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    Socioeconomic inequalities in cardiovascular mortality and the role of childhood socioeconomic conditions and adulthood risk factors: a prospective cohort study with 17-years of follow up.

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    32
    Author
    Kamphuis, CBM; Turrell, G; Giskes, K; Mackenbach, JP; van Lenthe, FJ
    Date
    2012-12-05
    Source Title
    BMC Public Health
    Publisher
    Springer Science and Business Media LLC
    University of Melbourne Author/s
    Turrell, Gavin
    Affiliation
    Medicine Dentistry & Health Sciences
    Metadata
    Show full item record
    Document Type
    Journal Article
    Citations
    Kamphuis, C. B. M., Turrell, G., Giskes, K., Mackenbach, J. P. & van Lenthe, F. J. (2012). Socioeconomic inequalities in cardiovascular mortality and the role of childhood socioeconomic conditions and adulthood risk factors: a prospective cohort study with 17-years of follow up.. BMC Public Health, 12 (1), pp.1045-. https://doi.org/10.1186/1471-2458-12-1045.
    Access Status
    Open Access
    URI
    http://hdl.handle.net/11343/256355
    DOI
    10.1186/1471-2458-12-1045
    Open Access at PMC
    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3539932
    Abstract
    BACKGROUND: The mechanisms underlying socioeconomic inequalities in mortality from cardiovascular diseases (CVD) are largely unknown. We studied the contribution of childhood socioeconomic conditions and adulthood risk factors to inequalities in CVD mortality in adulthood. METHODS: The prospective GLOBE study was carried out in the Netherlands, with baseline data from 1991, and linked with the cause of death register in 2007. At baseline, participants reported on adulthood socioeconomic position (SEP) (own educational level), childhood socioeconomic conditions (occupational level of respondent's father), and a broad range of adulthood risk factors (health behaviours, material circumstances, psychosocial factors). This present study is based on 5,395 men and 6,306 women, and the data were analysed using Cox regression models and hazard ratios (HR). RESULTS: A low adulthood SEP was associated with increased CVD mortality for men (HR 1.84; 95% CI: 1.41-2.39) and women (HR 1.80; 95%CI: 1.04-3.10). Those with poorer childhood socioeconomic conditions were more likely to die from CVD in adulthood, but this reached statistical significance only among men with the poorest childhood socioeconomic circumstances. About half of the investigated adulthood risk factors showed significant associations with CVD mortality among both men and women, namely renting a house, experiencing financial problems, smoking, physical activity and marital status. Alcohol consumption and BMI showed a U-shaped relationship with CVD mortality among women, with the risk being significantly greater for both abstainers and heavy drinkers, and among women who were underweight or obese. Among men, being single or divorced and using sleep/anxiety drugs increased the risk of CVD mortality. In explanatory models, the largest contributor to adulthood CVD inequalities were material conditions for men (42%; 95% CI: -73 to -20) and behavioural factors for women (55%; 95% CI: -191 to -28). Simultaneous adjustment for adulthood risk factors and childhood socioeconomic conditions attenuated the HR for the lowest adulthood SEP to 1.34 (95% CI: 0.99-1.82) for men and 1.19 (95% CI: 0.65-2.15) for women. CONCLUSIONS: Adulthood material, behavioural and psychosocial factors played a major role in the explanation of adulthood SEP inequalities in CVD mortality. Childhood socioeconomic circumstances made a modest contribution, mainly via their association with adulthood risk factors. Policies and interventions to reduce health inequalities are likely to be most effective when considering the influence of socioeconomic circumstances across the entire life course and in particular, poor material conditions and unhealthy behaviours in adulthood.

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