Social deprivation tied to greater atherosclerosis burden
MedWire News: People living in socioeconomically deprived areas have an increased burden of carotid atherosclerosis that is not fully explained by either classic or emerging cardiovascular risk factors, show UK researchers.
They say that the association between deprivation and atherosclerosis is multifactorial and call for further research to help unravel the biological mechanisms underlying these health inequalities.
The research, by Kevin Deans (Glasgow Royal Infirmary, UK) and team, was a cross-sectional population-based study conducted in Glasgow, a city with a wide range of socioeconomic deprivation levels.
A total of 666 adults were selected for inclusion on the basis of how their area ranked in the Scottish Index of Multiple Deprivation 2004. Roughly equal numbers of participants from the most and least deprived areas were included, as well as equal numbers of men and women and equal numbers of participants from each age group studied (35–44, 45–54, and 55–64 years).
All participants underwent carotid ultrasound to assess intima–media thickness (IMT) and plaque score in the common carotid artery, as surrogate markers of atherosclerosis burden.
Writing in the British Medical Journal, the team reports that mean IMT was significantly higher in participants from the most deprived areas than in those from the least deprived areas, after adjusting for age and gender (0.70 vs 0.68 mm).
Further analysis revealed that this difference was apparent only among men in the highest age tertile (56.3–66.5 years) and disappeared after adjusting for classic (currently recognized) risk factors, emerging (novel) risk factors, and individual-level markers of socioeconomic status.
Mean plaque scores differed significantly between the most and least deprived areas in men in the two highest age tertiles (46.8–56.2 and 56.3–66.5 years), at 1.0 versus 1.7. Furthermore, this difference remained statistically significant after adjusting for classic and emerging risk factors, although not after additional adjustment for individual-level markers of early-life socioeconomic status.
Dean and co-authors say their results indicate that deprivation is associated with an increased atherosclerosis burden and that this association is “not adequately explained by classic or emerging risk factors.”
“Health status is a reflection not only of features of the individual but also of wider social and economic influences, health and social services, early life experiences, and environmental factors,” they write.
“Further analyses focusing on the relative strengths of different pathways in explaining the health gap between the most and least deprived participants may help in unravelling the multifactorial nature of health inequalities.”
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By Joanna Lyford