Special Supplement: Distribution of cardiovascular disease risk factors by socioeconomic status among Canadian adults [CMAJ

Distribution of cardiovascular disease risk factors by socioeconomic status among Canadian adults

Robert Choinière, Pierre Lafontaine, Alison C. Edwards

Supplement to CMAJ 1999;162(9 Suppl)

Abstract

Background: This study was designed to describe the distribution of risk factors for cardiovascular disease by socioeconomic status in adult men and women across Canada using the Canadian Heart Health Surveys Database.

Methods: The data were derived from provincial cross-sectional surveys done between 1986 and 1992. Data were obtained through a home interview and a clinic visit using a probability sample of 29 855 men and women aged 18 74 years of whom 23 129 (77%) agreed to participate. The following risk factors for cardiovascular disease were considered: elevated total plasma cholesterol (greater than 5.2 mmol/L), regular current cigarette smoking (one or more daily), elevated diastolic or systolic blood pressure (140/90 mm Hg), overweight (body mass index and lack of leisure-time physical activity [less than once a week in the last month]). Education and income adequacy were used as measures of socioeconomic status and mother tongue as a measure of cultural affiliation.

Results: For most of the risk factors examined, the prevalence of the risk factors was inversely related to socioeconomic status, but the relationship was stronger and more consistent for education than for income. The inverse relationship between socioeconomic status and the prevalence of the risk factors was particularly strong for smoking and overweight, where a gradient was observed: 46% (standard error [SE] 1.4) of men and 42% (SE 4.3) of women who had not completed secondary school were regular smokers, but only 12% (SE 1.0) of men and 13% (SE 0.9) of women with a university degree were regular smokers. Thirty-nine percent (SE 1.4) of men and 19% (SE 3.8) of women who had not completed secondary school were overweight, compared with 26% (SE 2.6) of male and 19% of female university graduates. The prevalence of leisure-time physical inactivity and elevated cholesterol was highest in both men and women in the lowest socioeconomic category, particularly by level of education.

Interpretation: The differences in the prevalence of risk factors for cardiovascular disease between socioeconomic groups are still important in Canada and should be considered in planning programs to reduce the morbidity and mortality from cardiovascular disease.

The authors thank the members of the Canadian Heart Health Surveys Research Group for access to the data of the Canadian heart health surveys: C. Balram, P. Connelly, A. Edwards, D. Gelskey, K. Hogan, M. Joffres, R. Lessard, S. MacDonald, D. MacLean, E. MacLeod, M. Nargundkar, B. O'Connor, G. Paradis, A. Petrasovits, B. Reeder, R. Schabas, S. Stachenko and T. Young. They also acknowledge the helpful comments made on previous drafts by the members of this monograph group, especially Doreen Neville, the monograph coordinator.

Funding has been provided in part by the National Health Research and Development Program, Health Canada; provincial ministries of health and the Heart and Stroke Foundation of Canada.

Dr. Choinière is with the Direction de la santé publique de Montréal-Centre, Montréal, Que.; Mr. Lafontaine is with the Ministère de la santé et des services sociaux du Québec, Québec, Que.; Ms. Edwards is with the Division of Community Health, Memorial University of Newfoundland, St. John's, Nfld.

This article has been peer reviewed.

Reprint requests to: Dr. Robert Choinière, Direction de la santé publique, Régie régionale de Montréal-Centre, 3725 St-Denis, Montreal QC H2X 3L9