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Cited by 547Health disparities and outcomesCardiovascular Health and Risk FactorsPublic Health and Social Inequalities

Do Cardiovascular Risk Factors Explain the Relation between Socioeconomic Status, Risk of All-Cause Mortality, Cardiovascular Mortality, and Acute Myocardial Infarction?

Lynch, J. W., Kaplan, G. A., Cohen, R. D., Tuomilehto, J., Salonen, J. T.·1996·American Journal of Epidemiology
DOI 10.1093/oxfordjournals.aje.a008863
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Abstract

Much remains to be understood about how low socioeconomic status (SES) increases cardiovascular disease and mortality risk. Data from the Kuopio Ischemic Heart Disease Risk Factor Study (1984-1993) were used to estimate the associations between acute myocardial infarction and income, all-cause mortality, and cardiovascular mortality in a population-based sample of 2,272 Finnish men, with adjustment for 23 biologic, behavioral, psychologic, and social risk factors. Compared with the highest income quintile, those in the bottom quintile had age-adjusted relative hazards of 3.14 (95% confidence interval (CI) 1.77-5.56), 2.66 (95% CI 1.25-5.66), and 4.34 (95% CI 1.95-9.66) for all-cause mortality, cardiovascular mortality, and AMI, respectively. After adjustment for risk factors, the relative hazards for the same comparisons were 1.32 (95% CI 0.70-2.49), 0.70 (95% CI 0.29-1.69), and 2.83 (95% CI 1.14-7.00). In the lowest income quintile, adjustment for risk factors reduced the excess relative risk of all-cause mortality by 85%, that of cardiovascular mortality by 118%, and that of acute myocardial infarction by 45%. These data show how the association between SES and cardiovascular mortality and all-cause mortality is mediated by known risk factor pathways, but full "explanations" for these associations will need to encompass why these biologic, behavioral, psychologic, and social risk factors are differentially distributed by SES.

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Crossref · 10.1093/oxfordjournals.aje.a008863

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  • Higher total serum and LDL cholesterol, lower HDL cholesterol, and higher relative weight are recognized risk factors for poor health outcomes including mortality, cardiovascular disease, and functioning loss.

    “Metabolic parameters, including higher total serum and LDL cholesterol, lower HDL cholesterol, and higher relative weight, are also recognized risk factors for poor health outcomes including mortality, cardiovascular disease, and functioning loss.7,[11][12][13][14]”

    From Socio‐economic differentials in peripheral biology: Cumulative allostatic load (2010) · cites this paper as [12]

  • A growing body of evidence documents consistent SES gradients for nearly all major biological risk parameters, with lower SES groups exhibiting higher levels of risk.

    “A growing body of evidence documents consistent SES gradients for nearly all of these biological risk parameters-with lower SES groups exhibiting higher levels of risk.”

    From Socio‐economic differentials in peripheral biology: Cumulative allostatic load (2010) · cites this paper as [12]

  • SES gradients in these biological risk parameters are evident as early as the first 5 years of life, throughout childhood, early adolescence, and into early adulthood.

    “Much of the earliest work presented evidence for these SES gradients in adults 12,57 but more recent work has shown that these same SES gradients are evident as early as the first 5 years of life, [58][59][60] as well as throughout childhood, 59,[61][62][63][64][65] early adolescence, [66][67][68] and into early adulthood.[69][70][71][72][73]”

    From Socio‐economic differentials in peripheral biology: Cumulative allostatic load (2010) · cites this paper as [12]

  • Several published reports provide evidence supporting the role of multiple biological systems in mediating SES differentials in mortality.

    “Several published reports provide evidence supporting the role of multiple biological systems in mediating SES differentials in mortality.12,57,85,174”

    From Socio‐economic differentials in peripheral biology: Cumulative allostatic load (2010) · cites this paper as [12]

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Authors
Lynch, J. W., Kaplan, G. A., Cohen, R. D., Tuomilehto, J., & Salonen, J. T.
Affiliations
Public Health Foundation (US)
Corresponding author
Lynch, J. W.
ORCID
Venue
American Journal of Epidemiology
Publisher
Oxford University Press (OUP)
Published
1996-11-15
Volume
144
Issue
10
Pages
934-942
ISSN
  • 0002-9262 (ISSN-L)
  • 1476-6256
DOI
10.1093/oxfordjournals.aje.a008863
OpenAlex
W2165753268
Cited by
547
References
42
Citations by year
2026: 3 · 2025: 10 · 2024: 10 · 2023: 10 · 2022: 15 · 2021: 10 · 2020: 7 · 2019: 13 · 2018: 14 · 2017: 13 · 2016: 18 · 2015: 12 · 2014: 18 · 2013: 25 · 2012: 29
FWCI
22.27
Type
journal article
Language
en
Open access
closed
Locations
  • American Journal of Epidemiology (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • KONE
  • National Heart, Lung, and Blood Institute (HL-44199, R01HL044199)
Topics
  • Social Sciences › Health › Health disparities and outcomes
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Risk Factors
  • Social Sciences › Health › Public Health and Social Inequalities
Keywords
socioeconomic status, income, cardiovascular risk factors, all-cause mortality, cardiovascular mortality, acute myocardial infarction, ischemic heart disease, Finnish men
MeSH terms
Adult, Cardiovascular Diseases, Finland, Humans, Income, Male, Middle Aged, Mortality, Myocardial Infarction, Prospective Studies, Risk Factors, Socioeconomic Factors, Confidence Intervals, Proportional Hazards Models

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