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Differences in atherosclerosis according to area level socioeconomic deprivation: cross sectional, population based study

Creator:

Deans, Kevin A; Bezlyak, Vladimir; Ford, Ian; Batty, David G; Burns, Harry; Cavanagh, Jonathan; de Groot, Eric; McGinty, Agnes; Millar, Keith; Shiels, Paul G; Tannahill, Carol; Nathan, Yoga; Sattar, Naveed; Packard, Chris J;

Institution: BMJ
Subject Keywords: socioeconomic deprivation; atherosclerosis;
Region:
Description:

Objectives To examine the relation between area level
social deprivation and ultrasound markers of
atherosclerosis (common carotid intima-media thickness
and plaque score), and to determine whether any
differences can be explained by “classic” (currently
recognised) or “emerging” (novel) cardiovascular risk
factors.
Design Cross sectional, population based study.
Setting NHS Greater Glasgow Health Board area.
Participants 666 participants were selected on the basis
of how their area ranked in the Scottish Index of Multiple
Deprivation 2004. Approximately equal numbers of
participants from the most deprived areas and the 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).
Main outcome measures Carotid intima-media thickness
and plaque score, as detected by ultrasound.
Results The mean age and sex adjusted intima-media
thickness was significantly higher in participants from the
most deprived areas than in those from the least deprived
areas (0.70 mm (standard deviation (SD) 0.16 mm) v
0.68mm(SD 0.12 mm); P=0.015). On subgroup analysis,
however, this difference was only apparent in the highest
age tertile in men (56.3-66.5 years). The difference in
unadjusted mean plaque score between participants
from the most deprived and those from the least deprived
areas was more striking than the difference in intimamedia
thickness (least deprived 1.0 (SD 1.5) v most
deprived 1.7 (SD 2.0); P<0.0001). In addition, a significant
difference in plaque score was apparent in the two
highest age tertiles in men (46.8-56.2 years and 56.3-66.
5 years; P=0.0073 and P<0.001) and the highest age
tertile in women (56.3-66.5 years; P<0.001). The
difference in intima-media thickness between most
deprived and least deprived males remained significant
after adjustment for classic risk factors, emerging risk
1.7 (SD 2.0); P<0.0001). In addition, a significant
difference in plaque score was apparent in the two
highest age tertiles in men (46.8-56.2 years and 56.3-66.
5 years; P=0.0073 and P<0.001) and the highest age
tertile in women (56.3-66.5 years; P<0.001). The
difference in intima-media thickness between most
deprived and least deprived males remained significant
after adjustment for classic risk factors, emerging risk
factors, and individual level markers of socioeconomic
status (P=0.010). Adjustment for classic risk factors and
emerging cardiovascular risk factors, either alone or in
combination, did not abolish the deprivation based
difference in plaque presence (as a binary measure;
adjusted odds ratio of 1.73, 95% confidence interval 1.07
to 2.82). However, adjustment for classic risk factors and
individual level markers of early life socioeconomic status
abolished the difference in plaque presence between the
most deprived and the least deprived individuals
(adjusted odds ratio 0.94, 95% CI 0.54 to 1.65; P=0.84).
Conclusions Deprivation is associated with increased
carotid plaque score and intima-media thickness. The
association of deprivation with atherosclerosis is
multifactorial and not adequately explained by classic or
emerging risk factors.

Suggested citation:

Deans, Kevin A; Bezlyak, Vladimir; Ford, Ian; Batty, David G; Burns, Harry; Cavanagh, Jonathan; de Groot, Eric; McGinty, Agnes; Millar, Keith; Shiels, Paul G; Tannahill, Carol; Nathan, Yoga; Sattar, Naveed; Packard, Chris J; . () Differences in atherosclerosis according to area level socioeconomic deprivation: cross sectional, population based study [Online]. Available from: http://publichealthwell.ie/node/666107 [Accessed: 25th May 2019].

  

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