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      Trends in socioeconomic inequalities in five major risk factors for cardiovascular disease in the Korean population: a cross-sectional study using data from the Korea National Health and Nutrition Examination Survey, 2001–2014

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          Abstract

          Objectives

          To examine trends in socioeconomic inequalities in major cardiovascular disease (CVD) risk factors among the Korean population.

          Design

          Cross-sectional study.

          Setting

          A nationally representative population survey database.

          Participants

          A total of 42 725 Koreans, aged 25–64 years, who participated in the Korean National Health and Nutrition Examination Survey (KNHANES) II (2001) to VI (2013–2014).

          Main outcome measures

          Trends in socioeconomic inequalities in five major CVD risk factors (smoking, obesity, diabetes, hypertension and hypercholesterolaemia).

          Results

          Gender differences were noted in the time trends in socioeconomic inequalities in smoking, obesity, diabetes and hypertension. Among men, low socioeconomic status (SES) was associated with higher prevalence of smoking, but not with obesity, diabetes or hypertension. The magnitudes of socioeconomic inequalities in smoking, obesity and diabetes remained unchanged, and the magnitude of the inequality in hypertension decreased over time. However, among women, low SES was associated with higher prevalence of smoking, obesity, diabetes and hypertension. Time trends towards increasing socioeconomic inequalities, measured by income, in smoking, obesity and diabetes were found in women. Unlike the other CVD risk factors, hypercholesterolaemia was not associated with socioeconomic inequality.

          Conclusions

          SES had a stronger impact on major CVD risk factors among Korean women than men. Moreover, socioeconomic inequalities in smoking, obesity and diabetes worsened among Korean women over time. Public policies to prevent smoking, obesity and diabetes in women with lower SES are needed to address inequalities.

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          Most cited references25

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          Assessment of Cardiovascular Risk by Use of Multiple-Risk-Factor Assessment Equations: A Statement for Healthcare Professionals From the American Heart Association and the American College of Cardiology

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            Socioeconomic status and trends in disparities in 4 major risk factors for cardiovascular disease among US adults, 1971-2002.

            It is unknown whether the previously recognized disparities in cardiovascular disease (CVD) risk factors related to annual income and educational level have diminished, persisted, or worsened in recent decades. The objective of this study was to examine 31-year trends in CVD risk factors by annual income and educational levels among US adults. Four cross-sectional national surveys were used: National Health and Nutrition Examination Survey I (1971-1974), II (1976-1980), III (1988-1994), and 1999-2002. The main outcome measure was prevalence of high cholesterol (> or =240 mg/dL [> or =6.2 mmol/L]), high blood pressure (140/90 mm Hg), smoking, and diabetes mellitus. Between 1971 and 2002, the prevalence of all CVD risk factors, except diabetes, decreased in all income and education groups, but there has been little reduction in income- and education-related disparities in CVD risk factors and few improvements during the past 10 years. The prevalence of high blood pressure declined by about half in all income and education groups, ranging from 30.3% to 40.6% in 1971-1974 and 16.4% in 1999-2002, with the greatest reduction among those in the lowest income quartile and those with less than a high school education (18.0 and 15.9 percentage points, respectively). High cholesterol prevalence also declined in all groups and ranged from 28.8% to 32.4% in 1971-1974 and 15.3% to 22.0% in 1999-2002, with the largest decline (15.9 percentage points) among people with the highest incomes. Education- and income-related disparities in smoking widened considerably, because there were large declines in smoking prevalence among people with high incomes and education (from about 33% in 1971-1974 to about 14%-17% in 1999-2002) but only marginal reductions among those with low incomes and education (about 6-percentage point decline). Diabetes prevalence increased most among persons with low incomes and education. Despite the general success in reducing CVD risk factors in the US population, not all segments of society are benefiting equally and improvements may have slowed. Education- and income-related disparities have worsened for smoking, and increases in diabetes prevalence have occurred primarily among persons with a lower socioeconomic status. Diabetes prevention and smoking prevention and cessation programs need to specifically target persons of lower income and education.
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              Smoking in China: findings of the 1996 National Prevalence Survey.

              As the world's largest producer and consumer of tobacco products, China bears a large proportion of the global burden of smoking-related disease and may be experiencing a tobacco epidemic. To develop an evidence-based approach supporting tobacco control initiatives in China. A population-based survey consisting of a 52-item questionnaire that included information on demographics, smoking history, smoking-related knowledge and attitudes, cessation, passive smoke exposure, and health status was administered in 145 disease surveillance points in the 30 provinces of China from March through July 1996. A nationally representative random sample of 128766 persons aged 15 to 69 years were asked to participate; 120298 (93.8%) provided data and were included in the final analysis. About two thirds of those sampled were from rural areas and one third were from urban areas. Current smoking patterns and attitudes; changes in smoking patterns and attitudes compared with results of a previous national survey conducted in 1984. A total of 41187 respondents smoked at least 1 cigarette per day, accounting for 34.1% of the total number of respondents, an increase of 3.4 percentage points since 1984. Current smoking continues to be prevalent among more men (63%) than women (3.8%). Age at smoking initiation declined by about 3 years for both men and women (from 28 to 25 years). Only a minority of smokers recognized that lung cancer (36%) and heart disease (4%) can be caused by smoking. Of the nonsmokers, 53.5% were exposed to environmental tobacco smoke at least 15 minutes per day on more than 1 day per week. Respondents were generally supportive of tobacco control measures. The high rates of smoking in men found in this study signal an urgent need for smoking prevention and cessation efforts; tobacco control initiatives are needed to maintain or decrease the currently low smoking prevalence in women.
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                Author and article information

                Journal
                BMJ Open
                BMJ Open
                bmjopen
                bmjopen
                BMJ Open
                BMJ Open (BMA House, Tavistock Square, London, WC1H 9JR )
                2044-6055
                2017
                17 May 2017
                : 7
                : 5
                : e014070
                Affiliations
                [1 ] departmentDivision of Endocrinology and Metabolism, Department of Internal Medicine , Hangang Sacred Heart Hospital, Hallym University Medical Center , Seoul, Republic of Korea
                [2 ] departmentClinical Research Center , Asan Medical Center, University of Ulsan College of Medicine , Seoul, Republic of Korea
                [3 ] departmentDivision of Endocrinology and Metabolism, Department of Internal Medicine , Kangdong Sacred Heart Hospital, Hallym University Medical Center , Seoul, Republic of Korea
                [4 ] departmentDivision of Endocrinology and Metabolism, Department of Internal Medicine , Korea University College of Medicine , Seoul, Republic of Korea
                [5 ] departmentDivision of Endocrinology and Metabolism, Department of Internal Medicine , Kangdong Sacred Heart Hospital, Hallym University Medical Center , Seoul, Republic ok Korea
                [6 ] departmentDepartment of Pediatrics , Korea University College of Medicine , Seoul, Republic of Korea
                [7 ] departmentDepartment of Obstetrics and Gynecology , Inha University Hospital , Incheon, Republic of Korea
                [8 ] departmentDivision of Endocrinology and Metabolism, Department of Internal Medicine , Korea University College of Medicine , Seoul, Republic of Korea
                [9 ] departmentDepartment of Biostatistics , Korea University College of Medicine , Seoul, Republic of Korea
                Author notes
                [Correspondence to ] Professor Sin Gon Kim; k50367@ 123456korea.ac.kr and Professor Juneyoung Lee; jyleeuf@ 123456korea.ac.kr

                YJK and JSL contributed equally.

                SGK and JL contributed equally.

                Article
                bmjopen-2016-014070
                10.1136/bmjopen-2016-014070
                5623416
                28515188
                082152ff-e2c8-4b8f-b64b-bc624bb64287
                © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

                This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

                History
                : 29 August 2016
                : 17 February 2017
                : 02 March 2017
                Funding
                Funded by: Grant of College of Medicine, Korea University;
                Categories
                Epidemiology
                Research
                1506
                1692
                Custom metadata
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                Medicine
                trend,health inequality,cardiovascular disease,cardiovascular disease risk factors
                Medicine
                trend, health inequality, cardiovascular disease, cardiovascular disease risk factors

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