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      Combined effect of educational status and cardiovascular risk factors on the incidence of coronary heart disease and stroke in European cohorts: Implications for prevention

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          Background The combined effect of social status and risk factors on the absolute risk of cardiovascular disease has been insufficiently investigated, but results provide guidance on who could benefit most through prevention. Methods We followed 77,918 cardiovascular disease-free individuals aged 35-74 years at baseline, from 38 cohorts covering Nordic and Baltic countries, the UK and Central Europe, for a median of 12 years. Using Fine-Gray models in a competing-risks framework we estimated the effect of the interaction of education with smoking, blood pressure and body weight on the cumulative risk of incident acute coronary heart disease and stroke. Results Compared with more educated smokers, the less educated had an added increase in absolute risk of cardiovascular disease of 3.1% (95% confidence interval + 0.1%, +6.2%) in men and of 1.5% (-1.9%, +5.0%) in women, consistent across smoking categories. Conversely, the interaction was negative for overweight: -2.6% (95% CI: -5.6%, +0.3%) and obese: -3.6% (-7.6%, +0.4%) men, suggesting that the more educated would benefit more from the same reduction in body weight. A weaker interaction was observed for body weight in women, and for blood pressure in both genders. Less educated men and women with a cluster of two or more risk factors had an added cardiovascular disease risk of 3.6% (+0.1%, +7.0%) and of 2.6% (-0.5%, +5.6%), respectively, compared with their more educated counterparts. Conclusions Socially disadvantaged subjects have more to gain from lifestyle and blood pressure modification, hopefully reducing both their risk and also social inequality in disease.

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          Most cited references24

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          A Proportional Hazards Model for the Subdistribution of a Competing Risk

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            Indicators of socioeconomic position (part 1).

            This glossary presents a comprehensive list of indicators of socioeconomic position used in health research. A description of what they intend to measure is given together with how data are elicited and the advantages and limitation of the indicators. The glossary is divided into two parts for journal publication but the intention is that it should be used as one piece. The second part highlights a life course approach and will be published in the next issue of the journal.
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              Inequalities in non-communicable diseases and effective responses

              In most countries, people who have a low socioeconomic status and those who live in poor or marginalised communities have a higher risk of dying from non-communicable diseases (NCDs) than do more advantaged groups and communities. Smoking rates, blood pressure, and several other NCD risk factors are often higher in groups with low socioeconomic status than in those with high socioeconomic status; the social gradient also depends on the country's stage of economic development, cultural factors, and social and health policies. Social inequalities in risk factors account for more than half of inequalities in major NCDs, especially for cardiovascular diseases and lung cancer. People in low-income countries and those with low socioeconomic status also have worse access to health care for timely diagnosis and treatment of NCDs than do those in high-income countries or those with higher socioeconomic status. Reduction of NCDs in disadvantaged groups is necessary to achieve substantial decreases in the total NCD burden, making them mutually reinforcing priorities. Effective actions to reduce NCD inequalities include equitable early childhood development programmes and education; removal of barriers to secure employment in disadvantaged groups; comprehensive strategies for tobacco and alcohol control and for dietary salt reduction that target low socioeconomic status groups; universal, financially and physically accessible, high-quality primary care for delivery of preventive interventions and for early detection and treatment of NCDs; and universal insurance and other mechanisms to remove financial barriers to health care. Copyright © 2013 Elsevier Ltd. All rights reserved.

                Author and article information

                European Journal of Preventive Cardiology
                Eur J Prev Cardiolog
                SAGE Publications
                January 13 2017
                March 2017
                November 12 2016
                March 2017
                : 24
                : 4
                : 437-445
                [1 ]Centro Ricerche EPIMED – Epidemiologia e Medicina Preventiva, Università degli Studi dell'Insubria, Varese, Italy
                [2 ]Cardiovascular Epidemiology Unit, Institute of Cardiovascular Research, University of Dundee, UK
                [3 ]UKCRC Centre of Excellence for Public Health Research, Queens University Belfast, UK
                [4 ]THL-National Institute for Health and Welfare, Helsinki, Finland
                [5 ]Department of Biostatistics, University of North Carolina at Chapel Hill, USA
                [6 ]Department of Epidemiology & Public Health, Pasteur Institute of Lille, France
                [7 ]Department of Epidemiology and Public Health, EA 3430, FMTS, University of Strasbourg, France
                [8 ]Research Department of Epidemiology and Public Health, University College London, UK
                [9 ]Department of Cardiology, Toulouse University School of Medicine, France
                [10 ]Istituto Superiore di Sanità, Rome, Italy
                [11 ]Research Centre for Prevention and Health, Capital Region of Denmark, Glostrup, Denmark
                [12 ]Department of Public Health, Faculty of Medical Science, University of Copenhagen, Denmark
                [13 ]Faculty of Medicine, Aalborg University, Denmark
                [14 ]Helmholtz Zentrum München – German Research Centre for Environmental Health, Neuherberg, Germany
                [15 ]Department of Public Health and Clinical Medicine, Cardiology and Heart Centre, Umeå University, Sweden
                [16 ]Institute of Cardiology, Lithuanian University of Health Sciences, Kaunas, Lithuania
                [17 ]Centro Studi e Ricerche in Sanità Pubblica (CESP), Università degli Studi di Milano-Bicocca, Monza, Italy
                © 2017




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