Social class differences in ischaemic heart disease in British men
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Ischaemic heart disease (IHD) is more common in manual workers due to smoking, obesity, and inactivity. Addressing these risk factors, particularly smoking, could help reduce IHD disparities.
Area of Science:
- Cardiovascular epidemiology
- Public health research
- Occupational health
Background:
- Ischaemic heart disease (IHD) mortality rates in Britain are notably higher among manual laborers compared to non-manual workers.
- Understanding the underlying reasons for this social class disparity in IHD is crucial for targeted public health interventions.
Purpose of the Study:
- To investigate the factors contributing to the elevated incidence of ischaemic heart disease (IHD) in middle-aged British men employed in manual occupations compared to non-manual roles.
- To identify specific lifestyle and physiological differences that may explain the higher IHD attack rates in manual workers.
Main Methods:
- A prospective cohort study involving 7735 middle-aged men from the British Regional Heart Study.
- Follow-up for 6 years, recording major IHD events (myocardial infarction, sudden cardiac death).
- Analysis of prevalence rates, attack rates, and adjustment for risk factors including smoking, blood pressure, obesity, and physical activity.
Main Results:
- Manual workers exhibited higher IHD prevalence at screening and a 44% greater attack rate during follow-up.
- Cigarette smoking was a significant contributor to the increased IHD risk in manual workers.
- Higher blood pressure, obesity, and lower leisure-time physical activity levels were also observed in manual workers.
- Adjusting for these risk factors reduced, but did not eliminate, the difference in IHD attack rates between social classes.
Conclusions:
- While lifestyle factors like smoking, obesity, and physical inactivity contribute to higher IHD rates in manual workers, they do not fully explain the disparity.
- Given the high overall IHD risk across all social classes in Great Britain, broad prevention policies may be more effective than class-specific ones.
- Targeted anti-smoking strategies that consider social class differences are recommended to address IHD risk.
Abstract:
To examine why ischaemic heart disease (IHD) mortality rates in Britain are higher in manual than in non-manual workers 7735 middle-aged men in the British Regional Heart Study were followed up for 6 years, during which time 336 men experienced a major IHD event (fatal or non-fatal myocardial infarction or sudden cardiac death). The prevalence rates of IHD at screening, were higher in manual workers. Also, the attack rate of major IHD events during follow-up was 44% higher in manual workers. Marked differences in cigarette smoking contributed substantially to the increased risk of IHD in manual workers, who also had higher levels of blood pressure, were more obese, and took much less physical activity in leisure time. Adjustment for differences in these risk factors narrowed the gap between manual and non-manual workers in attack rates of IHD. Since the risk of IHD in Great Britain is high in all social classes, there would seem to be little justification for any overall policy for prevention of IHD to focus on social class. However, anti-smoking strategies might well take into account the social class differences described.