International Journal of Epidemiology 2001;30:248-255
© International Epidemiological Association 2001
Special Theme: Socioeconomic Differentials in Health |
Socioeconomic status and ischaemic heart disease mortality in middle-aged men: importance of the duration of follow-up. The Copenhagen Male Study
a Epidemiological Research Unit, Clinic of Occupational and Environmental Medicine, H:S Copenhagen University Hospital, Bispebjerg, Bispebjerg Bakke 23, DK-2400, Copenhagen, Denmark.
b The Glostrup Population Studies, Department of Internal Medicine C, Glostrup Hospital, University of Copenhagen, Denmark.
Correspondence: Poul Suadicani, Epidemiological Research Unit, Clinic of Occupational and Environmental Medicine, H:S Copenhagen University Hospital, Bispebjerg, Bispebjerg Bakke 23, DK-2400, Copenhagen. E-mail: poul.suadicani{at}jubiipost.dk
Abstract
Objectives The predictive value of some risk factors may diminish with increasing duration of follow-up. This study was performed to elucidate the role of socioeconomic status as a risk factor for ischaemic heart disease (IHD) mortality in middle-aged men, testing the hypothesis that the role of mediators of the association of socioeconomic status with risk of IHD would diminish with increasing length of follow-up.
Methods A cohort of 5249 men aged 40–59 was established in 1971. Baseline data on social class and other confounder variables were collected, and the cohort was followed through registers for 8, 15, and 22 years. In all, 5028 without a history of myocardial infarction or angina pectoris were included in the follow-up. Four factors associated with either occupation or lifestyle were strong mediators of the association found between social class and risk of fatal IHD, and were more common in the lower social classes (classes IV and V): occasional demand for vigorous activity at work, low leisure time physical activity level, high alcohol consumption, and smoking.
Results After the first 8 years, 78 men had died due to IHD, after 15 years: 222, and after 22 years: 411. Compared with social classes I, II, and III, the age-adjusted relative risk (RR) with 95% CI for classes IV and V was 1.69, P < 0.05 after the first 8 years; adjusted for the above potential risk factors the RR dropped to 1.09, P = NS. Corresponding RR after 15 years were 1.67, P < 0.001 and 1.33, P = NS; and after 22 years, 1.59, P < 0.001 and 1.36, P < 0.05.
Conclusions Risk factors with an uneven social distribution related to occupation and lifestyle were strong mediators of the association of socioeconomic status with risk of IHD. A quite strong explanatory potential persisted but diminished with length of follow-up.
Keywords Myocardial ischaemia, social class, epidemiology, confounding factors, work, risk factors
Accepted 28 June 2000
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  M A Denvir, A J Lee, J Rysdale, A Walker, H Eteiba, I R Starkey, and J P Pell Influence of socioeconomic status on clinical outcomes and quality of life after percutaneous coronary intervention. J. Epidemiol. Community Health, December 1, 2006; 60(12): 1085 - 1088. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T. Blakely and N. Wilson The contribution of smoking to inequalities in mortality by education varies over time and by sex: two national cohort studies, 1981-84 and 1996-99 Int. J. Epidemiol., October 1, 2005; 34(5): 1054 - 1062. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J Yarnell, S Yu, E McCrum, D Arveiler, B Hass, J Dallongeville, M Montaye, P Amouyel, J Ferrieres, J-B Ruidavets, et al. Education, socioeconomic and lifestyle factors, and risk of coronary heart disease: the PRIME Study Int. J. Epidemiol., April 1, 2005; 34(2): 268 - 275. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
B. H. Strand and A. Tverdal Can cardiovascular risk factors and lifestyle explain the educational inequalities in mortality from ischaemic heart disease and from other heart diseases? 26 year follow up of 50 000 Norwegian men and women J. Epidemiol. Community Health, August 1, 2004; 58(8): 705 - 709. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 B Ohlin, P.M Nilsson, J-A Nilsson, and G Berglund Chronic psychosocial stress predicts long-term cardiovascular morbidity and mortality in middle-aged men Eur. Heart J., May 2, 2004; 25(10): 867 - 873. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P R Ward, P R Noyce, and A S St Leger Are GP practice prescribing rates for coronary heart disease drugs equitable? A cross sectional analysis in four primary care trusts in England J. Epidemiol. Community Health, February 1, 2004; 58(2): 89 - 96. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 U. M. Kujala, J. Kaprio, and M. Koskenvuo Modifiable Risk Factors as Predictors of All-Cause Mortality: The Roles of Genetics and Childhood Environment Am. J. Epidemiol., December 1, 2002; 156(11): 985 - 993. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. Blane Commentary: Socioeconomic health differentials Int. J. Epidemiol., April 1, 2001; 30(2): 292 - 293. [Full Text] [PDF]
|
|
|
|
|
|
J. M Najman Commentary: General or cause-specific factors in explanations of class inequalities in health Int. J. Epidemiol., April 1, 2001; 30(2): 296 - 297. [Full Text] [PDF]
|
|