Understanding social variation in cardiovascular risk factors in women andmen: the advantage of theoretically based measures

Many studies have attempted to understand observed social variations in car diovascular disease in terms of sets of intermediate or confounding risk fa ctors. Tests of these models have tended to produce inconsistent evidence. This paper examines the relationships to cardiovascular risk factors or two theoretically based measures of social position. Tt shows that the strengt h of the relationships between social position and cardiovascular risk fact ors varies according to the definition of social position which is used: th ere is a closer relationship between most health behaviours and the Cambrid ge scale, an indicator of 'general social advantage and lifestyle', whereas the Erikson-Goldthorpe schema, which is based on employment relations and conditions, is more strongly related to work control and breathlessness. Th e implications of these findings for understanding the conflicting evidence in other studies of health inequalities are then discussed. The paper conc ludes that inconsistencies between studies may be in part due to unexamined differences between the conceptual bases of the measures of social positio n they use, combined with a failure to make explicit the hypothetical mecha nisms of effect. If neither the conceptual basis of the measure of social p osition, nor the links between social position and health outcome tested in each study are clear, inconsistencies between studies will be difficult to interpret, making policy recommendations highly problematic. (C) 1999 Publ ished by Elsevier Science Ltd. All rights reserved.