metabolic syndrome [101, 102]. "
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    ABSTRACT: Background: Social and behavioral risk markers (e.g., physical activity, diet, smoking, and socioeconomic position) cluster; however, little is known whether clustering is associated with coronary heart disease (CHD) risk. Objectives were to determine if sociobehavioral clustering is associated with biological CHD risk factors (total cholesterol, HDL cholesterol, systolic blood pressure, body mass index, waist circumference, and diabetes) and whether associations are independent of individual clustering components. Methods: Participants included 4,305 males and 4,673 females aged ≥ 20 years from NHANES 2001-2004. Sociobehavioral Risk Marker Index (SRI) included a summary score of physical activity, fruit/vegetable consumption, smoking, and educational attainment. Regression analyses evaluated associations of SRI with aforementioned biological CHD risk factors. Receiver operator curve analyses assessed independent predictive ability of SRI. Results: Healthful clustering (SRI = 0) was associated with improved biological CHD risk factor levels in 5 of 6 risk factors in females and 2 of 6 risk factors in males. Adding SRI to models containing age, race, and individual SRI components did not improve C-statistics. Conclusions: Findings suggest that healthful sociobehavioral risk marker clustering is associated with favorable CHD risk factor levels, particularly in females. These findings should inform social ecological interventions that consider health impacts of addressing social and behavioral risk factors.
    Full-text · Article · Feb 2014
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    • "Women may experience a greater degree of discrimination in all spheres of life (e.g. labor market, pay, household work etc.), and women of low SES might have worse living conditions than low SES men [29]. Additionally, women of low SES are exposed to a range of stressors compared to either high SES women or low SES men. "
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    ABSTRACT: Background Individual socioeconomic status (SES) has been found to be associated with cardiovascular diseases in developed countries, but the association between individual SES and metabolic syndrome (MetS) is still unclear in China. The objective of this study was to investigate the association between individual SES and MetS in China. Methods A cross-sectional study of 10054 community residents was performed from May to August 2007 using multistage stratified random sampling. SES was assessed in terms of education, personal monthly income, and household monthly income. The association between SES and MetS was determined by logistic regression models. Results After the adjustments regarding age, marital status, smoking, drinking, physical activity, body mass index (BMI), and community type, odds ratios (ORs) for MetS of individuals with education level of 7~12 years and >12 years were 0.87 (95% confidence interval [CI]: 0.75 to 0.99) and 0.83 (95% CI: 0.62 to 0.91) respectively compared with those with education level of <7 years in women. Following the adjustments as above, ORs for MetS of individuals with household monthly income level of middle and higher were 0.94 (95% CI: 0.86 to 0.97), and 0.72 (95% CI: 0.65 to 0.88) respectively compared with those with lower household monthly income level in women. The association between SES and MetS was not significant in men. Conclusions Gender had an influence on the association between individual SES and MetS. Lower education and household monthly income level were associated with higher risk of MetS among community residents in women, while such association was not significant in men.
    Full-text · Article · Oct 2012 · BMC Public Health
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