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11 Risk Factor: Socioeconomics CYAN MAGENTA YELLOW BLACK
Percentage increased CVD morortalityyof lowest socioeconomic (SE) grogroupover highest SE group,in people aged 25 to 64 years1969–1998
women
men
1969–1970 1997–199811
49%
30%
94%
79%
Percentage of peopleof peoplaged 20 years and above with diabetes,by income level2000
less thanUS$111
US$112–223
more thanUS$223
19%%%
13%
22%2
ercentage of people aged 20 years and abovePercentage of people ag 2222rcePerPerrcePerrPerx h Body Mass Index with w h w
than 30 kg/mmore than 30 kg/0 khan 3thof more more oo thahan 3 2
191990–––19993993
less than hantUS$5333
income US$533533–––106610666
US$106710067––2133211
more than e than moreeUS$213$2134UUS$$
24%22%
19%
28%
Percentage increased risk of obesity in peopleaged 35 to 74 years, in comparisonwith university graduatesty ggrad1998
women
men
60%
220%2202
250%250%
380%
noqualification
uupperererecondarydsec nn ryndarr
educatieddu atiooniionoodiplomamadiplpllomlommamaplo
Prevalence of CVD risk factorsrevalenPrev oncce of CCVD riCVD riof C k actorsby education in Canadacatby educat in Canadaby education in
age of people aged 18 to 74 f peo le aged 18 tPercentage of yearsh high levels of physical inactivitys ffl sicawith high levels of ph ty high cholesterol, by educational level,and high cholesterol, by e level
andardizrdage standardized 1986–19921
men
omenwomenwomenwo
secondary school completed
university degree obtained
secondary school not completedseeec ndarys
h cholesterolhhigh
nactivityphysical inact
high cholesterolhii
physical inactivityp
sterolestehigh cholesthig esthig
physical inactivitytysic vctphysys
47%
46% 43%
37% 33%
45% 42%
37% 31%
38% 35%
42%
Percentage of women aged 24 to 85 years with blood pressure ressudd ppppressuressuof 140/90 mmHg or above, or currently treated2001
39%
22%
31%
20% 19% 17%
monthly household income
less than US$134
US$134–267
US$268–533
US$534–1067
US$1068–2133
more than US$2133
Smoking by years of education in South Africa
Percentage of people aged 15 years and above who currently smoke daily1998
men
women
no education
up to5 years
6– 7 years
8–11years
12 years
more than 12 years
%45%
%10% 112% 11% 8% 8%9%
45%%39%
%35% %33%25%
g and occupation in Ugandaccupation and ocgSmSmoking a UgandaUin Ugg a ocgSm in Ug
ars and men aged 15 to 59 yearsn aged 15 to 999 yPe e of enof wome yeercentage o ars and to 54 years a arser e of to years ann mennn eawho currently smoke daily by category of workdaily by catw rrentlyy smoke daiy smwho curre workcategory of www urrently cat wdaiy sm200000–2200122
mmen
womemeneenenene
agriculture, self-employed
ununskilled manuamanual
skilled manual
sales professional,technical,
managerial, clerical
unemployed (previous
12 months)
%34%
4% 3%3%3% 2% 1% 2%0%
33%33%%%%29%
%221%
%14%3%
The CVD mortality gap e USAp in thep in the thep in e
Prevalence of high blood pressurePby income in Trinidad and Tobago
Prevalencee of diabetesPby incomee in India
ity in Saudi ArabiaIncome and obesit SSSa
Educational level andEobesity in Italy
4140
Risk factor: socioeconomic status
11“Wealth is both an enemy and a friend.”
Nepalese proverb
In developing countries, coronaryheart disease has historically beenmore common in the moreeducated and highersocioeconomic groups, but this isbeginning to change. In industrialcountries, such as Canada, theUnited Kingdom, and the UnitedStates, there is a widening socialclass difference in the oppositedirection.
Studies in developed countriessuggest that low income isassociated with a higher incidenceof coronary heart disease, andwith higher mortality after a heartattack. The prevalence of risk factors for heart disease, such ashigh blood pressure, smoking anddiabetes, is also higher. The use of medications is lower, especially of lipid-lowering agents and ACEinhibitors, as well as othertreatments, such as cardiaccatheterization.
The pathways by whichsocioeconomic status might affectcardiovascular disease include:lifestyle and behaviour patterns;ease of access to health care; andchronic stress.
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