Circulation, Vol 88, 2172-2179, Copyright © 1993 by American Heart Association
RV Luepker, WD Rosamond, R Murphy, JM Sprafka, AR Folsom, PG McGovern and H Blackburn
BACKGROUND. Socioeconomic status (SES) indicators including education,
income, and occupation are associated with coronary heart disease (CHD)
risk factors, morbidity, and mortality. In most industrialized nations,
individuals with less education, lower income, and blue collar occupations
have the highest CHD rates. It is suggested by some that these differences
by SES are increasing even as age-adjusted CHD mortality declines. METHODS
AND RESULTS. The Minnesota Heart Survey includes measurement of CHD risk
factors and behaviors in population- based samples of Minneapolis-St. Paul
adults aged 25 to 74 years in 1980 to 1982 (N = 3243) and 1985 to 1987 (N =
4538). Education was significantly and inversely related to blood pressure,
cigarette smoking, body mass index, and a summary risk score for both men
and women. Serum cholesterol was inversely related to education in women
but not in men. Education was positively associated with leisure physical
activity and health knowledge. Associations with household income were less
consistent in magnitude and direction. Risk characteristics improved
significantly between the 1980 to 1982 and 1985 to 1987 surveys. These
changes were similar across education and household income levels.
CONCLUSIONS. Improvement in CHD risk factors over time unrelated to
education or income suggests that population- wide factors such as improved
health knowledge, availability of healthy food items, hypertension
treatment, and restrictions on cigarette smoking are operating beneficially
in all SES groups. Although the SES gradient in risk factors is not
increasing, it remains substantial and indicates directions for future
prevention efforts.
ARTICLES
Socioeconomic status and coronary heart disease risk factor trends. The Minnesota Heart Survey
Division of Epidemiology, University of Minnesota, Minneapolis 55454- 1015.
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