Objective Recent large falls in Coronary Heart Disease (CHD) mortality rates have been attributed to reductions in behavioural and physiological risk factors, particularly smoking, cholesterol and high systolic blood pressure (SBP), and also to the increasingly widespread use of cardiological treatments. Such gains, however, have been partially offset by unfavourable trends in Body Mass Index (BMI), diabetes and physical inactivity, possibly exacerbating inequalities. Using data from the Health Survey for England from 1994 to 2007, we therefore examined differentials in CHD risk factors across socio-economic groups over recent years.
Methods The Health Survey for England (HSfE) is an annual, nationally representative health interview and examination survey containing a core element – which includes risk factors such as smoking and BMI as well as biomarkers like blood pressure and saliva cotinine — and a regularly repeated disease module. In 1998, 2003 and 2006 the HSfE focused on CHD risk factors. Socio-economic circumstance (SEC) was defined by grouped quintiles of residential deprivation. A series of regression models were used to analyse the influence of SEC and time on risk factor levels, separately for each gender. Interaction terms were used to test whether risk factor trends differed between SEC groups.
Results SEC gradients in risk factors were most pronounced for current smoking, fruit and vegetable consumption, BMI (women only) and diabetes (women aged 55–74). Recent trends present a mixed picture. Smoking and SBP declined year-on-year for most SEC groups; cholesterol levels fell significantly between 2003 and 2006; and (beneficial) physical activity and fruit and vegetable consumption increased. However, mean BMI and diabetes prevalence among older age-groups increased across all SEC groups. Despite favourable trends in major risk factors across all social groups, the inequality gap remained essentially unchanged between 1994 and 2007.
Conclusions Persistent SEC differentials in major risk factors (smoking and poor diet) highlight an important priority for more effective policies for healthy food and tobacco control. Furthermore, research is now crucial to quantify the extent to which these persistent inequalities in CHD risk factor levels might explain the substantial inequalities observed in CHD mortality.
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