American Journal of Epidemiology Vol. 144, No. 10: 934-942
Copyright © 1996 by The Johns Hopkins University School of Hygiene and Public Health
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Do Cardiovascular Risk Factors Explain the Relation between Socioeconomic Status, Risk of All-Cause Mortality, Cardiovascular Mortality, and Acute Myocardial Infarction?
1Human Population Laboratory, California Public Health Foundation Berkeley, CA
2National Public Health Institute Helsinki, Finland
3Department of Community Health and General Practice, University of Kuopio Kuopio, Finland
Reprint requests to Dr. John W. Lynch, Human Population Laboratory, 2151 Berkeley Way, Annex 2, Berkeley CA 94704.
Much remains to be understood about how low socioeconomic status (SES) increases cardiovascular disease and mortality risk. Data from the Kuopio Ischemic Heart Disease Risk Factor Study (1984–1993) were used to estimate the associations between acute myocardial infarction and income, all-cause mortality, and cardiovascular mortality in a population-based sample of 2, 272 Finnish men, with adjustment for 23 biologic, behavioral, psychologic, and social risk factors. Compared with the highest income quintile, those in the bottom quintile had age-adjusted relative hazards of 3.14 (95% confidence interval (Cl) 1.77–5.56), 2.66 (95% Cl 1.25–5.66), and 4.34 (95% Cl 1.95–9.66) for all-cause mortality, cardiovascular mortality, and AMI, respectively. After adjustment for risk factors, the relative hazards for the same comparisons were 1.32 (95% Cl 0.70–2.49), 0.70 (95% Cl 0.29–1.69), and 2.83 (95% Cl 1.14–7.00). In the lowest income quintile, adjustment for risk factors reduced the excess relative risk of all-cause mortality by 85%, that of cardiovascular mortality by 118%, and that of acute myocardial infarction by 45%. These data show how the association between SES and cardiovascular mortality and all-cause mortality is mediated by known risk factor pathways, but full "explanations" for these associations will need to encompass why these biologic, behavioral, psychologic, and social risk factors are differentially distributed by SES. Am J Epidemiol 1996; 144: 934-42.
mortality; myocardial infarction; risk factors; socioeconomic factors
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