Circulation, Vol 88, 1973-1998, Copyright © 1993 by American Heart Association
GA Kaplan and JE Keil
Despite recent declines in mortality, cardiovascular diseases are the
leading cause of death in the United States today. It appears that many of
the major risk factors for coronary disease have been identified.
Researchers are still learning about different modifiable factors that may
influence cardiovascular diseases. Socioeconomic status may provide a new
focus. The principal measures of SES have been education, occupation, and
income or combinations of these. Education has been the most frequent
measure because it does not usually change (as occupation or income might)
after young adulthood, information about education can be obtained easily,
and it is unlikely that poor health in adulthood influences level of
education. However, other measures of SES have merit, and the most
informative strategy would incorporate multiple indicators of SES. A
variety of psychosocial measures--for example, certain aspects of
occupational status--may be important mediators of SES and disease. The
hypothesis that high job strain may adversely affect health status has a
rational basis and is supported by evidence from a limited number of
studies. There is a considerable body of evidence for a relation between
socioeconomic factors and all-cause mortality. These findings have been
replicated repeatedly for 80 years across measures of socioeconomic level
and in geographically diverse populations. During 40 years of study there
has been a consistent inverse relation between cardiovascular disease,
primarily coronary heart disease, and many of the indicators of SES.
Evidence for this relation has been derived from prevalence, prospective,
and retrospective cohort studies. Of particular importance to the
hypothesis that SES is a risk factor for cardiovascular disease was the
finding by several investigators that the patterns of association of SES
with coronary disease had changed in men during the past 30 to 40 years and
that SES has been associated with the decline of coronary mortality since
the mid-1960s. However, the declines in coronary mortality of the last few
decades have not affected all segments of society equally. There is some
evidence that areas with the poorest socioenvironmental conditions
experience later onset in the decline in cardiovascular mortality. A number
of studies suggest that poor living conditions in childhood and adolescence
contribute to increased risk of arteriosclerosis. Some of these studies
have been criticized because of their nature, and others for inadequate
control of confounding factors.(ABSTRACT TRUNCATED AT 400 WORDS)
ARTICLES
Socioeconomic factors and cardiovascular disease: a review of the literature
Office of Scientific Affairs, American Heart Association, Dallas, TX 75231-4596.
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L. F. Berkman Tracking Social and Biological Experiences: The Social Etiology of Cardiovascular Disease Circulation, June 14, 2005; 111(23): 3022 - 3024. [Full Text] [PDF]
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C. Tonne, J. Schwartz, M. Mittleman, S. Melly, H. Suh, and R. Goldberg Long-Term Survival After Acute Myocardial Infarction Is Lower in More Deprived Neighborhoods Circulation, June 14, 2005; 111(23): 3063 - 3070. [Abstract] [Full Text] [PDF]
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Y.-H. Khang and H. R. Kim Explaining socioeconomic inequality in mortality among South Koreans: an examination of multiple pathways in a nationally representative longitudinal study Int. J. Epidemiol., June 1, 2005; 34(3): 630 - 637. [Abstract] [Full Text] [PDF]
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 T Chandola, J Siegrist, and M Marmot Do changes in effort-reward imbalance at work contribute to an explanation of the social gradient in angina? Occup. Environ. Med., April 1, 2005; 62(4): 223 - 230. [Abstract] [Full Text] [PDF]
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J. Dalstra, A. Kunst, C Borrell, E Breeze, E Cambois, G Costa, J. Geurts, E Lahelma, H Van Oyen, N. Rasmussen, et al. Socioeconomic differences in the prevalence of common chronic diseases: an overview of eight European countries Int. J. Epidemiol., April 1, 2005; 34(2): 316 - 326. [Abstract] [Full Text] [PDF]
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T. T. Lewis, S. A. Everson-Rose, B. Sternfeld, K. Karavolos, D. Wesley, and L. H. Powell Race, Education, and Weight Change in a Biracial Sample of Women at Midlife Arch Intern Med, March 14, 2005; 165(5): 545 - 551. [Abstract] [Full Text] [PDF]
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F. T. Shaya, S. W. Blume, C. M. Blanchette, M. R. Weir, and C. D. Mullins Selective Cyclooxygenase-2 Inhibition and Cardiovascular Effects: An Observational Study of a Medicaid Population Arch Intern Med, January 24, 2005; 165(2): 181 - 186. [Abstract] [Full Text] [PDF]
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D. A. Lawlor, G. Davey Smith, R. Patel, and S. Ebrahim Life-Course Socioeconomic Position, Area Deprivation, and Coronary Heart Disease: Findings From the British Women's Heart and Health Study Am J Public Health, January 1, 2005; 95(1): 91 - 97. [Abstract] [Full Text] [PDF]
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E. Goodman, B. S. McEwen, B. Huang, L. M. Dolan, and N. E. Adler Social Inequalities in Biomarkers of Cardiovascular Risk in Adolescence Psychosom Med, January 1, 2005; 67(1): 9 - 15. [Abstract] [Full Text] [PDF]
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H. Schroder, J. Marrugat, J. Vila, M. I. Covas, and R. Elosua Adherence to the Traditional Mediterranean Diet Is Inversely Associated with Body Mass Index and Obesity in a Spanish Population J. Nutr., December 1, 2004; 134(12): 3355 - 3361. [Abstract] [Full Text] [PDF]
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J. Barth, M. Schumacher, and C. Herrmann-Lingen Depression as a Risk Factor for Mortality in Patients With Coronary Heart Disease: A Meta-analysis Psychosom Med, November 1, 2004; 66(6): 802 - 813. [Abstract] [Full Text] [PDF]
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 S. L. Isaacs and S. A. Schroeder Class -- The Ignored Determinant of the Nation's Health N. Engl. J. Med., September 9, 2004; 351(11): 1137 - 1142. [Full Text] [PDF]
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 K. Fiscella and P. Franks Should Years of Schooling Be Used to Guide Treatment of Coronary Risk Factors? Ann. Fam. Med, September 1, 2004; 2(5): 469 - 473. [Abstract] [Full Text] [PDF]
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