RT Journal Article
SR Electronic
T1 Educational class inequalities in the incidence of coronary heart disease in Europe
JF Heart
JO Heart
FD BMJ Publishing Group Ltd and British Cardiovascular Society
SP 958
OP 965
DO 10.1136/heartjnl-2015-308909
VO 102
IS 12
A1 Giovanni Veronesi
A1 Marco M Ferrario
A1 Kari Kuulasmaa
A1 Martin Bobak
A1 Lloyd E Chambless
A1 Veikko Salomaa
A1 Stefan Soderberg
A1 Andrzej Pajak
A1 Torben Jørgensen
A1 Philippe Amouyel
A1 Dominique Arveiler
A1 Wojciech Drygas
A1 Jean Ferrieres
A1 Simona Giampaoli
A1 Frank Kee
A1 Licia Iacoviello
A1 Sofia Malyutina
A1 Annette Peters
A1 Abdonas Tamosiunas
A1 Hugh Tunstall-Pedoe
A1 Giancarlo Cesana
YR 2016
UL http://heart.bmj.com/content/102/12/958.abstract
AB Objective To estimate the burden of social inequalities in coronary heart disease (CHD) and to identify their major determinants in 15 European populations.Methods The MORGAM (MOnica Risk, Genetics, Archiving and Monograph) study comprised 49 cohorts of middle-aged European adults free of CHD (110 928 individuals) recruited mostly in the mid-1980s and 1990s, with comparable assessment of baseline risk and follow-up procedures. We derived three educational classes accounting for birth cohorts and used regression-based inequality measures of absolute differences in CHD rates and HRs (ie, Relative Index of Inequality, RII) for the least versus the most educated individuals.Results N=6522 first CHD events occurred during a median follow-up of 12 years. Educational class inequalities accounted for 343 and 170 additional CHD events per 100 000 person-years in the least educated men and women compared with the most educated, respectively. These figures corresponded to 48% and 71% of the average event rates in each gender group. Inequalities in CHD mortality were mainly driven by incidence in the Nordic countries, Scotland and Lithuania, and by 28-day case-fatality in the remaining central/South European populations. The pooled RIIs were 1.6 (95% CI 1.4 to 1.8) in men and 2.0 (1.7 to 2.4) in women, consistently across population. Risk factors accounted for a third of inequalities in CHD incidence; smoking was the major mediator in men, and High-Density-Lipoprotein (HDL) cholesterol in women.Conclusions Social inequalities in CHD are still widespread in Europe. Since the major determinants of inequalities followed geographical and gender-specific patterns, European-level interventions should be tailored across different European regions.