Veronesi, G.* ; Ferrario, M.M.* ; Kuulasmaa, K.* ; Bobak, M.* ; Chambless, L.E.* ; Salomaa, V.* ; Söderberg, S.* ; Pajak, A.* ; Jørgensen, T.* ; Amouyel, P.* ; Arveiler, D.* ; Drygas, W.* ; Ferrieres, J.* ; Giampaoli, S.* ; Kee, F.* ; Iacoviello, L.* ; Malyutina, S.A.* ; Peters, A. ; Tamosiunas, A.* ; Tunstall-Pedoe, H.* ; Cesana, G.*
     
 
    
        
Educational class inequalities in the incidence of coronary heart disease in Europe.
    
    
        
    
    
        
        Heart 102, 958-965 (2016)
    
    
    
		
		
			
				OBJECTIVE: To estimate the burden of social inequalities in coronary heart disease (CHD) and to identify their major determinants in 15 European populations. METHODS: The MORGAM (MOnica Risk, Genetics, Archiving and Monograph) study comprised 49 cohorts of middle-aged European adults free of CHD (110 928 individuals) recruited mostly in the mid-1980s and 1990s, with comparable assessment of baseline risk and follow-up procedures. We derived three educational classes accounting for birth cohorts and used regression-based inequality measures of absolute differences in CHD rates and HRs (ie, Relative Index of Inequality, RII) for the least versus the most educated individuals. RESULTS: N=6522 first CHD events occurred during a median follow-up of 12 years. Educational class inequalities accounted for 343 and 170 additional CHD events per 100 000 person-years in the least educated men and women compared with the most educated, respectively. These figures corresponded to 48% and 71% of the average event rates in each gender group. Inequalities in CHD mortality were mainly driven by incidence in the Nordic countries, Scotland and Lithuania, and by 28-day case-fatality in the remaining central/South European populations. The pooled RIIs were 1.6 (95% CI 1.4 to 1.8) in men and 2.0 (1.7 to 2.4) in women, consistently across population. Risk factors accounted for a third of inequalities in CHD incidence; smoking was the major mediator in men, and High-Density-Lipoprotein (HDL) cholesterol in women. CONCLUSIONS: Social inequalities in CHD are still widespread in Europe. Since the major determinants of inequalities followed geographical and gender-specific patterns, European-level interventions should be tailored across different European regions.
			
			
				
			
		 
		
			
				
					
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        Publikationstyp
        Artikel: Journalartikel
    
 
    
        Dokumenttyp
        Wissenschaftlicher Artikel
    
 
    
        Typ der Hochschulschrift
        
    
 
    
        Herausgeber
        
    
    
        Schlagwörter
        Acute Myocardial-infarction; Middle-aged Men; Case-fatality; Risk-factors; Socioeconomic Inequalities; Cardiovascular Events; Health Inequalities; Life-style; Mortality; Population
    
 
    
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        Sprache
        englisch
    
 
    
        Veröffentlichungsjahr
        2016
    
 
    
        Prepublished im Jahr 
        
    
 
    
        HGF-Berichtsjahr
        2016
    
 
    
    
        ISSN (print) / ISBN
        1355-6037
    
 
    
        e-ISSN
        1468-201X
    
 
    
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	    Band: 102,  
	    Heft: 12,  
	    Seiten: 958-965 
	    Artikelnummer: ,  
	    Supplement: ,  
	
    
 
  
        
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            Verlag
            BMJ Publishing Group
        
 
        
            Verlagsort
            London
        
 
	
        
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        Begutachtungsstatus
        Peer reviewed
    
 
    
        Institut(e)
        Institute of Epidemiology (EPI)
    
 
    
        POF Topic(s)
        30202 - Environmental Health
    
 
    
        Forschungsfeld(er)
        Genetics and Epidemiology
    
 
    
        PSP-Element(e)
        G-504000-002
G-504090-001
    
 
    
        Förderungen
        
    
 
    
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        Erfassungsdatum
        2016-02-08