Cardiovascular Disease Mortality in Relation to Childhood and Adulthood Socio-Economic Markers in British South Asian Men

Therese Tillin ^1*, Nita G Forouhi ², George Davey-Smith ³, Paul M McKeigue ⁴ and Nish Chaturvedi ¹

¹ International Centre for Circulatory Health, Imperial College, United Kingdom
² MRC Epidemiology Unit, Cambridge., United Kingdom
³ Epidemiology Division, University of Bristol, United Kingdom
⁴ University College Dublin, Eire

^* To whom correspondence should be addressed. E-mail: t.tillin{at}imperial.ac.uk.

Accepted 11 June 2007

Abstract

Objective To study the effects of childhood and adulthood socio-economic 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 1,400 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, 0.88). Men with 11+ years of education had reduced risk compared with those with <11 years of education (HR: 0.66 (0.47, 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, 0.73) than those who were most socially disadvantaged during childhood and adulthood (27deaths, 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: British South Asian, cardiovascular disease, cohort study, migration, socioeconomic factors,

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