Abstract MP04: Individual Material and Social Deprivation is Associated with Poor Cardiovascular Health. The Paris Prospective Study III
Purpose: Primordial prevention has been recognized as a public health priority, by the American Heart Association and more recently by the United Nations and World Health Organization. Reduction in social inequalities in health is a major challenge. We hypothesized that subjects in a socio-economical precarious position would be characterized by a poor cardiovascular health (CVH).
Methods: We included 8748 men and women aged 50-75 years who enrolled the Paris Prospective Study III from June 2008 to May 2012 (Paris, France). The CVH status was defined as poor (0 or 1 ideal health metric), intermediate (2, 3 or 4 ideal health metrics) and ideal (5, 6 or 7 ideal health metrics). A validated multidimensional index (ranging from 0 to 100) of material and social deprivation including 11 questions derived from a principal component analysis (based on 42 questions) and covering employment, income, education, socio professional categories, accommodation, family composition, social networking, financial difficulties, life events and perceived health was used. The association of individual deprivation index (in quartiles) with poor and intermediate CVH as compared to ideal CVH was estimated by multivariable polytomic logistic regression analysis.
Results: Mean age was 59.5 (standard deviation: 6.2), 61.5% were men and 40% had more than 12 years of school education. One-fourth of the study cohort was precarious (score of material deprivation>30), slightly more women than men. The prevalence of poor and ideal CVH was respectively 43.3% and 8.6% in precarious subjects compared to 39.4% and 10.7% in the non precarious (p<0.001). After adjusting for age, sex, depressive symptoms, migrant status and ethnicity, the odds of poor CVH was 1.38 (95%: 1.12-1.70), 1.55 (1.25-1.91) and 1.86 (1.48-2.32) for the second, third and fourth quartile of the individual deprivation index compared to the first quartile (p for trend<0.001). This reflected an association with the behavioural but not the biological component of CVH. In sex stratified analyses, associations were stronger in magnitude and were significant for each upper quartile of the deprivation index whereas in men only the last quartile was significant (p for interaction=0.04). Furthermore and contrary to the main analysis, a significant association between individual deprivation and the biological component of CVH was noted in women but not in men (p for interaction=0.002).
Conclusion: Subjects from the community in precarious situation are more frequently in poor cardiovascular health and should be targeted in priority for primordial prevention. The reasons behind the gender difference deserve additional investigations.
Author Disclosures: J. Empana: None. B. Gaye: None. M. Perier: None. C. Guibout: None. F. Thomas: None. B. Pannier: None. P. Boutouyrie: None. X. Jouven: None.
- © 2016 by American Heart Association, Inc.