Socio-economic factors in cardiovascular disease.

INCREASING RATES OF CARDIOVASCULAR DISEASE AMONG LOWER SOCIO-ECONOMIC GROUPS: Evidence from English studies indicates that not only is cardiovascular disease mortality more common among lower social classes, but there is an inverse social gradient. For example, one study showed that the higher the employment grade the lower the mortality, a finding that also held for most of the major causes of death. Between the early 1970s and early 1980s, coronary heart disease mortality rates declined by 15% in men in non-manual occupations and increased by 1% in manual occupations. Differences could not be attributed to medical care alone. This widening social gap in mortality rates has continued, and a similar pattern has been observed in other countries. EAST-WEST DIFFERENCES: Through the 1950s and 1960s, cardiovascular mortality and life expectancy were similar in central European countries on both sides of the iron curtain. From the late 1960s, however, there was marked divergence in mortality rates with improvement in the West and stagnation or deterioration in the countries of central and eastern Europe. After 1989 with the lifting of the iron curtain, Russia and some other eastern countries began to show a marked deterioration in life expectancy. In Russia life expectancy appears to have declined from 63 to 59 years in about 4 years. CURRENT RESEARCH ON MULTIPLE PATHWAYS: As we understand more of the biological mechanisms underlying the pathogenesis of cardiovascular disease, the more it becomes clear that these processes have multiple influences driving them. In our current research, we are using a model of potential pathways linking socio-economic status to diabetes mellitus and coronary heart disease in an attempt to confirm or refute the links in this model.