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The contribution of modifiable risk factors to socioeconomic inequities in cardiovascular disease morbidity and mortality: A nationally representative population-based cohort study

Sara Nejatinamini · David J.T. Campbell · Jenny Godley · Leia Michelle Minaker · Tolulope T. Sajobi · Gavin R. McCormack +1 more

10 citations0/0 files storedPreventive Medicine

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Health disparities and outcomes Health Promotion and Cardiovascular Prevention Cardiovascular Health and Risk Factors

Abstract

This study examined the individual and joint effects of modifiable risk factors mediating the associations between socioeconomic position (SEP) and morbidity and mortality from cardiovascular diseases (CVD) in a nationally representative sample of adults in Canada. Participants in the Canadian Community Health Survey (n = 289,800) were followed longitudinally for CVD morbidity and mortality using administrative health and mortality data. SEP was measured as a latent variable consisting of household income and individual educational attainment. Mediators included smoking, physical inactivity, obesity, diabetes and hypertension. The primary outcome was CVD morbidity and mortality, defined as the first fatal/nonfatal CVD event during follow-up (median 6.2 years). Generalized structural equation modeling tested the mediating effects of modifiable risk factors in associations between SEP and CVD in the total population and stratified by sex. Lower SEP was associated with 2.5 times increased odds of CVD morbidity and mortality (OR: 2.52, 95% CI: 2.28, 2.76). Modifiable risk factors mediated 74% of associations between SEP and CVD morbidity and mortality in the total population and were more important mediators of associations in females (83%) than males (62%). Smoking mediated these associations independently and jointly with other mediators. The mediating effects of physical inactivity were through joint mediating effects with obesity, diabetes or hypertension. There were additional joint mediating effects of obesity through diabetes or hypertension in females. Findings point to modifiable risk factors as important targets for interventions along with interventions that target structural determinants of health to reduce socioeconomic inequities in CVD.

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2019Modifiable risk factors, cardiovascular disease, and mortality in 155 722 individuals from 21 high-income, middle-income, and low-income countries (PURE): a prospective cohort study 2010Association of Socioeconomic Position With Health Behaviors and Mortality 2018The contribution of health behaviors to socioeconomic inequalities in health: A systematic review 2001Gender and health: reassessing patterns and explanations 1999Gender differences in structural and behavioral determinants of health: an analysis of the social production of health 2016Sex differences in the relationship between socioeconomic status and cardiovascular disease: a systematic review and meta-analysis 2007Socioeconomic Position, Co-Occurrence of Behavior-Related Risk Factors, and Coronary Heart Disease: the Finnish Public Sector Study 2006Explaining the social gradient in coronary heart disease: comparing relative and absolute risk approaches

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