International Journal of Epidemiology, Vol 28, 46-52, Copyright © 1999 by International Epidemiological Association
M Bobak, C Hertzman, Z Skodova and M Marmot
BACKGROUND: In western countries, prevalence of cardiovascular diseases and
most risk factors is higher in lower socioeconomic groups. The social
gradients in the former communist societies are less well known. Because in
western countries different indicators of socioeconomic status (SES) are
correlated, this gradient is found with a number of different measures of
SES. We have analysed the presence and magnitude of the socioeconomic
gradient in cardiovascular risk factors in a former communist country. As
the relationship between material conditions and education has been much
weaker than in the west, we have also attempted to separate their effects.
METHODS: A cross-sectional survey examined a random sample of men and women
resident in six Czech districts participating in the MONICA study in 1992.
Participants completed a questionnaire, underwent anthropometric and blood
pressure measurements, and provided a blood sample. Two indicators of SES
were used: education and material conditions, the indicator constructed
from car ownership and crowding. Linear regression was employed to analyse
the relation between SES and total and high-density lipoprotein (HDL)
cholesterol, body mass index (BMI), waist-hip ratio (WHR) and height.
Logistic regression was used to assess the association between SES and
smoking and hypertension. RESULTS: A total of 1141 men and 1212 women
(overall response rate 75%) participated in the study. After controlling
for age, all risk factors were associated with education, except HDL
cholesterol in women and BMI in men; only smoking in both sexes and WHR in
women and height in men were significantly related to material conditions.
In mutually adjusted analyses, educational gradients persisted but
associations with material conditions disappeared or became substantially
weaker. The magnitude of the educational differences was similar to those
found in western countries. CONCLUSIONS: Socioeconomic differences in
cardiovascular risk factors in Czech Republic in 1992 had the same
direction and similar magnitude as in Western Europe, and were strongly
related to education rather than material conditions. Materialist
explanations for the social differences seem unlikely in this population.
ARTICLES
Socioeconomic status and cardiovascular risk factors in the Czech Republic
International Centre for Health and Society, Department of Epidemiology and Public Health, University College London, UK.
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