Socioeconomic inequalities in cardiovascular disease mortality - An international study

Background Differences between socioeconomic groups in mortality from and r isk factors for cardiovascular diseases have been reported in many countrie s. We have made a comparative analysis of these inequalities in the United States and ii western European countries. The aims of the analysis were (1) to compare the size of inequalities in cardiovascular disease mortality be tween countries, and (2) to explore the possible contribution of cardiovasc ular risk factors to the explanation of between-country differences in ineq ualities in cardiovascular disease mortality. Data and Methods Data on ischaemic heart disease, cerebrovascular disease a nd total cardiovascular disease mortality by occupational class and/or educ ational level were obtained from national longitudinal or unlinked cross-se ctional studies. Data on smoking, alcohol consumption, overweight and infre quent consumption of fresh vegetables by occupational class and/or educatio nal level were obtained from national health interview or multipurpose surv eys and from the European Union's Eurobarometer survey. Age-adjusted rate r atios for mortality were correlated with age-adjusted odds ratios for the b ehavioural risk factors. Results In all countries mortality from cardiovascular diseases is higher a mong persons with lower occupational class or lower educational level. With in western Europe, a north-south gradient is apparent, with relative and ab solute inequalities being larger in the north than in the south. For ischae mic heart disease, but not for cerebrovascular disease, an even more striki ng north-south gradient is seen, with some 'reverse' inequalities in southe rn Europe. The United States occupy intermediate positions on most indicato rs. Inequalities in cardiovascular disease mortality are associated with in equalities in some risk factors, especially cigarette smoking and excessive alcohol consumption. Conclusions Socioeconomic inequalities in cardiovascular disease mortality are a major public health problem in most industrialized countries. Closing the gap between low and high socioeconomic groups offers great potential f or reducing cardiovascular disease mortality. Developing effective methods of behavioural risk factor reduction in the lower socioeconomic groups shou ld be a top priority in cardiovascular disease prevention. (Eur Heart J 200 0; 21: 1141-1151) (C) 2000 The European Society of Cardiology.