Widening inequalities in the risk factors for cardiovascular disease amongst men in England between 1998 and 2006

Objectives: Cardiovascular disease is a major cause of morbidity and mortality for which there are many modifiable risk factors. This study investigated changes in social inequalities of cardiovascular disease risk factors amongst men aged 20-64 years in England between 1998 and 2006.

Study design: Repeated cross-sectional study.

Methods: Health Survey for England data from 1998, 2003 and 2006 were used. The following physiological risk factors were considered: body mass index, waist-to-hip ratio, blood pressure and total serum cholesterol level. The behavioural risk factors considered were limited physical exercise, smoking status and level of social support. The National Statistics Socio-economic Classification was used to measure socio-economic position. An index of inequality for each risk factor was calculated, and change in inequality over time was assessed by t-tests.

Results: Significant cross-sectional inequality was found for waist-to-hip ratio, systolic blood pressure, smoking, limited physical exercise and social support at one or more time points. Between 1998 and 2006, there was a significant increase in inequality for smoking status [relative index of inequality (RII) 4.06-6.65 (t-test: 2.88, P = 0.003)] and limited physical exercise [RII 1.06-1.74 (t-test: 2.92, P = 0.003)]; these increases in inequality over time were due to improvements for those in higher socio-economic classes.

Conclusions: Policies have not had the desired impact of reducing inequalities. Although the long-term effects of these policies might not yet be apparent, available evidence needs to be used to monitor impact and direct policy change to address the possibility of widening inequalities.