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Socio-economic Status and Health in Women: Population-based studies with emphasis on lifestyle and cardiovascular disease
Nordic Council of Ministers, Nordic School of Public Health NHV.
2005 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The aim of this thesis was to investigate socio-economic status in relation to morbidity and mortality, in particular cardiovascular disease among women using data from two population based studies from Sweden. The secondary aim was to explore mechanisms potentially linking socio-economic status to health, assessing for example dental, dietary, and lifestyle factors. Samples: The Population Study of Women in Gothenburg Sweden was begun in 1968-69. A representative random sample of 1,622 women was selected according to date of birth and within the strata 38, 46, 50, 54, and 60 years of age; the participation rate was 90 percent. The Gerontological and Geriatric Population Studies in Gothenburg (H-70) are based on representative samples of 70-year olds from Göteborg, Sweden who participated in a series of cross sectional and longitudinal studies between1971 and 2000. Participation rates ranged from 86 percent for men and 83 percent for women in the 1901/2 birth cohort to 65 percent for men and 69 percent for women in the 1930 birth cohort. Main results: High socio-economic status was associated with a decreased risk for cardiovascular disease [RR 0.49; CI 0.24 – 0.99] in middle aged women independently of risk factors such as smoking and obesity;moreover opposing monotonic trends were seen for mortality from cancer and cardiovascular disease in relation to socio-economic status. Tooth loss, a proxy for cumulative lifetime oral infection was also associated with an increased risk for cardiovascular disease in women independently of socio-economic factors such as the husband’s occupational category, income, and educational level. Among 70-year old cohorts, later-born women were heavier and had higher body mass index than earlier-born women within the high education group only. However, secular increases in waist-hip ratio were seen in both educational groups. Compared to earlier-born cohorts of 70-year old men, later-born cohorts had higher body mass index and cholesterol levels across social strata, and heart disease and diabetes mellitus became more prevalent. Among the elderly, secular trends indicated greater improvements in cardiovascular risk factors among women than men, with exception to smoking and alcohol consumption. Diet quality and food selection were assessed in relation to socio-economic status in the youngest cohort of 70-year olds born in 1930. Socio-economic disparities in diet quality were detected in men but not in women. Conclusions: From a public health perspective, it is suggested that risk factor patterns should be investigated in association with socio-economic status in order to expose health inequalities, and to develop more equitable interventions for cardiovascular disease prevention.

Place, publisher, year, edition, pages
Göteborg: Nordic School of Public Health NHV Göteborg, Sweden , 2005. , 86 p.
Series
NHV Reports and Doctor of Public Health-Theses, ISSN 0283-1961 ; Report 2005:3
Keyword [en]
cardiovascular disease, dental health, diet, epidemiology, obesity, women, socio-economic status.
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:norden:org:diva-3401ISBN: 91-7997-093-1 (print)OAI: oai:DiVA.org:norden-3401DiVA: diva2:748260
Available from: 2014-09-18 Created: 2014-09-18 Last updated: 2014-09-18Bibliographically approved
List of papers
1. Can the relation between tooth loss and chronic disease be explained by socio-economic status? A 24-year follow-up from the population study of women in Gothenburg, Sweden.
Open this publication in new window or tab >>Can the relation between tooth loss and chronic disease be explained by socio-economic status? A 24-year follow-up from the population study of women in Gothenburg, Sweden.
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2005 (English)In: European Journal of Epidemiology, ISSN 0393-2990, E-ISSN 1573-7284, Vol. 20, no 3, 229-36 p.Article in journal (Refereed) Published
Abstract [en]

The objective of this study was to evaluate the association between number of missing teeth and all cause, cardiovascular, and cancer mortality as well as morbidity and to explore whether socio-economic factors mediate this association. An ongoing prospective cohort study of 1462 Swedish women included a dental survey in 1968/69 with follow-up until 1992/93. The dental examination included a panoramic radiographic survey and a questionnaire. Number of missing teeth at baseline was analysed in a Cox proportional hazards model to estimate time to mortality and morbidity. Number of missing teeth, independently of socio-economic status variables (the husband's occupational category, combined income, and education) was associated with increased all cause mortality and cardiovascular disease mortality respectively (relative risk (RR): 1.36; 95% confidence interval (95% CI): 1.18-1.58) and (RR: 1.46; 95% CI: 1.15-1.85 per 10 missing teeth), but no associations were found for cancer mortality (RR: 1.18; 95% CI: 0.91-1.52). The relation between poor oral health and future cardiovascular disease could not be explained by measures of socio-economic status in this study.

Keyword
Cancer, Cardiovascular disease, Diabetes Mellitus, Socio-economics Satus, Tooth Loss, Women
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:norden:org:diva-3398 (URN)15921040 (PubMedID)
Available from: 2014-09-18 Created: 2014-09-18 Last updated: 2014-09-18Bibliographically approved
2. Socioeconomic status and mortality in Swedish women: opposing trends for cardiovascular disease and cancer.
Open this publication in new window or tab >>Socioeconomic status and mortality in Swedish women: opposing trends for cardiovascular disease and cancer.
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2001 (English)In: Epidemiology (Cambridge, Mass.), ISSN 1044-3983, Vol. 12, no 5, 532-6 p.Article in journal (Refereed) Published
Abstract [en]

We examined relations between socioeconomic status and cardiovascular disease, cancer, and diabetes mellitus in a 24-year prospective study of 1,462 Swedish women. Two socioeconomic indicators were used: the husband's occupational category for married women and a composite indicator combining women's educational level with household income for all women. The husband's occupational category was strongly associated with cardiovascular disease and cancer mortality in opposite directions, independent of age and other potential confounders. Women with husbands of lower occupational categories had an increased risk of cardiovascular disease mortality [relative risk (RR) = 1.60; 95% confidence interval (95% CI) = 1.09-2.33] while experiencing lower rates of all-site cancer mortality (RR = 0.69; 95% CI = 0.50-0.96). A similar relation was seen with the composite variable: women with low socioeconomic status had an increased risk of cardiovascular disease (RR = 1.37; 95% CI = 1.01-1.84) but a somewhat lower risk for cancer of all sites (RR = 0.86; 95% CI = 0.66-1.11). Finally, morbidity data (diabetes mellitus, stroke, and breast cancer) yielded results that were consistent with the mortality trends, and breast cancer appeared to account for a major part of the association between total cancer and high socioeconomic status. In summary, higher socioeconomic status was associated with decreased cardiovascular disease mortality and excess cancer mortality, in such a way that only a weak association was seen for all-cause mortality.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:norden:org:diva-3397 (URN)11505172 (PubMedID)
Available from: 2014-09-18 Created: 2014-09-18 Last updated: 2014-09-18Bibliographically approved
3. Socio-economic gradient in food selection and diet quality among 70-year olds.
Open this publication in new window or tab >>Socio-economic gradient in food selection and diet quality among 70-year olds.
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2007 (English)In: The Journal of Nutrition, Health & Aging, ISSN 1279-7707, E-ISSN 1760-4788, Vol. 11, no 6, 466-73 p.Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: The aim of this study was to assess social disparities in food choices and diet quality in a population of 70-year old Swedes.

DESIGN: Cross-sectional study among participants in the 2000 Gerontological and Geriatric Population Studies in Goteborg.

PARTICIPANTS: A representative population of men (n=233) and women (n=321) from Goteborg, a city on the south western coast of Sweden.

METHODS: One hour diet history interviews were performed and 35 specific foods and food groups were identified; in addition a diet quality index (DQI) was calculated. Differences in food choices and diet quality scores were tested across educational and socio-economic index categories (SEI).

RESULTS: Men with higher education and SEI had higher diet quality scores than those with lower socio-economic status, while no differences in DQI were noted in women. Further analysis of women based on their husband's occupational group also yielded no differences in diet quality. When studying individual foods, socio-economic differences were observed in women and men.

CONCLUSIONS: Selection of food varies by education and occupational status in both sexes although socio-economic disparities in diet quality were observed in men only.

Keyword
Diet Quality Index, Education, Gerontology, Nitrition, Socio-Economic Status
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:norden:org:diva-3400 (URN)17985061 (PubMedID)
Available from: 2014-09-18 Created: 2014-09-18 Last updated: 2014-09-18Bibliographically approved
4. Cohort differences in obesity-related health indicators among 70-year olds with special reference to gender and education.
Open this publication in new window or tab >>Cohort differences in obesity-related health indicators among 70-year olds with special reference to gender and education.
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2003 (English)In: European Journal of Epidemiology, ISSN 0393-2990, E-ISSN 1573-7284, Vol. 18, no 9, 883-90 p.Article in journal (Refereed) Published
Abstract [en]

The aim of this study was to describe cohort differences in health indicators among four birth cohorts of 70-year old men and women from Göteborg, Sweden, born in 1901/2, 1905/6, 1911/12, and 1922. With special reference to gender, education, and obesity, it is hypothesized that changes in health among elderly men and women may not be occurring in a uniform manner. The variables studied were: systolic and diastolic blood pressures, triglycerides, cholesterol, height, weight, body mass index, waist-hip ratio, physical inactivity, current smoking, and alcohol consumption, plus selected prevalent diseases. Logistic and linear regression models were used to test for secular trends and effect modification by gender. Most trends in metabolic and lifestyle indicators varied in relation to gender as well as education. For instance, later-born male cohorts were more overweight than earlier-born groups while the later-born female cohorts had similar relative weights but a more centralized fat patterning. These cohort differences further varied by education where later-born men with less education and later-born women with higher education tended to be more overweight, compared to earlier-born cohorts. Finally, significant cohort differences in previously diagnosed myocardial infarction, stroke, and diabetes mellitus at age 70 were observed in men only. Interaction terms revealed that the gender difference was statistically significant only in the case of diabetes mellitus. In conclusion, secular trends in many obesity-related health indicators among 70-year old Swedish cohorts were dependent on both gender and socio-economic factors.

Keyword
Cardiovascular Disease, Diabetes Mellitus, Education, Gender, Gerontology, Obesity
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:norden:org:diva-3399 (URN)14561048 (PubMedID)
Available from: 2014-09-18 Created: 2014-09-18 Last updated: 2014-09-18Bibliographically approved

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