International Journal of Epidemiology, Vol 26, 47-57, Copyright © 1997 by International Epidemiological Association
T Lang, P Ducimetiere, D Arveiler, P Amouyel, JP Cambou, JB Ruidavets, M Montaye, V Meyer and A Bingham
OBJECTIVES: To assess the incidence and case fatality rate (CFR) from acute
coronary insufficiency in men among occupational categories and to analyse
the relationship between these disparities and the distribution of
cardiovascular risk factors in the French population. SETTING: Three
registers of the WHO-MONICA project in France: the urban area of Lille and
two French districts: Bas-Rhin and Haute-Garonne. METHODS: Two sets of data
were used: 1) the incident cases collected by the three MONICA
Collaborating Centres (MCC) of the French WHO-MONICA Project (Lille,
Strasbourg and Toulouse), between 1985 and 1989; 2) a cross-sectional study
on cardiovascular risk factor prevalence performed in 1985-1989 in the
three areas corresponding to the MCC. SUBJECTS: The data concern 5133 new
coronary events in men aged 30-59 and a sample of 1863 men aged 30-59.
RESULTS: A strong relationship was observed between occupational categories
and the incidence of acute myocardial infarction and coronary events as
well as CFR. Both incidence and CFR were lower among senior executives.
Incidence was higher among employees and workers. However, employees, as
opposed to unskilled workers, did not have higher CFR. Using occupational
category as a statistical unit, the incidence of first acute myocardial
infarction and coronary events was associated with the prevalence of
smokers in the population (r = 0.50, P = 0.06 and r = 0.61, P = 0.02). The
CFR was associated with systolic blood pressure (r = 0.82, P = 0.002), and
the prevalence of smokers (r = 0.65, P = 0.02). None of the measures of
incidence or case fatality among categories was related to cholesterol,
HDL-cholesterol or body mass index. CONCLUSIONS: Strong differences were
observed between occupational categories and the incidence of acute
myocardial infarction, coronary events and CFR. These differences were
found to be closely related to the social distribution of two major
cardiovascular risk factors: tobacco smoking and blood pressure.
ARTICLES
Incidence, case fatality, risk factors of acute coronary heart disease and occupational categories in men aged 30-59 in France
INSERM U258, Hopital Broussais, Paris, France.
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