CHANGING SOCIAL PATTERNS OF RISK-FACTORS FOR CARDIOVASCULAR-DISEASE IN A SWEDISH COMMUNITY INTERVENTION PROGRAM

Since 1985 a small-scale community-based cardiovascular disease (CVD) preventive programme has been in operation in an inland municipality, Norsjo, in Northern Sweden. The aim of this study was to assess the de velopment of the relationship between social position and CVD risk fac tors in repeated cross-sectional surveys (1985-1990) among all men and women aged 30, 40, 50 and 60 years in the study area, using an age-st ratified random sample from the Northern Sweden MONICA Study of 1986 a nd 1990 as reference population. These multiple cross-sectional survey s comprised a self-administered questionnaire and a health examination . Of the study population 95% (n = 1499) and 80% of those in the refer ence area (n = 3208) participated. Subjects were classified with regar d to demographic, structural and social characteristics in relation to CVD risk factors and self-reported health status. Time trends in clas sical risk factor occurrence were assessed in terms of age- and sex- a djusted odds ratios using Mantel-Haenszel procedures. When simultaneou sly adjusting for several potential confounders we used a logistic reg ression analysis. Initially, more than half of the study population, b oth males and females, had an elevated (greater than or equal to 6.5 m mol/l) serum cholesterol level. After adjustments had been made for ag e and social factors it was found that the relative risk of hyperchole sterolaemia dropped substantially and significantly among both sexes d uring the 6 years df CVD intervention in the study area. However, the probability of being a smoker was significantly reduced only in highly educated groups. Among other risk factors no single statistically sig nificant change over time could be found. In the reference area there were no changes over time for the selected CVD risk factors. People in the study area had a less favourable perception of their health than those in the reference area. Social differences were found when percei ved good health was measured, especially in variables indicating emoti onal and social support. When sex, age and social factors had been acc ounted for there was no clear change over the years in perceived good health.