Social class and coronary heart disease

Area of Science:

• Epidemiology
• Cardiovascular Disease Research
• Social Determinants of Health

Background:

• Significant disparities in coronary heart disease (CHD) mortality exist across social classes in England and Wales.
• CHD mortality has risen in working-class men while remaining stable in professional men over 40 years.
• This social class gradient is more pronounced in women and has persisted for decades.

Purpose of the Study:

• To investigate the social class gradient in coronary heart disease prevalence and mortality.
• To identify risk factors contributing to the disparity in CHD between different social classes.
• To explore unexplained factors influencing CHD risk in higher social strata.

Main Methods:

• Analysis of mortality data in England and Wales over 40 years.
• Utilized the Whitehall Study, surveying 17,530 London civil servants aged 40-64.
• Compared CHD prevalence and 7.5-year coronary mortality between lowest and top employment grades.

Main Results:

• Lower social grades exhibited significantly higher age-adjusted prevalence rates for angina and electrocardiographic abnormalities.
• Coronary mortality was 3.6 times higher in the lowest employment grade compared to the top grade.
• Known risk factors like smoking, obesity, and hypertension partially explained the difference, but a substantial portion remains unexplained.

Conclusions:

• A strong social class gradient in coronary heart disease exists, with lower social classes facing substantially higher risks.
• While established risk factors contribute, significant unidentified factors likely influence CHD risk across social strata.
• Further research is needed to uncover these novel risk factors to understand and mitigate social inequalities in cardiovascular health.