Social distribution of cardiovascular disease risk factors: change among men in England 1984-1993

Objective-To investigate change in the social distribution of some of the m ain risk factors for cardiovascular disease in men in England during a peri od when inequality in cardiovascular disease mortality widened Design-Age standardised comparison of the social distribution of seven know n risk factors for cardiovascular disease (body mass index, waist to hip ra tio, systolic and diastolic blood pressure, consumption of fresh green vege tables, leisure time exercise, cigarette smoking and levels of social suppo rt) in two large cross sectional representative samples of the English repr esentative population. Subjects-Men aged 20-64 years in the 1984 Health and Lifestyle Survey (excl uding Scotland and Wales) first sweep and the 1993 Health Survey for Englan d. Main outcome measures-Mean values of continuous variables; age adjusted proportions of categorical variables; change in the relative index of inequ ality for each risk factor. Results-The overall prevalence of cardiovascular disease risk factors impro ved during the period in which cardiovascular disease mortality was falling . The social distribution of cardiovascular disease risk factors, in contra st, did not become more extreme. Increases in the relative index of inequal ity for angina from 1.75 to 1.86, for eating vegetables less than once a da y from 1.76 in 1984 to 1.96 in 1993, and an apparently larger increase in i nequality of social support, from 1.92 to 2.53 were not statistically signi ficant. In most cases the degree of inequality in risk factors tended to na rrow non-significantly for example the relative index of inequality fell fr om 5.02 in 1984 to 3.07 in 1993 for systolic blood pressure, from 5.60 to 4 .29 for current smoking and from 6.24 to 4.19 for eating other than wholeme al bread as the main form of bread in the diet. The two statistically signi ficant changes in inequality were in the direction of narrowing inequality: fi om a relative index of inequality of 2.12 to 0.90 for diastolic blood p ressure (p<0.01) and from 19.3 to 0.87 (p<0.01) for psychological distress as indicated by the General Health Questionnaire. Conclusions-Healthier lifestyle options have not been adopted at a signific antly faster rate by middle class than working class people over this time period. At the population level the change in risk factors is consistent wi th falling cardiovascular mortality. The change in the social distribution of risk factors within the population, however, shows little or no relation to the pattern of widening inequality in cardiovascular mortality. This ma y be because the effect is lagged, or because the adoption of healthier beh aviour confers greater benefits on those in higher socioeconomic status gro ups.