International Journal of Epidemiology 2003;32:375-380
© International Epidemiological Association 2003
Special Theme: Socio-economic position |
Income inequality and ischaemic heart disease in Danish men and women
1 Department of Social Medicine, Institute of Public Health, University of Copenhagen, Blegdamsvej 3, 2200 N, Denmark.
2 The Copenhagen Center of Prospective Population Studies, Danish Epidemiology Science Centre at the Institute of Preventive Medicine, HS: Copenhagen University Hospital, 1399 Copenhagen, Denmark.
Correspondence:
Professor Merete Osler, Department of Social Medicine, Institute of Public Health, University of Copenhagen, Blegdamsvej 3, 2200 N, Denmark. E-mail:
m.osler{at}pubhealth.ku.dk
Background It has been hypothesized that areas with an unequal income distribution are less likely to invest in health and more likely to have a social environment that influences the development of ischaemic heart disease (IHD)
Methods We used pooled data from two cohort studies conducted in Copenhagen to analyse the association between area income inequality and first admission to hospital or death from IHD in women and men while controlling for individual income and other IHD risk factors. A total of 11 685 women and 10 036 men, with initial health examinations between 1964 and 1992, were followed for a median of 13.8 years. Information on median income share at parish and municipality levels was obtained from population registers.
Results During follow-up 1700 men and 1204 women experienced an IHD event. At parish level income share was inversely associated with an increased risk of IHD in men (hazard ratio [HR]most versus least equal quartile = 0.85 (95% CI: 0.73–0.98). Among women there was no relation between parish income inequality and IHD. Subject’s household income was inversely related to IHD, and when this variable was controlled for, the association between income inequality at parish level and IHD in men attenuated slightly. When behavioural and biological risk factors were entered into the Cox model this relation attenuated further. However, some of these risk factors might mediate rather than confound the effect of income inequality. The association between income inequality at municipality level and IHD was insignificant for men, while in women the relation had a curved shape with those living in the least equal areas having the lowest risk.
Conclusions This study provides no clear evidence for an association between income inequality measured at parish or municipality level and IHD in Danish adults. The associations were weak and varied between different strata and geographical levels.
Keywords Ischaemic heart disease, income inequality, multilevel study
Accepted 26 July 2002
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