The contribution of modifiable risk factors to socioeconomic inequities in cardiovascular disease morbidity and mortality: a nationally representative population-based cohort study
Date
2023-04-12
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Publisher
Elsevier
Abstract
This study examined the individual and joint effects of modifiable risk factors mediating the associations between socioeconomic position (SEP) and morbidity and mortality from cardiovascular diseases (CVD) in a nationally representative sample of adults in Canada.
Participants in the Canadian Community Health Survey (n=289,800) were followed longitudinally for CVD morbidity and mortality using administrative health and mortality data. SEP was measured as a latent variable consisting of household income and individual educational attainment. Mediators included smoking, physical inactivity, obesity, diabetes and hypertension. The primary outcome was CVD morbidity and mortality, defined as the first fatal/nonfatal CVD event during follow-up (median 6.2 years). Generalized structural equation modeling tested the mediating effects of modifiable risk factors in associations between SEP and CVD in the total population and stratified by sex.
Lower SEP was associated with 2.5 times increased odds of CVD morbidity and mortality (OR: 2.52, 95% CI: 2.28, 2.76). Modifiable risk factors mediated 74% of associations between SEP and CVD morbidity and mortality in the total population and were more important mediators of associations in females (83%) than males (62%). Smoking mediated these associations independently and jointly with other mediators. The mediating effects of physical inactivity were through joint mediating effects with obesity, diabetes or hypertension. There were additional joint mediating effects of obesity through diabetes or hypertension in females.
Findings point to modifiable risk factors as important targets for interventions along with interventions that target structural determinants of health to reduce socioeconomic inequities in CVD.
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Citation
Nejatinamini, S., Campbell, D. J. T., Godley, J., Minaker, L. M., Sajobi, T. T., McCormack, G. R., & Olstad, D. L. (2023). The contribution of modifiable risk factors to socioeconomic inequities in cardiovascular disease morbidity and mortality: A nationally representative population-based cohort study. Preventive Medicine, 171, 107497. https://doi.org/10.1016/j.ypmed.2023.107497