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Best-practice interventions to reduce socioeconomic inequalities of coronary heart disease mortality in UK: a prospective occupational cohort study

Summary Background How much the successful implementation of the most effective (ie, best-practice) interventions could reduce socioeconomic inequalities of coronary heart disease mortality is not known. We assessed this issue in an occupational cohort study comparing low with high socioeconomic gro... Full description

Journal Title: The Lancet (British edition) 2008, Vol.372 (9650), p.1648-1654
Main Author: Kivimäki, Mika, Prof
Other Authors: Shipley, Martin J, MSc , Ferrie, Jane E, PhD , Singh-Manoux, Archana, PhD , Batty, G David, PhD , Chandola, Tarani, DSc , Marmot, Michael G, Prof , Smith, George Davey, Prof
Format: Electronic Article Electronic Article
Language: English
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Quelle: Alma/SFX Local Collection
Publisher: England: Elsevier Ltd
ID: ISSN: 0140-6736
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recordid: cdi_hal_primary_oai_HAL_inserm_00340645v1
title: Best-practice interventions to reduce socioeconomic inequalities of coronary heart disease mortality in UK: a prospective occupational cohort study
format: Article
creator:
  • Kivimäki, Mika, Prof
  • Shipley, Martin J, MSc
  • Ferrie, Jane E, PhD
  • Singh-Manoux, Archana, PhD
  • Batty, G David, PhD
  • Chandola, Tarani, DSc
  • Marmot, Michael G, Prof
  • Smith, George Davey, Prof
subjects:
  • Adult
  • Aged
  • Benchmarking
  • Cardiovascular disease
  • Causes of
  • Cohort Studies
  • Coronary Disease
  • Coronary Disease - etiology
  • Coronary Disease - mortality
  • Coronary Disease - prevention & control
  • Coronary heart disease
  • Diabetes
  • Diabetes Complications
  • Economic aspects
  • Employment
  • Employment - classification
  • France
  • Great Britain
  • Health aspects
  • Humans
  • Hypercholesterolemia
  • Hypercholesterolemia - complications
  • Hypercholesterolemia - drug therapy
  • Hypertension
  • Hypertension - complications
  • Hypertension - drug therapy
  • Internal Medicine
  • Life Sciences
  • Linear Models
  • Male
  • Medical research
  • Middle Aged
  • Mortality
  • Prognosis
  • Registries
  • Risk Factors
  • Santé publique et épidémiologie
  • Smoking
  • Smoking - adverse effects
  • Social Class
  • Social classes
  • United Kingdom
  • United Kingdom - epidemiology
ispartof: The Lancet (British edition), 2008, Vol.372 (9650), p.1648-1654
description: Summary Background How much the successful implementation of the most effective (ie, best-practice) interventions could reduce socioeconomic inequalities of coronary heart disease mortality is not known. We assessed this issue in an occupational cohort study comparing low with high socioeconomic groups. Methods We undertook a prospective cohort study on 17 186 male civil servants aged 40–69 years between 1967 and 1970 in the UK (the Whitehall study). Socioeconomic position was based on employment grade. We compared the potential reduction in excess coronary heart disease mortality in men of low with those of high socioeconomic position with either best-practice interventions (reduction of systolic blood pressure by 10 mm Hg, of total cholesterol by 2 mmol/L, and of blood glucose by 1 mmol/L in pre-diabetic people; halving the prevalence of non-insulin-dependent diabetes; and complete cessation of cigarette smoking) or primordial prevention. Findings 15-year absolute risk of death due to coronary heart disease per 100 men, standardised to age 55 years, was 11·0 for men in the low employment grade group and 7·5 for those in the high grade group. Population-wide best-practice interventions would reduce coronary heart disease mortality by 57%, and the difference in mortality between socioeconomic groups by 69%. For primordial prevention, the corresponding reductions would be 73% and 86%, respectively. Interpretation Our results suggest that current best-practice interventions to reduce classic coronary risk factors, if successfully implemented in both high and low socioeconomic groups, could eliminate most of the socioeconomic differences in coronary heart disease mortality. Modest further benefits would result if the classic coronary risk factors could be reduced to primordial levels for the whole population. Funding Department of Health and Social Security (UK), Tobacco Research Council (UK), British Heart Foundation (UK), Medical Research Council (UK), European Science Foundation (EU), Wellcome Trust (UK), and Academy of Finland (Finland).
language: eng
source: Alma/SFX Local Collection
identifier: ISSN: 0140-6736
fulltext: fulltext
issn:
  • 0140-6736
  • 1474-547X
url: Link


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creatorKivimäki, Mika, Prof ; Shipley, Martin J, MSc ; Ferrie, Jane E, PhD ; Singh-Manoux, Archana, PhD ; Batty, G David, PhD ; Chandola, Tarani, DSc ; Marmot, Michael G, Prof ; Smith, George Davey, Prof
creatorcontribKivimäki, Mika, Prof ; Shipley, Martin J, MSc ; Ferrie, Jane E, PhD ; Singh-Manoux, Archana, PhD ; Batty, G David, PhD ; Chandola, Tarani, DSc ; Marmot, Michael G, Prof ; Smith, George Davey, Prof
descriptionSummary Background How much the successful implementation of the most effective (ie, best-practice) interventions could reduce socioeconomic inequalities of coronary heart disease mortality is not known. We assessed this issue in an occupational cohort study comparing low with high socioeconomic groups. Methods We undertook a prospective cohort study on 17 186 male civil servants aged 40–69 years between 1967 and 1970 in the UK (the Whitehall study). Socioeconomic position was based on employment grade. We compared the potential reduction in excess coronary heart disease mortality in men of low with those of high socioeconomic position with either best-practice interventions (reduction of systolic blood pressure by 10 mm Hg, of total cholesterol by 2 mmol/L, and of blood glucose by 1 mmol/L in pre-diabetic people; halving the prevalence of non-insulin-dependent diabetes; and complete cessation of cigarette smoking) or primordial prevention. Findings 15-year absolute risk of death due to coronary heart disease per 100 men, standardised to age 55 years, was 11·0 for men in the low employment grade group and 7·5 for those in the high grade group. Population-wide best-practice interventions would reduce coronary heart disease mortality by 57%, and the difference in mortality between socioeconomic groups by 69%. For primordial prevention, the corresponding reductions would be 73% and 86%, respectively. Interpretation Our results suggest that current best-practice interventions to reduce classic coronary risk factors, if successfully implemented in both high and low socioeconomic groups, could eliminate most of the socioeconomic differences in coronary heart disease mortality. Modest further benefits would result if the classic coronary risk factors could be reduced to primordial levels for the whole population. Funding Department of Health and Social Security (UK), Tobacco Research Council (UK), British Heart Foundation (UK), Medical Research Council (UK), European Science Foundation (EU), Wellcome Trust (UK), and Academy of Finland (Finland).
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subjectAdult ; Aged ; Benchmarking ; Cardiovascular disease ; Causes of ; Cohort Studies ; Coronary Disease ; Coronary Disease - etiology ; Coronary Disease - mortality ; Coronary Disease - prevention & control ; Coronary heart disease ; Diabetes ; Diabetes Complications ; Economic aspects ; Employment ; Employment - classification ; France ; Great Britain ; Health aspects ; Humans ; Hypercholesterolemia ; Hypercholesterolemia - complications ; Hypercholesterolemia - drug therapy ; Hypertension ; Hypertension - complications ; Hypertension - drug therapy ; Internal Medicine ; Life Sciences ; Linear Models ; Male ; Medical research ; Middle Aged ; Mortality ; Prognosis ; Registries ; Risk Factors ; Santé publique et épidémiologie ; Smoking ; Smoking - adverse effects ; Social Class ; Social classes ; United Kingdom ; United Kingdom - epidemiology
ispartofThe Lancet (British edition), 2008, Vol.372 (9650), p.1648-1654
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descriptionSummary Background How much the successful implementation of the most effective (ie, best-practice) interventions could reduce socioeconomic inequalities of coronary heart disease mortality is not known. We assessed this issue in an occupational cohort study comparing low with high socioeconomic groups. Methods We undertook a prospective cohort study on 17 186 male civil servants aged 40–69 years between 1967 and 1970 in the UK (the Whitehall study). Socioeconomic position was based on employment grade. We compared the potential reduction in excess coronary heart disease mortality in men of low with those of high socioeconomic position with either best-practice interventions (reduction of systolic blood pressure by 10 mm Hg, of total cholesterol by 2 mmol/L, and of blood glucose by 1 mmol/L in pre-diabetic people; halving the prevalence of non-insulin-dependent diabetes; and complete cessation of cigarette smoking) or primordial prevention. Findings 15-year absolute risk of death due to coronary heart disease per 100 men, standardised to age 55 years, was 11·0 for men in the low employment grade group and 7·5 for those in the high grade group. Population-wide best-practice interventions would reduce coronary heart disease mortality by 57%, and the difference in mortality between socioeconomic groups by 69%. For primordial prevention, the corresponding reductions would be 73% and 86%, respectively. Interpretation Our results suggest that current best-practice interventions to reduce classic coronary risk factors, if successfully implemented in both high and low socioeconomic groups, could eliminate most of the socioeconomic differences in coronary heart disease mortality. Modest further benefits would result if the classic coronary risk factors could be reduced to primordial levels for the whole population. Funding Department of Health and Social Security (UK), Tobacco Research Council (UK), British Heart Foundation (UK), Medical Research Council (UK), European Science Foundation (EU), Wellcome Trust (UK), and Academy of Finland (Finland).
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titleBest-practice interventions to reduce socioeconomic inequalities of coronary heart disease mortality in UK: a prospective occupational cohort study
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abstractSummary Background How much the successful implementation of the most effective (ie, best-practice) interventions could reduce socioeconomic inequalities of coronary heart disease mortality is not known. We assessed this issue in an occupational cohort study comparing low with high socioeconomic groups. Methods We undertook a prospective cohort study on 17 186 male civil servants aged 40–69 years between 1967 and 1970 in the UK (the Whitehall study). Socioeconomic position was based on employment grade. We compared the potential reduction in excess coronary heart disease mortality in men of low with those of high socioeconomic position with either best-practice interventions (reduction of systolic blood pressure by 10 mm Hg, of total cholesterol by 2 mmol/L, and of blood glucose by 1 mmol/L in pre-diabetic people; halving the prevalence of non-insulin-dependent diabetes; and complete cessation of cigarette smoking) or primordial prevention. Findings 15-year absolute risk of death due to coronary heart disease per 100 men, standardised to age 55 years, was 11·0 for men in the low employment grade group and 7·5 for those in the high grade group. Population-wide best-practice interventions would reduce coronary heart disease mortality by 57%, and the difference in mortality between socioeconomic groups by 69%. For primordial prevention, the corresponding reductions would be 73% and 86%, respectively. Interpretation Our results suggest that current best-practice interventions to reduce classic coronary risk factors, if successfully implemented in both high and low socioeconomic groups, could eliminate most of the socioeconomic differences in coronary heart disease mortality. Modest further benefits would result if the classic coronary risk factors could be reduced to primordial levels for the whole population. Funding Department of Health and Social Security (UK), Tobacco Research Council (UK), British Heart Foundation (UK), Medical Research Council (UK), European Science Foundation (EU), Wellcome Trust (UK), and Academy of Finland (Finland).
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