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Occupational social class, risk factors and cardiovascular disease incidence in men and women: a prospective study in the European Prospective Investigation of Cancer and Nutrition in Norfolk (EPIC-Norfolk) cohort

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Abstract

Objectives To investigate the association between occupational social class and cardiovascular disease (CVD) incidence, and the extent to which classical and lifestyle risk factors explain such relationships, and if any differences persist after 65 years of age. Design, Setting and Participants Prospective population study of 22,478 men and women aged 39–79 years living in the general community in Norfolk, United Kingdom, recruited using general practice age-sex registers in 1993–1997 and followed up for total mortality to 2006. Main results In both men and women an inverse relationship was observed between social class and CVD incidence, with a relative risk of social class V compared to I of 1.90 in men (95% CI 1.47 to 2.47, P < 0.001) and 1.90 in women (95% CI 1.45 to 2.49, P < 0.001). Adjusting for classical and lifestyle risk factors (age, smoking, BMI, systolic blood pressure, total blood cholesterol, history of diabetes, physical activity, weekly alcohol intake and plasma vitamin C levels) had little effect in men; the relative risk of social class V compared to I of 1.70 (95% CI 1.31 to 2.22, P < 0.001), while there was some attenuation seen in women, relative risk of social class V compared to I of 1.56 (95% CI 1.18 to 2.05, P = 0.011). The association persisted in men and women aged ≥65 years. Conclusions Some but not all of the socioeconomic differential in CVD incidence can be explained by potentially modifiable classical and lifestyle risk factors. Low social class remains a risk factor for CVD after age 65 years. Further understanding of the mechanisms underlying the association is needed if we are to reduce inequalities in health.

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Abbreviations

BMI:

Body mass index

CVD:

Cardiovascular disease

EPIC-Norfolk:

European Prospective Investigation of Cancer and Nutrition

ICD:

International Classification of Disease

SES:

Socioeconomic status

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Acknowledgments

We thank the participants and general practitioners who took part in the study and the staff of EPIC-Norfolk.

Funding

EPIC-Norfolk is supported by research programme grant funding from the Cancer Research Campaign and Medical Research Council with additional support from the Stroke Association, British Heart Foundation, and Research Into Ageing.

Competing interests

None declared.

Contributors

KTK, SB, and NW are principal investigators in the EPIC-Norfolk population study. SB is responsible for the dietary measurements and analyses. RL is responsible for data management and computing and data linkages for post coding. EM conducted the data analyses and wrote the paper with KTK with contributions from other co-authors.

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Authors and Affiliations

  1. Institute of Public Health, University of Cambridge, Cambridge, UK

    Emily McFadden, Robert Luben, Nicholas Wareham, Sheila Bingham & Kay-Tee Khaw

  2. Room 311, Strangeways Research Laboratory, Wort’s Causeway, Cambridge, CB1 8RN, UK

    Emily McFadden

  3. MRC Dunn Nutrition Unit, Cambridge, UK

    Sheila Bingham

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  1. Emily McFadden
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  5. Kay-Tee Khaw
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Correspondence to Emily McFadden.

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McFadden, E., Luben, R., Wareham, N. et al. Occupational social class, risk factors and cardiovascular disease incidence in men and women: a prospective study in the European Prospective Investigation of Cancer and Nutrition in Norfolk (EPIC-Norfolk) cohort. Eur J Epidemiol 23, 449–458 (2008). https://doi.org/10.1007/s10654-008-9262-2

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