IJE Advance Access originally published online on August 22, 2006
International Journal of Epidemiology 2006 35(5):1239-1245; doi:10.1093/ije/dyl163
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Cardiovascular Disease and Diabetes |
Social disadvantage and cardiovascular disease: development of an index and analysis of age, sex, and ethnicity effects
1 Department of Medicine, McMaster University, Hamilton, Canada
2 Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Canada
3 Six Nations Health Services, Ohsweken, Canada
4 University of Toronto, Toronto, Canada
* Corresponding author. Hamilton General Hospital, 237 Barton Street East, 4 EAST Room 441, Hamilton, Ontario, Canada L8L 2X2. E-mail: anands{at}mcmaster.ca
Background Social disadvantage is defined by adverse socio-economic characteristics and is distributed unequally by age, sex, and ethnicity. We studied the relationship between social disadvantage, cardiovascular risk factors, and cardiovascular disease (CVD) among men and women from diverse ethno-racial backgrounds.
Methods A total of 1227 men and women of South Asian, Chinese, Aboriginal, and European ancestry were randomly selected from four communities in Canada to undergo a health assessment. Socio-economic factors, conventional and novel CV risk factors, atherosclerosis, and CVD were measured. A social disadvantage index was generated and included employment status, income, and marital status. Social disadvantage was examined in relation to risk factors for CVD, atherosclerosis, and prevalent CVD.
Results Social disadvantage was higher among older people, women, and non-white ethnic groups. Cigarette smoking, glucose, overweight, abdominal obesity, and CRP were higher among individuals with higher social disadvantage, whereas systolic blood pressure, lipids, norepinephrine, and atherosclerosis were not. Social disadvantage is an independent predictor of CVD after adjustment for conventional and novel risk markers for CVD (OR for 1 point increase = 1.25; 95% CI 1.06–1.47).
Conclusion The social disadvantage index combines social and economic exposures into a single continuous measure. Significant variation in social disadvantage by age, sex, and ethnic group exists. Increased social disadvantage is associated with an increased burden of some CV risk factors, and is an independently associated with CVD.
Keywords Social disadvantage, cardiovascular disease, social and economic status, ethnicity, variations in health status
Accepted 4 July 2006
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