EPIDEMIOLOGY

Cardiovascular disease mortality in relation to childhood and adulthood socioeconomic markers in British South Asian men

T Tillin¹, N Chaturvedi¹, N G Forouhi², G D Smith³, P M McKeigue⁴

¹ International Centre for Circulatory Health, Imperial College, St Mary’s & Hammersmith Hospitals, London, UK
² MRC Epidemiology Unit, Cambridge, UK
³ Epidemiology Division, University of Bristol, UK
⁴ University College, Dublin, Republic of Ireland

Dr T Tillin, International Centre for Circulatory Health, Imperial College, St Mary’s & Hammersmith Hospitals, 59–61 North Wharf Road, London W2 1LA, UK; t.tillin{at}imperial.ac.uk

Objective: To study the effects of childhood and adulthood socioeconomic position (SEP) including length of education on rates of cardiovascular disease (CVD) mortality in British South Asians.

Design: Cross-sectional study with ongoing mortality follow-up.

Setting: West London Borough of Ealing, population-based study.

Patients: 1400 South Asian men (52% Punjabi Sikh origin) aged 40–69, first studied 1988–1990 and followed for mortality to October 2006.

Main outcome measures: Deaths due to cardiovascular disease.

Results: 143 men have died from CVD. Men in non-manual adult occupations were less likely to die from CVD than those in unskilled manual occupations (age-adjusted hazard ratio (HR) 0.55 (95% CI 0.35 to 0.88)). Men with 11+ years of education had reduced risk compared with those with <11 years of education (HR 0.66 (95% CI 0.47 to 0.94)). Men who had both non-manual occupations and 11+ years of education were less likely to die from CVD (15 deaths, 282 men; HR 0.39, 95% CI 0.21 to 0.73) than those who were most socially disadvantaged during childhood and adulthood (27 deaths, 187 men). These associations remained after adjustment for other markers of SEP, lifestyle and conventional risk factors. Similar, but weaker, associations were observed when paternal occupation defined childhood SEP.

Conclusions: Years of education, and to a lesser extent paternal occupation, as markers of childhood SEP, had cumulative effects with adulthood socioeconomic circumstances on risk of CVD death; these cumulative effects were strongest in men whose own occupation was non-manual and were unexplained by conventional risk factors measured in middle age.

Keywords: socioeconomic factors; cardiovascular disease; British South Asian; migration; cohort study

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