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.
This article has been cited by other articles:
 |
|
 |
|
  B. Mezuk, W. W. Eaton, S. H. Golden, and Y. Ding The Influence of Educational Attainment on Depression and Risk of Type 2 Diabetes Am J Public Health, August 1, 2008; 98(8): 1480 - 1485. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. Ito, R. Takachi, M. Inoue, N. Kurahashi, M. Iwasaki, S. Sasazuki, H. Iso, Y. Tsubono, S. Tsugane, and for the JPHC Study Group Education in relation to incidence of and mortality from cancer and cardiovascular disease in Japan Eur J Public Health, July 15, 2008; (2008) ckn052v1. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. Erikson and J. Torssander Social class and cause of death Eur J Public Health, June 18, 2008; (2008) ckn053v1. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R A Pollitt, J S Kaufman, K M Rose, A V Diez-Roux, D Zeng, and G Heiss Cumulative life course and adult socioeconomic status and markers of inflammation in adulthood J. Epidemiol. Community Health, June 1, 2008; 62(6): 484 - 491. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L. Alcocer and L. Cueto Review: Hypertension, a health economics perspective Therapeutic Advances in Cardiovascular Disease, June 1, 2008; 2(3): 147 - 155. [Abstract] [PDF]
|
|
|
|
|
|
D. A. I. Groffen, H. Bosma, M. van den Akker, G. I. J. M. Kempen, and J. Th. M. van Eijk Material deprivation and health-related dysfunction in older Dutch people: findings from the SMILE study Eur J Public Health, June 1, 2008; 18(3): 258 - 263. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 B. E. Cohen, S. K. Garg, S. Ali, W. S. Harris, and M. A. Whooley Red Blood Cell Docosahexaenoic Acid and Eicosapentaenoic Acid Concentrations Are Positively Associated with Socioeconomic Status in Patients with Established Coronary Artery Disease: Data from the Heart and Soul Study J. Nutr., June 1, 2008; 138(6): 1135 - 1140. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T. Truelsen and R. Bonita Epidemiological Transition of Stroke in China? Stroke, June 1, 2008; 39(6): 1653 - 1654. [Full Text] [PDF]
|
|
|
|
|
|
L C H Fernald and N E Adler Blood pressure and socioeconomic status in low-income women in Mexico: a reverse gradient? J. Epidemiol. Community Health, May 1, 2008; 62(5): e8 - e8. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. M. Shuey and A. E. Willson Cumulative Disadvantage and Black-White Disparities in Life-Course Health Trajectories Research on Aging, March 1, 2008; 30(2): 200 - 225. [Abstract] [PDF]
|
|
|
|
 |
|
 S-S. Lee, S. Singh, L. Magder, and M. Petri Predictors of high sensitivity C-reactive protein levels in patients with systemic lupus erythematosus Lupus, February 1, 2008; 17(2): 114 - 123. [Abstract] [PDF]
|
|
|
|
 |
|
 J P Bagger, M-B Edwards, and K M Taylor Influence of socioeconomic status on survival after primary aortic or mitral valve replacement Heart, February 1, 2008; 94(2): 182 - 185. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S E Ramsay, R W Morris, L T Lennon, S G Wannamethee, and P H Whincup Are social inequalities in mortality in Britain narrowing? Time trends from 1978 to 2005 in a population-based study of older men J. Epidemiol. Community Health, January 1, 2008; 62(1): 75 - 80. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
Y H Khang, J W Lynch, K Jung-Choi, and H J Cho Explaining age-specific inequalities in mortality from all causes, cardiovascular disease and ischaemic heart disease among South Korean male public servants: relative and absolute perspectives Heart, January 1, 2008; 94(1): 75 - 82. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. N Rasmussen, G. H Gislason, S. Rasmussen, S. Z Abildstrom, T. K Schramm, L. Kober, F. Diderichsen, M. Osler, C. Torp-Pedersen, and M. Madsen Use of statins and beta-blockers after acute myocardial infarction according to income and education J. Epidemiol. Community Health, December 1, 2007; 61(12): 1091 - 1097. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 N. Ranjit, A. V. Diez-Roux, S. Shea, M. Cushman, H. Ni, and T. Seeman Socioeconomic Position, Race/Ethnicity, and Inflammation in the Multi-Ethnic Study of Atherosclerosis Circulation, November 20, 2007; 116(21): 2383 - 2390. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. C. Thurston and L. D. Kubzansky Multiple Sources of Psychosocial Disadvantage and Risk of Coronary Heart Disease Psychosom Med, October 1, 2007; 69(8): 748 - 755. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M Rosvall, G Engstrom, L Janzon, G Berglund, and B Hedblad The role of low grade inflammation as measured by C-reactive protein levels in the explanation of socioeconomic differences in carotid atherosclerosis Eur J Public Health, August 1, 2007; 17(4): 340 - 347. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. Caplan Latinos, Acculturation, and Acculturative Stress: A Dimensional Concept Analysis Policy Politics Nursing Practice, May 1, 2007; 8(2): 93 - 106. [Abstract] [PDF]
|
|
|
|
 |
|
 E. Janzon, G. Engstrom, B. Hedblad, G. Berglund, and L. Janzon Smoking as a determinant of the geographical pattern of cardiac events among women in an urban population Scand J Public Health, May 1, 2007; 35(3): 272 - 277. [Abstract] [PDF]
|
|
|
|
|
|
M. Kivimaki, D. A. Lawlor, G. D. Smith, A. Kouvonen, M. Virtanen, M. Elovainio, and J. Vahtera Socioeconomic Position, Co-Occurrence of Behavior-Related Risk Factors, and Coronary Heart Disease: the Finnish Public Sector Study Am J Public Health, May 1, 2007; 97(5): 874 - 879. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
B. Chaix, M. Rosvall, and J. Merlo Assessment of the magnitude of geographical variations and socioeconomic contextual effects on ischaemic heart disease mortality: a multilevel survival analysis of a large Swedish cohort J. Epidemiol. Community Health, April 1, 2007; 61(4): 349 - 355. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. A. Albert, R. J. Glynn, J. Buring, and P. M Ridker Impact of Traditional and Novel Risk Factors on the Relationship Between Socioeconomic Status and Incident Cardiovascular Events Circulation, December 12, 2006; 114(24): 2619 - 2626. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. Kanjilal, E. W. Gregg, Y. J. Cheng, P. Zhang, D. E. Nelson, G. Mensah, and G. L. A. Beckles Socioeconomic Status and Trends in Disparities in 4 Major Risk Factors for Cardiovascular Disease Among US Adults, 1971-2002 Arch Intern Med, November 27, 2006; 166(21): 2348 - 2355. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. M. Kittleson, L. A. Meoni, N.-Y. Wang, A. Y. Chu, D. E. Ford, and M. J. Klag Association of Childhood Socioeconomic Status With Subsequent Coronary Heart Disease in Physicians Arch Intern Med, November 27, 2006; 166(21): 2356 - 2361. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C R Chittleborough, F E Baum, A W Taylor, and J E Hiller A life-course approach to measuring socioeconomic position in population health surveillance systems. J. Epidemiol. Community Health, November 1, 2006; 60(11): 981 - 992. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. P. Tracy The Five Cardinal Signs of Inflammation: Calor, Dolor, Rubor, Tumor ... and Penuria (Apologies to Aulus Cornelius Celsus, De medicina, c. A.D. 25). J. Gerontol. A Biol. Sci. Med. Sci., October 1, 2006; 61(10): 1051 - 1052. [Full Text] [PDF]
|
|
|
|
 |
|
 A. Tarasiuk, S. Greenberg-Dotan, T. Simon, A. Tal, A. Oksenberg, and H. Reuveni Low socioeconomic status is a risk factor for cardiovascular disease among adult obstructive sleep apnea syndrome patients requiring treatment. Chest, September 1, 2006; 130(3): 766 - 773. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 H. Kuper, H.-O. Adami, T. Theorell, and E. Weiderpass Psychosocial Determinants of Coronary Heart Disease in Middle-Aged Women: A Prospective Study in Sweden Am. J. Epidemiol., August 15, 2006; 164(4): 349 - 357. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M.-A. Munoz, I. Rohlfs, S. Masuet, C. Rebato, M. Cabanero, J. Marrugat, and for the ICAR Study Group Analysis of inequalities in secondary prevention of coronary heart disease in a universal coverage health care system Eur J Public Health, August 1, 2006; 16(4): 361 - 367. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. A. Alter and for the SESAMI Study Group Socioeconomic Status and Mortality Ann Intern Med, May 16, 2006; 144(10): 782 - 782. [Full Text] [PDF]
|
|
|
|
|
|
M. H. Shishehbor and D. Litaker Socioeconomic Status and Mortality Ann Intern Med, May 16, 2006; 144(10): 781 - 782. [Full Text] [PDF]
|
|
|
|
|
|
J. Lynch, G. Davey Smith, S. Harper, and K. Bainbridge Explaining the social gradient in coronary heart disease: comparing relative and absolute risk approaches J. Epidemiol. Community Health, May 1, 2006; 60(5): 436 - 441. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L. L. Yan, K. Liu, M. L. Daviglus, L. A. Colangelo, C. I. Kiefe, S. Sidney, K. A. Matthews, and P. Greenland Education, 15-year risk factor progression, and coronary artery calcium in young adulthood and early middle age: the Coronary Artery Risk Development in Young Adults study. JAMA, April 19, 2006; 295(15): 1793 - 1800. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. N Rasmussen, S. Rasmussen, G. H Gislason, P. Buch, S. Z Abildstrom, L. Kober, M. Osler, F. Diderichsen, C. Torp-Pedersen, and M. Madsen Mortality after acute myocardial infarction according to income and education. J. Epidemiol. Community Health, April 1, 2006; 60(4): 351 - 356. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. B. Loucks, L. M. Sullivan, L. J. Hayes, R. B. D'Agostino Sr., M. G. Larson, R. S. Vasan, E. J. Benjamin, and L. F. Berkman Association of Educational Level with Inflammatory Markers in the Framingham Offspring Study Am. J. Epidemiol., April 1, 2006; 163(7): 622 - 628. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. Silventoinen, S. Zdravkovic, A. Skytthe, P. McCarron, A. M. Herskind, M. Koskenvuo, U. de Faire, N. Pedersen, K. Christensen, J. Kaprio, et al. Association between Height and Coronary Heart Disease Mortality: A Prospective Study of 35,000 Twin Pairs Am. J. Epidemiol., April 1, 2006; 163(7): 615 - 621. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Koster, H. Bosma, B. W. J. H. Penninx, A. B. Newman, T. B. Harris, J. Th. M. van Eijk, G. I. J. M. Kempen, E. M. Simonsick, K. C. Johnson, R. N. Rooks, et al. Association of inflammatory markers with socioeconomic status. J. Gerontol. A Biol. Sci. Med. Sci., March 1, 2006; 61(3): 284 - 290. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G. Engstrom, B. Hedblad, M. Rosvall, L. Janzon, and F. Lindgarde Occupation, Marital Status, and Low-Grade Inflammation: Mutual Confounding or Independent Cardiovascular Risk Factors? Arterioscler. Thromb. Vasc. Biol., March 1, 2006; 26(3): 643 - 648. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L. Fezeu, E. Minkoulou, B. Balkau, A.-P. Kengne, P. Awah, N. Unwin, G. K. Alberti, and J.-C. Mbanya Association between socioeconomic status and adiposity in urban Cameroon Int. J. Epidemiol., February 1, 2006; 35(1): 105 - 111. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. A. Alter, A. Chong, P. C. Austin, C. Mustard, K. Iron, J. I. Williams, C. D. Morgan, J. V. Tu, J. Irvine, C. D. Naylor, et al. Socioeconomic Status and Mortality after Acute Myocardial Infarction Ann Intern Med, January 17, 2006; 144(2): 82 - 93. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. Regidor, J. L Gutierrez-Fisac, J. R Banegas, V. Dominguez, and F. Rodriguez-Artalejo Association of adult socioeconomic position with hypertension in older people J. Epidemiol. Community Health, January 1, 2006; 60(1): 74 - 80. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. C. Thurston, L. D. Kubzansky, I. Kawachi, and L. F. Berkman Do Depression and Anxiety Mediate the Link Between Educational Attainment and CHD? Psychosom Med, January 1, 2006; 68(1): 25 - 32. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. Simpson, I. Janssen, W. M Craig, and W. Pickett Multilevel analysis of associations between socioeconomic status and injury among Canadian adolescents J. Epidemiol. Community Health, December 1, 2005; 59(12): 1072 - 1077. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. D. Low, B. J. Low, E. R. Baumler, and P. T. Huynh Can education policy be health policy? Implications of research on the social determinants of health. Journal of Health Politics Policy and Law, December 1, 2005; 30(6): 1131 - 1162. [Abstract] [PDF]
|
|
|
|
|
|
D. Jaffe, Z Eisenbach, Y. Neumark, and O Manor Does one's own and one's spouse's education affect overall and cause-specific mortality in the elderly? Int. J. Epidemiol., December 1, 2005; 34(6): 1409 - 1416. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. M. O'Rand and J. Hamil-Luker Processes of Cumulative Adversity: Childhood Disadvantage and Increased Risk of Heart Attack Across the Life Course J. Gerontol. B. Psychol. Sci. Soc. Sci., October 1, 2005; 60(suppl_Special_Issue_2): S117 - S124. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. V. Diez Roux, R. Detrano, S. Jackson, D. R. Jacobs Jr, P. J. Schreiner, S. Shea, and M. Szklo Acculturation and Socioeconomic Position as Predictors of Coronary Calcification in a Multiethnic Sample Circulation, September 13, 2005; 112(11): 1557 - 1565. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Koster, B. W. J. H. Penninx, H. Bosma, G. I. J. M. Kempen, T. B. Harris, A. B. Newman, R. N. Rooks, S. M. Rubin, E. M. Simonsick, J. T. M. van Eijk, et al. Is There a Biomedical Explanation for Socioeconomic Differences in Incident Mobility Limitation? J. Gerontol. A Biol. Sci. Med. Sci., August 1, 2005; 60(8): 1022 - 1027. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. Ordunez, J. L. B. Munoz, A. Espinosa-Brito, L. C. Silva, and R. S. Cooper Ethnicity, Education, and Blood Pressure in Cuba Am. J. Epidemiol., July 1, 2005; 162(1): 49 - 56. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. C. Thurston, L. D. Kubzansky, I. Kawachi, and L. F. Berkman Is the Association between Socioeconomic Position and Coronary Heart Disease Stronger in Women than in Men? Am. J. Epidemiol., July 1, 2005; 162(1): 57 - 65. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. V. Diez Roux Persistent Social Patterning of Cardiovascular Risk: Rethinking the Familiar Circulation, June 14, 2005; 111(23): 3020 - 3021. [Full Text] [PDF]
|
|
|
|
|
|
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]
|
|
|
|
|
|
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]
|
|
|
|
|
|
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]
|
|
|
|
 |
|
 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]
|
|
|
|
|
|
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]
|
|
|
|
|
|
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]
|
|
|
|
 |
|