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

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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

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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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