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Low Socioeconomic Status and Psychological Distress as Synergistic Predictors of Mortality From Stroke and Coronary Heart Disease
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BACKGROUND: The purpose of this study was to test whether lower socioeconomic status (SES) augments the effect of psychological distress on mortality from stroke or coronary heart disease (CHD). METHODS: We prospectively linked data from 66,500 participants 35 years or older in the Health Survey for England, selected using stratified random sampling from 1994 to 2004, and free of cardiovascular disease and cancer at baseline, with mortality records. The median follow-up time was 7.9 years. SES was indexed by occupational class, and psychological distress was assessed using the 12-item General Health Questionnaire (GHQ-12). RESULTS: After adjustment for demographic and clinical variables, both psychological distress and low SES were associated with increased mortality: the hazard ratios (HR) for one-category increase in low SES (three categories in total) were 1.15 for stroke-death (95% confidence interval [CI] = 1.00-1.31, p = .043) and 1.24 for CHD-death (95% CI = 1.09-1.41, p = .001); the HR for one-category increase in GHQ-12 (three categories in total) was 1.18 for stroke-death (95% CI = 1.07-1.30, p = .001) and 1.24 for CHD-death (95% CI = 1.13-1.36, p < .001). In stratified analyses, the strongest associations were found in the lowest SES categories: the HR for GHQ-12 toward stroke-death was 1.15 in high-SES participants (95% CI = 0.97-1.37, p = .107) and 1.31 in low-SES ones (95% CI = 1.13-1.51, p < .001); the HR for GHQ-12 toward CHD-death was 1.10 in high-SES participants (95% CI = 0.97-1.25, p = .129) and 1.33 in low-SES ones (95% CI = 1.19-1.48, p < .001). CONCLUSIONS: People in low socioeconomic circumstances are more vulnerable to the adverse effect of psychological distress. This pattern should be taken into account when evaluating the association between psychosocial variables and health outcomes.
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“Consistent with the vulnerability model, studies have reported stronger associations of presumably adaptive (e.g., perceived control) and maladaptive (e.g., neuroticism and negative affectivity) dispositions with physical functioning and mortality at lower levels of SES, thereby contributing to smaller or larger socioeconomic gradients (33-36).”
From Socioeconomic Status Interacts with Conscientiousness and Neuroticism to Predict Circulating Concentrations of Inflammatory Markers (2017) · cites this paper as [35]
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“Biobehavioral differences may also be present, with more rapid recovery in cardiovascular responses after acute stress in higher SES categories (32,33); these may contribute to reduced progression in CVD pathology (34).”
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Metadata
- Authors
- Lazzarino, A. I., Hamer, M., Stamatakis, E., & Steptoe, A.
- Affiliations
- University College London (GB)
- Corresponding author
- Lazzarino, Antonio Ivan
- Venue
- Psychosomatic Medicine
- Published
- 2013-04
- Volume
- 75
- Issue
- 3
- Pages
- 311-316
- ISSN
- 0033-3174 (ISSN-L)
- PMC
- PMC4196790
- OpenAlex
- W2029153449
- Cited by
- 140
- References
- 34
- Citations by year
- 2026: 3 · 2025: 5 · 2024: 8 · 2023: 48 · 2022: 6 · 2021: 11 · 2020: 7 · 2019: 10 · 2018: 10 · 2017: 6 · 2016: 11 · 2015: 8 · 2014: 4 · 2013: 3
- FWCI
- 9.86
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- cc-by
- Locations
- Psychosomatic Medicine (publishedVersion, cc-by)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- LSHTM Research Online (London School of Hygiene and Tropical Medicine) (acceptedVersion)
- UCL Discovery (University College London) (submittedVersion)
- Funders
- British Heart Foundation (RG/10/005/28296)
- Topics
- Social Sciences › Health › Health disparities and outcomes
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Health and Mental Health
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Employment and Welfare Studies
- Keywords
- socioeconomic status, psychological distress, stroke mortality, coronary heart disease mortality, occupational class, GHQ-12, cardiovascular mortality, Health Survey for England, health disparities, synergistic risk factors
- MeSH terms
- Adult, Aged, Coronary Disease, England, Female, Follow-Up Studies, Health Surveys, Humans, Male, Middle Aged, Prospective Studies, Surveys and Questionnaires, Risk Factors, Social Class, Stress, Psychological, Stroke
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