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BEDREHELSE-Bedre helse og livskvalitet

Socioeconomic inequalities in cardiovascular disease risk over the life course and in different generations

Awarded: NOK 3.5 mill.

Despite the fact that Norway has a well-developed welfare state, good health is not equally divided between social strata of the population. In Norway, groups with low education have significantly higher mortality from cardiovascular disease compared with groups with longer education. Lifestyle risk factors such as smoking, physical inactivity and obesity are more prevalent in groups with low education, and explains a good part of these social differences. It is crucial to understanding how social differences in illness occur to provide advice on how to prevent social inequalities in cardiovascular disease. We have investigated whether other factors such as childhood environment, cognitive abilities and changes in life style risk factors throughout life, are better able to explain the social differences. To understand these social differences we have compiled health data from national and regional health surveys, survey results measured by military session, data from death certificates, information from central registers of affiliation and education, and diagnoses from hospitalizations. Our analysis suggests that repeated measurements of risk factors through life explaining more of education differences in cardiovascular disease than only once in a lifetime, and that prevention of smoking, physical inactivity, obesity, elevated blood pressure, elevated cholesterol are the most important factors to reduce social inequalities in heart disease. Preventable risk factors seem to play an equally important role in explaining educational differences in cardiovascular mortality for the ones bon in the 1930s, 1940s and in the beginning of the 1950s. Tobacco smoking appears to be the most important driving force behind explaining educational differences in cardiovascular mortality. Analysis of the common factors that siblings share suggests that part of education differences in cardiovascular disease caused by childhood environment through childhood. Cognitive abilities can also be a potentially important factor that might explain the differences in education CVD. We can conclude that preventable risk factors explain the majority of the educational differences in cardiovascular disease. A focus on reduction of risk factors, especially tobacco smoking, in the entire population, from childhood and through the life course can reduce educational differences in cardiovascular disease.

Cardiovascular diseases (CVD) are the main causes of inequalities in mortality in Norway and other European countries and share risk with other diseases. Several important health behaviours and modifiable risk factors have been established as important pr oximal causes of CVD. Population level policies on nutrition, physical activity and smoking may have been adopted more in advantaged groups giving widening socioeconomic distribution. CVD have been linked to socioeconomic inequalities at all stages of the life course. Policy makers will need better evidence on the relative impact of key determinants of inequalities for CVD. Early life interventions and interventions on key health behaviours and modifiable risk factors have been highlighted as key to reduc e social inequalities. The higher prevalence of unhealthy behaviors and modifiable risk factors in disadvantaged socioeconomic groups is considered one of the mechanisms linking lower socioeconomic position to CVD. 50% of the decline in coronary heart dis ease mortality is considered to be explained by medical technology and secondary prevention. The project is based on taking full advantage of the large scale Norwegian health surveys and a multigenerational database. Norwegian data are comprehensive and u nique in terms of size and length of follow up through the life course. The novel contribution of this project will be the use of new methodology in life course epidemiology in combination with these cohort studies and data linkages. This will give a more complete picture on the causal role of early life environment, health behaviour, modifiable risk factors and health care in Norwegian large scale data on socioeconomic inequalities in CVD.

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BEDREHELSE-Bedre helse og livskvalitet