Browse by author
Lookup NU author(s): Professor Sheena Ramsay
This is the final published version of an article that has been published in its final definitive form by Wiley-Blackwell, 2009.
For re-use rights please refer to the publisher's terms and conditions.
Background: Evidence on socioeconomic inequalities in coronary heart disease (CHD) and their pathways in the elderly is limited. Little is also known about the contributions that novel coronary risk factors (particularly inflammatory/hemostatic markers) make to socioeconomic inequalities in CHD. Objectives: To examine the extent of socioeconomic inequalities in CHD in older age, and the contributions (relative and absolute) of established and novel coronary risk factors. Methods: A population-based cohort of 3761 British men aged 60-79 years was followed up for 6.5 years for CHD mortality and incidence (fatal and non-fatal). Social class was based on longest-held occupation recorded at 40-59 years. Results: There was a graded relationship between social class and CHD incidence. The hazard ratio for CHD incidence comparing social class V (unskilled workers) with social class I (professionals) was 2.70 [95% confidence interval (CI) 1.37-5.35; P-value for trend = 0.008]. This was reduced to 2.14 (95% CI 1.06-4.33; P-value for trend = 0.11) after adjustment for behavioral factors (cigarette smoking, physical activity, body mass index, and alcohol consumption), which explained 38% of the relative risk gradient (41% of absolute risk). Additional adjustment for inflammatory markers (C-reactive protein, interleukin-6, and von Willebrand factor) explained 55% of the relative risk gradient (59% of absolute risk). Blood pressure and lipids made little difference to these estimates; results were similar for CHD mortality. Conclusions: Socioeconomic inequalities in CHD persist in the elderly and are at least partly explained by behavioral risk factors; novel (inflammatory) coronary risk markers made some further contribution. Reducing inequalities in behavioral factors (especially cigarette smoking) could reduce these social inequalities by at least one-third. © 2009 International Society on Thrombosis and Haemostasis.
Author(s): Ramsay SE, Morris RW, Whincup PH, Papacosta O, Rumley A, Lennon L, Lowe G, Wannamethee SG
Publication type: Article
Publication status: Published
Journal: Journal of Thrombosis and Haemostasis
Year: 2009
Volume: 7
Issue: 11
Pages: 1779-1786
Print publication date: 01/11/2009
Online publication date: 21/10/2009
Date deposited: 14/06/2017
ISSN (print): 1538-7933
ISSN (electronic): 1538-7836
Publisher: Wiley-Blackwell
URL: https://doi.org/10.1111/j.1538-7836.2009.03602.x
DOI: 10.1111/j.1538-7836.2009.03602.x
PubMed id: 20015318
Altmetrics provided by Altmetric