Social class and coronary heart disease.

G Rose, M G Marmot

Over the past 40 years in England and Wales the rise in mortality from coronary heart disease has continued unabated among working-class men, whereas among professional men the rate has changed little for the past 20 years. As a result it is now 26 per cent higher in social class V compared with social class I. The difference in women is larger (+ 152%), and it has been present for at least 40 years. The social class gradient for men was confirmed in a survey of 17530 London civil servants aged between 40 and 64 (the Whitehall Study). When men in the lowest employment grade were compared with those in the top (administrative) grade, the age-adjusted prevalence rate was 53 per cent higher for angina, 77 per cent higher for ischaemic-type electrocardiographic abnormalities, and 75 per cent higher for the prevalence of electrocardiographic abnormality among men with angina. At follow-up, the seven-and-a-half year coronary mortality was 3.6 times higher in the lowest than in the top grade. This social class difference was partly explained by known coronary risk factors: men in the lower grades smoked more and exercised less, they were shorter and more overweight, and they had higher blood pressures and lower levels of glucose tolerance. Most of the difference, however, remains unexplained. It seems that there are major risk factors yet to be identified, and that these may throw light on how it is possible for members of a highly-placed social group to have a relatively low risk of coronary heart disease.

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

This article has been cited by other articles:

• Gimeno, D, Ferrie, J E, Elovainio, M, Pulkki-Raback, L, Keltikangas-Jarvinen, L, Eklund, C, Hurme, M, Lehtimaki, T, Marniemi, J, Viikari, J S A, Raitakari, O T, Kivimaki, M (2008). When do social inequalities in C-reactive protein start? A life course perspective from conception to adulthood in the Cardiovascular Risk in Young Finns Study. Int J Epidemiol 37: 290-298 [Abstract] [Full Text]  
• Campbell, T. S., Key, B. L., Ireland, A. D., Bacon, S. L., Ditto, B. (2008). Early Socioeconomic Status is Associated With Adult Nighttime Blood Pressure Dipping. Psychosom. Med. 70: 276-281 [Abstract] [Full Text]  
• Casas, J. P (2008). Commentary: Social class, C-reactive protein and coronary heart disease. Int J Epidemiol 37: 299-300 [Full Text]  
• Khang, Y H, Lynch, J W, Jung-Choi, K, Cho, H J (2008). Explaining age-specific inequalities in mortality from all causes, cardiovascular disease and ischaemic heart disease among South Korean male public servants: relative and absolute perspectives. Heart 94: 75-82 [Abstract] [Full Text]  
• Kittleson, M. M., Meoni, L. A., Wang, N.-Y., Chu, A. Y., Ford, D. E., Klag, M. J. (2006). Association of Childhood Socioeconomic Status With Subsequent Coronary Heart Disease in Physicians. Arch Intern Med 166: 2356-2361 [Abstract] [Full Text]  
• Lynch, J., Davey Smith, G., Harper, S., Bainbridge, K. (2006). Explaining the social gradient in coronary heart disease: comparing relative and absolute risk approaches. J. Epidemiol. Community Health 60: 436-441 [Abstract] [Full Text]  
• Peterson, J. J., Lowe, J. B., Peterson, N. A., Janz, K. F. (2006). The relationship between active living and health-related quality of life: income as a moderator. Health Educ Res 21: 146-156 [Abstract] [Full Text]  
• Ranjit, N., Diez-Roux, A. V., Chambless, L., Jacobs, D. R. Jr, Nieto, F. J., Szklo, M. (2006). Socioeconomic Differences in Progression of Carotid Intima-Media Thickness in the Atherosclerosis Risk in Communities Study. Arterioscler. Thromb. Vasc. Bio. 26: 411-416 [Abstract] [Full Text]  
• Alter, D. A., Chong, A., Austin, P. C., Mustard, C., Iron, K., Williams, J. I., Morgan, C. D., Tu, J. V., Irvine, J., Naylor, C. D., for the SESAMI Study Group*, (2006). Socioeconomic Status and Mortality after Acute Myocardial Infarction. ANN INTERN MED 144: 82-93 [Abstract] [Full Text]  
• Thurston, R. C., Kubzansky, L. D., Kawachi, I., Berkman, L. F. (2006). Do Depression and Anxiety Mediate the Link Between Educational Attainment and CHD?. Psychosom. Med. 68: 25-32 [Abstract] [Full Text]  
• Nilsson, P. M., Nilsson, J.-A., Ostergren, P.-O., Berglund, G. (2005). Social mobility, marital status, and mortality risk in an adult life course perspective: The Malmo Preventive Project. Scand J Public Health 33: 412-423 [Abstract]  
• Barker, D. J.P., Bagby, S. P. (2005). Developmental Antecedents of Cardiovascular Disease: A Historical Perspective. J. Am. Soc. Nephrol. 16: 2537-2544 [Abstract] [Full Text]  
• Thurston, R. C., Kubzansky, L. D., Kawachi, I., Berkman, L. F. (2005). Is the Association between Socioeconomic Position and Coronary Heart Disease Stronger in Women than in Men?. Am J Epidemiol 162: 57-65 [Abstract] [Full Text]  
• Schulz, A. J., Zenk, S., Odoms-Young, A., Hollis-Neely, T., Nwankwo, R., Lockett, M., Ridella, W., Kannan, S. (2005). Healthy Eating and Exercising to Reduce Diabetes: Exploring the Potential of Social Determinants of Health Frameworks Within the Context of Community-Based Participatory Diabetes Prevention. AJPH 95: 645-651 [Abstract] [Full Text]  
• Strand, B. H., Tverdal, A. (2004). Can cardiovascular risk factors and lifestyle explain the educational inequalities in mortality from ischaemic heart disease and from other heart diseases? 26 year follow up of 50 000 Norwegian men and women. J. Epidemiol. Community Health 58: 705-709 [Abstract] [Full Text]  
• Connolly, V., Nag, S. (2004). `Sociotype': a key determinant of diabetes health. British Journal of Diabetes & Vascular Disease 4: 141-144  
• Mayer, O Jr, Simon, J, Heidrich, J, Cokkinos, D V, De Bacquer, D (2004). Educational level and risk profile of cardiac patients in the EUROASPIRE II substudy. J. Epidemiol. Community Health 58: 47-52 [Abstract] [Full Text]  
• Lynch, J., Davey Smith, G. (2003). Rates and states: reflections on the health of nations. Int J Epidemiol 32: 663-670 [Full Text]  
• Humphrey, L. L., Nelson, H. D., Chan, B. K. S., Nygren, P., Allan, J., Teutsch, S. (2003). Relationship Between Hormone Replacement Therapy, Socioeconomic Status, and Coronary Heart Disease. JAMA 289: 45-45 [Full Text]  
• Humphrey, L. L., Chan, B. K.S., Sox, H. C. (2002). Postmenopausal Hormone Replacement Therapy and the Primary Prevention of Cardiovascular Disease. ANN INTERN MED 137: 273-284 [Abstract] [Full Text]  
• Schulz, A. J., Krieger, J., Galea, S. (2002). Addressing Social Determinants of Health: Community-Based Participatory Approaches to Research and Practice. Health Educ Behav 29: 287-295  
• Schnohr, P., Jensen, J.S., Scharling, H., Nordestgaard, B.G. (2002). Coronary heart disease risk factors ranked by importance for the individual and community. A 21 year follow-up of 12000 men and women from The Copenhagen City Heart Study. Eur Heart J 23: 620-626 [Abstract] [Full Text]  
• Bassuk, S. S., Berkman, L. F., Amick, B. C. III (2002). Socioeconomic Status and Mortality among the Elderly: Findings from Four US Communities. Am J Epidemiol 155: 520-533 [Abstract] [Full Text]  
• Critchley, J.A., Capewell, S. (2002). Why model coronary heart disease?. Eur Heart J 23: 110-116 [Full Text]  
• Gallo, L. C., Matthews, K. A., Kuller, L. H., Sutton-Tyrrell, K., Edmundowicz, D. (2001). Educational Attainment and Coronary and Aortic Calcification in Postmenopausal Women. Psychosom. Med. 63: 925-935 [Abstract] [Full Text]  
• Paris, R. M., Bedno, S. A., Krauss, M. R., Keep, L. W., Rubertone, M. V. (2001). Weighing in on Type 2 Diabetes in the Military: Characteristics of U.S. military personnel at entry who develop type 2 diabetes. Diabetes Care 24: 1894-1898 [Abstract] [Full Text]  
• Salomaa, V, Miettinen, H, Niemela, M, Ketonen, M, Mahonen, M, Immonen-Raiha, P, Lehto, S, Vuorenmaa, T, Koskinen, S, Palomaki, P, Mustaniemi, H, Kaarsalo, E, Arstila, M, Torppa, J, Kuulasmaa, K, Puska, P, Pyorala, K, Tuomilehto, J (2001). Relation of socioeconomic position to the case fatality, prognosis and treatment of myocardial infarction events; the FINMONICA MI Register Study. J. Epidemiol. Community Health 55: 475-482 [Abstract] [Full Text]  
• Kristenson, M., Kucinskiene, Z., Bergdahl, B., Orth-Gomer, K. (2001). Risk factors for coronary heart disease in different socioeconomic groups of Lithuania and Sweden -- the LiVicordia study. Scand J Public Health 29: 140-150 [Abstract]  
• Suadicani, P., Hein, H. O., Gyntelberg, F. (2001). Socioeconomic status and ischaemic heart disease mortality in middle-aged men: importance of the duration of follow-up. The Copenhagen Male Study. Int J Epidemiol 30: 248-255 [Abstract] [Full Text]  
• Rosvall, M., Ostergren, P. O., Hedblad, B., Isacsson, S-O., Janzon, L., Berglund, G. (2000). Occupational Status, Educational Level, and the Prevalence of Carotid Atherosclerosis in a General Population Sample of Middle-aged Swedish Men and Women: Results from the Malmo Diet and Cancer Study. Am J Epidemiol 152: 334-346 [Abstract] [Full Text]  
• Vargas, C. M., Ingram, D. D., Gillum, R. F. (2000). Incidence of Hypertension and Educational Attainment The NHANES I Epidemiologic Followup Study. Am J Epidemiol 152: 272-278 [Abstract] [Full Text]  
• Matthews, K. A., Raikkonen, K., Everson, S. A., Flory, J. D., Marco, C. A., Owens, J. F., Lloyd, C. E. (2000). Do the Daily Experiences of Healthy Men and Women Vary According to Occupational Prestige and Work Strain?. Psychosom. Med. 62: 346-353 [Abstract] [Full Text]  
• Salomaa, V., Niemela, M., Miettinen, H., Ketonen, M., Immonen-Raiha, P., Koskinen, S., Mahonen, M., Lehto, S., Vuorenmaa, T., Palomaki, P., Mustaniemi, H., Kaarsalo, E., Arstila, M., Torppa, J., Kuulasmaa, K., Puska, P., Pyorala, K., Tuomilehto, J. (2000). Relationship of Socioeconomic Status to the Incidence and Prehospital, 28-Day, and 1-Year Mortality Rates of Acute Coronary Events in the FINMONICA Myocardial Infarction Register Study. Circulation 101: 1913-1918 [Abstract] [Full Text]  
• Connolly, V, Unwin, N, Sherriff, P, Bilous, R, Kelly, W (2000). Diabetes prevalence and socioeconomic status: a population based study showing increased prevalence of type 2 diabetes mellitus in deprived areas. J. Epidemiol. Community Health 54: 173-177 [Abstract] [Full Text]  
• Matthews, K. A., Flory, J. D., Muldoon, M. F., Manuck, S. B. (2000). Does Socioeconomic Status Relate to Central Serotonergic Responsivity in Healthy Adults?. Psychosom. Med. 62: 231-237 [Abstract] [Full Text]  
• Gabhainn, S. N., Kelleher, C. C., Naughton, A. M., Carter, F., Flanagan, M., McGrath, M. J. (1999). Socio-demographic variations in perspectives on cardiovascular disease and associated risk factors. Health Educ Res 14: 619-628 [Abstract] [Full Text]  
• Favaloro, R. (1999). A Revival of Paul Dudley White : An Overview of Present Medical Practice and of Our Society. Circulation 99: 1525-1537 [Full Text]  
• Lantz, P. M., House, J. S., Lepkowski, J. M., Williams, D. R., Mero, R. P., Chen, J. (1998). Socioeconomic Factors, Health Behaviors, and Mortality: Results From a Nationally Representative Prospective Study of US Adults. JAMA 279: 1703-1708 [Abstract] [Full Text]  
• Johnson-Down, L., O'Loughlin, J., Koski, K. G., Gray-Donald, K. (1997). High Prevalence of Obesity in Low Income and Multiethnic Schoolchildren: A Diet and Physical Activity Assessment. J. Nutr. 127: 2310-2315 [Abstract] [Full Text]  
• Lynch, J. W., Kaplan, G. A. (1997). Understanding How Inequality in the Distribution of Income Affects Health. J Health Psychol 2: 297-314 [Abstract]  
• Iribarren, C., Luepker, R. V., McGovern, P. G., Arnett, D. K., Blackburn, H. (1997). Twelve-Year Trends in Cardiovascular Disease Risk Factors in the Minnesota Heart Survey: Are Socioeconomic Differences Widening?. Arch Intern Med 157: 873-881 [Abstract]  
• Mittleman, M. A., Maclure, M., Nachnani, M., Sherwood, J. B., Muller, J. E. (1997). Educational Attainment, Anger, and the Risk of Triggering Myocardial Infarction Onset. Arch Intern Med 157: 769-775 [Abstract]  
• Lynch, J., Kaplan, G. A., Salonen, R., Salonen, J. T. (1997). Socioeconomic Status and Progression of Carotid Atherosclerosis : Prospective Evidence From the Kuopio Ischemic Heart Disease Risk Factor Study. Arterioscler. Thromb. Vasc. Bio. 17: 513-519 [Abstract] [Full Text]  
• Lynch, J., Kaplan, G. A., Salonen, R., Cohen, R. D., Salonen, J. T. (1995). Socioeconomic Status and Carotid Atherosclerosis. Circulation 92: 1786-1792 [Abstract] [Full Text]  
• Mackenbach, J. P (1995). Tackling inequalities in health. BMJ 310: 1152-1153 [Full Text]  
• Gupta, R, Gupta, V P, Ahluwalia, N S (1994). Educational status, coronary heart disease, and coronary risk factor prevalence in a rural population of India. BMJ 309: 1332-1336 [Abstract] [Full Text]  
• Lester, C., Weston, C., Morgan, M., Donnelly, P., Assar, D. (1994). The Heartstart school programme: teaching cardiopulmonary resuscitation to schoolchildren. Health Education Journal 53: 454-461  
• Guralnik, J. M., Land, K. C., Blazer, D., Fillenbaum, G. G., Branch, L. G. (1993). Educational Status and Active Life Expectancy among Older Blacks and Whites. NEJM 329: 110-116 [Abstract] [Full Text]  
• Hebert, P. R., Buring, J. E., O'Connor, G. T., Rosner, B., Hennekens, C. H. (1992). Occupation and Risk of Nonfatal Myocardial Infarction. Arch Intern Med 152: 2253-2257 [Abstract]  
• Manolio, T. A., Furberg, C. D., Wahl, P. W., Tracy, R. P., Borhani, N. O., Gardin, J. M., Fried, L. P., O'Leary, D. H., Kuller, L. H. (1992). Eligibility for Cholesterol Referral in Community-dwelling Older Adults: The Cardiovascular Health Study. ANN INTERN MED 116: 641-649 [Abstract]  
• Janlert, U., Asplund, K., Weinehall, L. (1992). Unemployment and Cardiovascular Risk Indicators Data from the MONICA Survey in Northern Sweden. Scand J Public Health 20: 14-18 [Abstract]  
• Moller, L., Kristensen, T. S., Hollnagel, H. (1991). Social Class and Cardiovascular Risk Factors in Danish Men. Scand J Public Health 19: 116-126 [Abstract]  
• Tate, J., Cade, J. (1990). Public knowledge of dietary fat and coronary heart disease. Health Education Journal 49: 32-35 [Abstract]  
• Buring, J. E., Evans, D. A., Fiore, M., Rosner, B., Hennekens, C. H. (1987). Occupation and Risk of Death From Coronary Heart Disease. JAMA 258: 791-792 [Abstract]  
• Guzzetta, C. E. (1987). The Human Factor and the Ailing Heart: Folklore or Fact?. J Intensive Care Med 2: 3-5  
• Dressler, W. W. (1984). Social and Cultural Influences in Cardiovascular Disease: A Review. Transcultural Psychiatry 21: 5-42