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Trends in adult cardiovascular disease risk factors and their socio-economic patterning in the Scottish population 1995–2008: cross-sectional surveys
  1. Joel W Hotchkiss1,
  2. Carolyn Davies1,
  3. Linsay Gray1,
  4. Catherine Bromley2,
  5. Simon Capewell3,
  6. Alastair H Leyland1
  1. 1MRC/CSO Social and Public Health Sciences Unit, Glasgow, UK
  2. 2Scottish Centre for Social Research, Edinburgh, UK
  3. 3Division of Public Health, University of Liverpool, Liverpool, UK
  1. Correspondence to Dr Joel W Hotchkiss; joel.hotchkiss{at}


Objectives To examine secular and socio-economic changes in cardiovascular disease risk factor prevalences in the Scottish population. This could contribute to a better understanding of why the decline in coronary heart disease mortality in Scotland has recently stalled along with a widening of socio-economic inequalities.

Design Four Scottish Health Surveys 1995, 1998, 2003 and 2008 (6190, 6656, 5497 and 4202 respondents, respectively, aged 25–64 years) were used to examine gender-stratified, age-standardised prevalences of smoking, alcohol consumption, physical activity, fruit and vegetable consumption, discretionary salt use and self-reported diabetes or hypertension. Prevalences were determined according to education and social class. Inequalities were assessed using the slope index of inequality, and time trends were determined using linear regression.

Results There were moderate secular declines in the prevalence of smoking, excess alcohol consumption and physical inactivity. Smoking prevalence declined between 1995 and 2008 from 33.4% (95% CI 31.8% to 35.0%) to 29.9% (27.9% to 31.8%) for men and from 36.1% (34.5% to 37.8%) to 27.4% (25.5% to 29.3%) for women. Adverse trends in prevalence were noted for self-reported diabetes and hypertension. Over the four surveys, the diabetes prevalence increased from 1.9% (1.4% to 2.4%) to 3.6% (2.8% to 4.4%) for men and from 1.7% (1.2% to 2.1%) to 3.0% (2.3% to 3.7%) for women. Socio-economic inequalities were evident for almost all risk factors, irrespective of the measure used. These social gradients appeared to be maintained over the four surveys. An exception was self-reported diabetes where, although inequalities were small, the gradient increased over time. Alcohol consumption was unique in consistently showing an inverse gradient, especially for women.

Conclusions There has been only a moderate decline in behavioural cardiovascular risk factor prevalences since 1995, with increases in self-reported diabetes and hypertension. Adverse socio-economic gradients have remained unchanged. These findings could help explain the recent stagnation in coronary heart disease mortalities and persistence of related inequalities.

  • Cardiovascular diseases
  • risk factors
  • socio-economic factors
  • cross-sectional studies
  • Scotland
  • epidemiology
  • public health
  • social medicine
  • coronary heart disease
  • multilevel modelling
  • inequalities
  • modelling
  • prevention
  • health services research
  • mortality
  • routine data
  • statistics

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: and

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  • To cite: Hotchkiss JW, Davies C, Gray L, et al. Trends in adult cardiovascular disease risk factors and their socio-economic patterning in the Scottish population 1995–2008: cross-sectional surveys. BMJ Open 2011;1:e000176. doi:10.1136/bmjopen-2011-000176

  • Funding The Social and Public Health Sciences Unit is jointly funded by the Medical Research Council and the Chief Scientist Office of the Scottish government Health Directorate. This research was funded by the Chief Scientist Office as part of the ‘Measuring health, variations in health and determinants of health’ programme, wbs U.1300.00.001.

  • Competing interests CB had support from the Scottish Government Health Directorates (for the Scottish Health Surveys 2008–2011), and LG had support from the Scottish Centre for Social Research.

  • Contributors JWH drafted the manuscript, with contributions from all other co-authors. AHL and JWH conceived the study design with contributions from the other authors. JWH did all the analyses. JWH is guarantor. All authors had full access to all the data in the study and take full responsibility for their integrity and the accuracy of their analysis.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement The Scottish Health Survey datasets used in these analyses are available from the Economic and Social Data Service Data Catalogue

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