Inequalities in cardiovascular disease mortality : the role of behavioural, physiological and social risk factors

Background: While the relationship between socioeconomic disadvantage and cardiovascular disease (CVD) is well established, the role that traditional cardiovascular risk factors play in this association remains unclear. We examined the association between education attainment and CVD mortality and the extent to which behavioural, social and physiological factors explained this relationship. Methods: Adults (n=38 355) aged 40-69 years living in Melbourne, Australia were recruited in 1990-1994. Subjects with baseline CVD risk factor data ascertained through questionnaire and physical measurement were followed for an average of 9.4 years with CVD deaths verified by review of medical records and autopsy reports. Results: CVD mortality was higher for those with primary education only compared to those who had completed tertiary education, with a hazard ratio (HR) of 1.66 (95% confidence interval [CI] 1.11-2.49) after adjustment for age, country of birth and gender. Those from the lowest educated group had a more adverse cardiovascular risk factor profile compared to the highest educated group, and adjustment for these risk factors reduced the HR to 1.18 (95% CI 0.78-1.77). In analysis of individual risk factors, smoking and waist circumference explained most of the difference in CVD mortality between the highest and lowest education groups. Conclusions: Most of the excess CVD mortality in lower socioeconomic groups can be explained by known risk factors, particularly smoking and overweight. While targeting cardiovascular risk factors should not divert efforts from addressing the underlying determinants of health inequalities, it is essential that known risk factors are addressed effectively among lower socioeconomic groups.

QEPR Editorial Vol 17 Issue 78

Welcome to another issue of the Queensland Environmental Practice Reporter. This issue begins with a paper by QUT masters student, Jenny Kortlaender, which considers the effectiveness of the United Nations Convention on Biological Diversity in addressing global biodiversity decline. This is followed by a paper by Fiona Leddy which critically analyses international shipping in Australian waters and the approach taken by Australia laws in addressing the risks posed by ship-based oil pollution. The third paper in this issue is by Adjunct Professor Hugh Lavery, Gina Lee and Carolyn S. Sandercoe. This paper considers the ecological principles to be followed in the sustainable design of large-scale marina developments. This paper highlights the differences between the practice of landscape ecology and the design of ecological landscapes...