Table 2

Socioeconomic status and cardiovascular health

AuthorsYear of publicationFindings
SE status and excess cardiovascular risk factors
Marmot et alw751991
  • Common cardiovascular risk factors account for no more than 40% of the difference in mortality between socioeconomic grades of employment.

Steptoe et alw762007
  •  Lower socioeconomic status is associated with:

    •  Larger hip/waist ratio (p=0.04).

    •  Lower high-density lipoprotein cholesterol (p<0.001).

    •  Elevated fasting glucose (p=0.006).

    •  Elevated HbA1c (p<0.001).

    •  Elevated smoking rates (OR 4.41, 95% CI 1.45 to 13.5).

    •  Elevated diabetes incidence (OR 5.93, 95% CI 1.52 to 23.2).

Palomo et alw772014
  •  Lower socioeconomic status is associated with:

    •  Female obesity (OR 2.5, 95% CI 1.5 to 4.2).

    •  Male obesity (OR 1.5, 95% CI 1.0 to 2.3).

    •  Male arterial hypertension (OR 1.5, 95% CI 1.0 to 2.4).

    •  Male hypercholesterolaemia (OR 1.5, 95% CI 1.0 to 2.2).

Floud et alw782016
  •  A cohort of 1.6 million UK women with endpoints of a first coronary event and coronary heart disease mortality yielded a social gradient for coronary heart disease risk and incidence.

  •  This was related to four main health factors:

    •  Smoking.

    •  Alcohol consumption.

    •  Physical inactivity.

    •  High BMI.

  •  Adjustment for these factors together reduced the likelihood ratio of the statistics for education and deprivation by 76% and 71%, respectively, for the first coronary heart disease event, and by 87% and 89% for coronary heart disease mortality.

SE status and excess cardiovascular morbidity
McCartney et alw792015
  • Only 25% of the disparity in cardiovascular disease burden between Scotland and the rest of the UK could be explained by socioeconomic factors.

  • These were more likely due to differences in hospital access, ambulance services or higher case fatality rates.

Veronesi et alw802016
  • Educational inequalities accounted for 343 and 170 additional coronary heart disease events per 100 000 person-years in the least educated males and females over a 12-year period.

Bhatnagar et alw812016
  • Scotland has a higher cardiovascular disease burden than the rest of the UK.

Socioeconomic status and excess cardiovascular mortality
Peters et alw822001
  • Excess mortality from acute myocardial infarction has been observed in areas with increased concentrations of air pollutants (OR 1.48, 95% CI 1.09 to 2.20).

Huisman et alw832005
  • From 1 million deaths between 1990 and 1997, cardiovascular disease accounted for 39% of the total mortality disparity between low and high educational groups.

  • In females, this disparity reached 60%.

Stirbu et alw842012
  • Low socioeconomic status patients in the Netherlands were less likely to receive intervention, such as percutaneous coronary intervention, when presenting with acute myocardial infarction.

Lemstra et alw852013
  • Cardiac rehabilitation is less likely to be attended by low socioeconomic status individuals (OR 1.58, 95% CI 1.39 to 1.71).

Shah et alw862013
  • Excess mortality from heart failure has been observed in areas with increased concentrations of air pollutants (2.12% increase, 95% CI 1.42 to 2.82).

Hajat et alw872013
  • Levels of air pollutants tend to be higher in areas of lower socioeconomic status and could be contributing to some of the excess mortality observed.

Doll et alw882015
  • Cardiac rehabilitation demonstrates reduced mortality after acute MI (HR 0.87, 95% CI 0.83 to 0.92).

Doerschuk et alw892016
  • In low and middle-income countries, educational status is a better indicator to cardiovascular health than wealth.

Schultz et alw902018
  • The cause for substandard care in low socioeconomic status individuals is unclear, but may be attributed to poor availability of quality healthcare.

Foster et alw912018
  • The interaction between lifestyle and deprivation for all-cause and cardiovascular disease mortality was significant (pinteraction<0.0001).

  • The interaction with cardiovascular disease incidence was not significant (pinteraction=0.11).

Rosengren et alw922019
  • Low and middle-income countries possess a higher incidence and mortality from cardiovascular disease, but have less detrimental risk factor profiles.

Di Girolamo et alw932020
  • Cardiovascular mortality is decreasing across socioeconomic boundaries.

  • It is reducing at a slower rate in those of a lower socioeconomic status.

  • References w75–93 can be found in online supplemental file 1.

  • BMI, body mass index; MI, myocardial infarction; SE, socioeconomic.