Contribution of contemporaneous risk factors to social inequality in coronary heart disease and all causes mortality

Background The relationship between low social status and premature mortality is well established, although the explanation for this link is unclear. This study explores the contribution to the social inequalities in coronary heart disease (CHD) and death of smoking status, cotinine, alcohol status, type A personality score, leisure activity, diabetes, systolic and diastolic blood pressure, body mass index, total and HDL cholesterol, triglycerides, fibrinogen, and vitamin C consumption. Methods A random sample of 11,629 Scottish men and women, ages 40–59 years, was recruited in 1984–1987 and followed up for an average of 7.7 years for death and major coronary events. Social status was measured by housing tenure—renters being more socially deprived. Hazard ratios were computed from Cox models. Results Adjusted for age, renters have 1.48 times the risk of CHD compared to owner–occupiers (95% CI: 1.21, 1.80) in men and 2.64 (1.89, 3.68) in women, and for all-cause mortality 1.55 (1.26, 1.90) and 2.12 (1.58, 2.84). The 14 risk factors explained 73% (men) and 77% (women) of the social differences in CHD. Equivalent figures for deaths were 51 and 64%. Conclusions Fourteen contemporaneous risk factors, smoking being the most important, explain most of the social differential in CHD and death.