Abstract P089: Social Inequalities in Coronary Heart Disease Across European Populations. The MORGAM Project Cohort Component
Aims: To compare the magnitude of educational classes inequalities in CHD morbidity in Europe, and to assess to what extent they are explained by major risk factors.
Methods: The MORGAM study comprised 45 cohorts from Finland, Denmark, Sweden, Northern Ireland, Scotland, France, Germany, Northern Italy, Lithuania, Poland and Russia. Baseline data collection and follow-up (median 12 years) of fatal and non-fatal CHD events adhered to MONICA-like procedures. We derived 3 educational classes from population-, sex- and birth year-specific tertiles of years of schooling.
We estimated the age-adjusted difference in event rates, and the age- and risk factors-adjusted hazard ratio (HR), between the bottom and the top of the educational classes distribution from sex- and population-specific Poisson and Cox regression models, respectively. We provided pooled HR estimates too, and tested the hypothesis of homogeneity of inequalities adding population*education interaction terms. We defined the contribution of risk factors to HRs as (lnHR[RFadj]- lnHR[AGEadj]) / lnHR[AGEadj] .
Results: The cohorts included 89,307 CHD-free subjects aged 35-64 at baseline (48,706 men). The age-adjusted difference in CHD incidence rates ranged in men from 116 CHD events per 100,000 person-years in Germany to 782 in Scotland; in women from 17 (West Finland) to 391 (Scotland). In north Italian women the rate difference corresponded to 130% of the average event rate. Age-adjusted pooled HRs were 1.6 in men and 2.0 in women, with some variability across populations (homogeneity test p-value=0.3 in men and 0.1 in women) and genders (figure). Blood lipids, systolic BP, smoking and diabetes explained 37% of risk excess in each sex; main contributors were smoking in men (20%) and HDL-cholesterol in women (14%). Geographic gradients for CHD mortality were similar.
Conclusions: Social inequalities in CHD are present in most European populations, with no clear North-South geographic gradient in women. To target major risk factors may in part reduce the gap.
Author Disclosures: G. Veronesi: None. M.M. Ferrario: None. L.E. Chambless: None. K. Kuulasmaa: None. S. Soderberg: None. V. Salomaa: None. A. Pajak: None. P. Amouyel: None. D. Arveiler: None. W. Drygas: None. J. Ferrieres: None. N. Hart: None. T. Jorgensen: None. S. Malyutina: None. A. Peters: None. A. Tamosiunas: None. H. Tunstall-Pedoe: None. G. Cesana: None.
- © 2015 by American Heart Association, Inc.