Socioeconomic status in relation to cardiovascular disease and cause-specific mortality: a comparison of Asian and Australasian populations in a pooled analysis

Mark Woodward; Sanne A E Peters; G David Batty; Hirotsugu Ueshima; Jean Woo; Graham G Giles; Federica Barzi; Suzanne C Ho; Rachel R Huxley; Hisatomi Arima; Xianghua Fang; Annette Dobson; Tai Hing Lam; Prin Vathesatogkit; Asia Pacific Cohort Studies Collaboration

doi:10.1136/bmjopen-2014-006408

Socioeconomic status in relation to cardiovascular disease and cause-specific mortality: a comparison of Asian and Australasian populations in a pooled analysis

BMJ Open. 2015 Mar 17;5(3):e006408. doi: 10.1136/bmjopen-2014-006408.

Authors

Collaborators

Asia Pacific Cohort Studies Collaboration:
R Huxley, X Fang, D F Gu, Y Imai, T H Lam, W H Pan, A Rodgers, I Suh, H C Kim, H Ueshima, M Woodward, A Okayama, H Ueshima, H Maegawa, M Nakamura, N Aoki, Z S Wu, C H Yao, Z S Wu, Mary Luszcz, T A Welborn, Z Tang, L S Liu, J X Xie, R Norton, S Ameratunga, S MacMahon, G Whitlock, M W Knuiman, H Christensen, X G Wu, J Zhou, X H Yu, A Tamakoshi, W H Pan, Z L Wu, L Q Chen, G L Shan, P Sritara, D F Gu, X F Duan, S MacMahon, R Norton, G Whitlock, R Jackson, Y H Li, T H Lam, C Q Jiang, Y Kiyohara, H Arima, M Iida, J Woo, S C Ho, Z Hong, M S Huang, B Zhou, J L Fuh, H Ueshima, Y Kita, S R Choudhury, I Suh, S H Jee, I S Kim, G G Giles, T Hashimoto, K Sakata, A Dobson, Y Imai, T Ohkubo, A Hozawa, K Jamrozik, M Hobbs, R Broadhurst, K Nakachi, X H Fang, S C Li, Q D Yang, Z M Chen, H Tanaka, Y Kita, A Nozaki, H Ueshima, H Horibe, Y Matsutani, M Kagaya, K Hughes, J Lee, D Heng, S K Chew, B F Zhou, H Y Zhang, K Shimamoto, S Saitoh, Z Z Li, H Y Zhang, P Norman, K Jamrozik, Y He, T H Lam, S X Yao

Affiliations

¹ Nuffield Department of Population Health, The George Institute for Global Health, University of Oxford, Oxford, UK The George Institute for Global Health, University of Sydney, Sydney, Australia Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, USA.
² Nuffield Department of Population Health, The George Institute for Global Health, University of Oxford, Oxford, UK Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
³ Department of Epidemiology and Public Health, University College London, London, UK Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK Alzheimer Scotland Dementia Research Centre, University of Edinburgh, Edinburgh, UK.
⁴ Department of Health Science, Shiga University of Medical Science, Shiga, Japan.
⁵ Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China.
⁶ Cancer Epidemiology and Intelligence Division, Cancer Council Victoria, Melbourne, Australia.
⁷ The George Institute for Global Health, University of Sydney, Sydney, Australia.
⁸ Division of Epidemiology, School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China.
⁹ Faculty of Medicine and Biomedical Sciences, School of Population Health, University of Queensland, Australia.
¹⁰ The George Institute for Global Health, University of Sydney, Sydney, Australia Department of Health Science, Shiga University of Medical Science, Shiga, Japan.
¹¹ Xuanwu Hospital, Capital Medical University, Bejing, China.
¹² School of Public Health, The University of Hong Kong, Hong Kong, China.
¹³ The George Institute for Global Health, University of Sydney, Sydney, Australia Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Thailand.

Abstract

Objectives: In Western countries, lower socioeconomic status is associated with a higher risk of cardiovascular disease (CVD) and premature mortality. These associations may plausibly differ in Asian populations, but data are scarce and direct comparisons between the two regions are lacking. We, thus, aimed to compare such associations between Asian and Western populations in a large collaborative study, using the highest level of education attained as our measure of social status.

Setting: Cohort studies in general populations conducted in Asia or Australasia.

Participants: 303,036 people (71% from Asia) from 24 studies in the Asia Pacific Cohort Studies Collaboration. Studies had to have a prospective cohort study design, have accumulated at least 5000 person-years of follow-up, recorded date of birth (or age), sex and blood pressure at baseline and date of, or age at, death during follow-up.

Outcome measures: We used Cox regression models to estimate relationships between educational attainment and CVD (fatal or non-fatal), as well as all-cause, cardiovascular and cancer mortality.

Results: During more than two million person-years of follow-up, 11,065 deaths (3655 from CVD and 4313 from cancer) and 1809 CVD non-fatal events were recorded. Adjusting for classical CVD risk factors and alcohol drinking, hazard ratios (95% CIs) for primary relative to tertiary education in Asia (Australasia) were 1.81 (1.38, 2.36) (1.10 (0.99, 1.22)) for all-cause mortality, 2.47(1.47, 4.17) (1.24 (1.02, 1.51)) for CVD mortality, 1.66 (1.00, 2.78) (1.01 (0.87, 1.17)) for cancer mortality and 2.09 (1.34, 3.26) (1.23 (1.04, 1.46)) for all CVD.

Conclusions: Lower educational attainment is associated with a higher risk of CVD or premature mortality in Asia, to a degree exceeding that in the Western populations of Australasia.

Keywords: CARDIOLOGY; EPIDEMIOLOGY; PUBLIC HEALTH.

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Publication types

Comparative Study

MeSH terms

Asia / epidemiology
Australasia / epidemiology
Cardiovascular Diseases / mortality*
Health Status Disparities*
Humans
Incidence
Proportional Hazards Models
Prospective Studies
Risk Factors
Social Class