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BMC Public Health
Published in: BMC Public Health 1/2011

Open Access 01-12-2011 | Research article

The impact of social status inconsistency on cardiovascular risk factors, myocardial infarction and stroke in the EPIC-Heidelberg cohort

Authors: Stefanie Braig, Richard Peter, Gabriele Nagel, Silke Hermann, Sabine Rohrmann, Jakob Linseisen

Published in: BMC Public Health | Issue 1/2011

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Abstract

Background

Social inequalities in cardiovascular diseases are well documented. Yet, the relation of social status inconsistency (having different ranks in two or more status indicators like education, occupational position or income) and medical conditions of heart or vessels is not clear. Status inconsistency (SI) is assumed to be stressful, and the association of psychosocial distress and health is well known. Therefore, we aimed to analyze the relationship between cardiovascular diseases (CVD) and status inconsistency. Another target was to assess the influence of behaviour related risk factors on this association.

Methods

8960 men and 6070 women, aged 45-65 years, from the EPIC-Heidelberg cohort (European Prospective Investigation into Cancer and Nutrition) were included. Socio-economic status was assessed by education/vocational training and occupational position at recruitment. During a median follow-up of 8.7 years, information on CVD was collected.

Results

Compared to status consistent subjects, men who were in a higher occupational position than could be expected given their educational attainment had a nearly two-fold increased incidence of CVD (Odds Ratio (OR) = 1.8, 95% Confidence Interval (CI) = 1.5; 2.4, adjusted for age). Smoking behaviour and BMI differed significantly between those who had adequate occupational positions and those who did not. Yet, these lifestyle factors, as opposed to age, did not contribute to the observed differences in CVD. No association of cardiovascular diseases and status inconsistency was found for women or in cases where education exceeded occupational position.

Conclusions

Status inconsistent men (occupational position > education) had a higher risk of cardiovascular diseases than status consistent men. However, harmful behaviour did not explain this relationship.
Literature
1.
Mackay J, Mensah GA: The Atlas of heart disease and stroke. 2004, Geneva: World Health Organization (WHO)
2.
Kaplan GA, Keil JE: Socioeconomic factors and cardiovascular disease: a review of the literature. Circulation. 1993, 88 (4 Pt 1): 1973-1998.CrossRefPubMed
3.
Dalstra JA, Kunst AE, Borrell C, Breeze E, Cambois E, Costa G, et al: Socioeconomic differences in the prevalence of common chronic diseases: an overview of eight European countries. Int J Epidemiol. 2005, 34: 316-326. 10.1093/ije/dyh386.CrossRefPubMed
4.
Kivimäki M, Lawlor DA, Davey Smith G, Kouvonen A, Virtanen M, Elovainio M, Vahtera J: Socioeconomic position, co-occurrence of behavior-related risk factors, and coronary heart disease: the Finnish Public Sector study. Am J Public Health. 2007, 97: 874-879.CrossRefPubMedPubMedCentral
5.
McFadden E, Luben R, Wareham N, Bingham S, Khaw KT: Occupational social class, risk factors and cardiovascular disease incidence in men and women: a prospective study in the European Prospective Investigation of Cancer and Nutrition in Norfolk (EPIC-Norfolk) cohort. Eur J Epidemiol. 2008, 23 (7): 449-458. 10.1007/s10654-008-9262-2.CrossRefPubMed
6.
Groot W, Maassen van den Brink H: Overeducation in the labor market: a meta analysis. Economics education review. 2000, 19: 149-158. 10.1016/S0272-7757(99)00057-6.CrossRef
7.
Mooser J: Auflösung des proletarischen Milieus. Klassenbindung und Individualisierung in der Arbeiterschaft vom Kaiserreich bis in die Bundesrepublik Deutschland. (Disintegration of the proletarian milieu. Individualization among the labour force from the empire to the Federal Republic of Germany). Soziale Welt. 1983, 34: 270-306.
8.
Kohler U: Statusinkonsistenz und Entstrukturierung von Lebenslagen. Empirische Untersuchung zweier Individualisierungshypothesen mit Querschnittsdaten aus 28 Ländern. (Status inconsistency and diminished structures. Empirical analyses of two hypotheses of individualization by using survey data of 28 countries). KZfSS. 2005, 57 (2): 230-253.CrossRef
9.
Hope K: Models of status inconsistency and social mobility effects. Am Socio Rev. 1975, 40: 322-43. 10.2307/2094461.CrossRef
10.
Lenski GE: Status Crystallization: A Non-Vertical Dimension of Social Status. Am Socio Rev. 1954, 19: 405-413. 10.2307/2087459.CrossRef
11.
Gschwender JA: Continuities in Theories of Status inconsistency and cognitive dissonance. Social forces. 1967, 46 (2): 160-171. 10.2307/2574596.CrossRef
12.
Runciman WG: Relative Deprivation and Social Justice. 1966, Routledge & Paul
13.
Yitzhaki S: Relative deprivation and the GINI coefficient. Q J Econ. 1979, 321-324. 10.2307/1883197.
14.
House JS, Harkins EB: Why and when is status inconsistency stressful?. Am J Socio. 1985, 81: 395-353. 10.1086/226079.CrossRef
15.
16.
Rosengren A, Hawken S, Onpuu S, Sliwa K, Zubaid M, Almahmeed WA, Blacklett KN, Sato H, Yusuf S, for the INTERHEART investigators 2004: Association of psychosocial risk factors with risk of acute myocardial infarction in 11 119 cases and 13 648 controls from 52 countries (the INTERHEART study): case-control study 2004. Lancet. 2004, 364: 953-962. 10.1016/S0140-6736(04)17019-0.CrossRefPubMed
17.
Dressler WW: Social consistency and psychological distress. J Health Soc Behav. 1988, 29: 79-91. 10.2307/2137182.CrossRefPubMed
18.
19.
Vernon SW, Buffler PA: The status of status inconsistency. Epidemiol Rev. 1988, 10: 65-86.PubMed
20.
Gal G, Kaplan G, Gross R, Levav I: Status inconsistency and common mental disorders in the Israel-based world mental health survey. Soc Psychiatry Psychiatr Epidemiol. 2008, 43 (12): 999-1003. 10.1007/s00127-008-0393-2.CrossRefPubMed
21.
Smith P, Frank J: When aspiration and achievements don't meet. A longitudinal examination of the differential effect of education and occupational attainment on declines in self-rated health in Canadian labour force participants. Int J Epidemiol. 2005, 34 (4): 827-834.CrossRefPubMed
22.
Faresjö T, Svärdsudd K, Tibblin G: The concept of status incongruence resvisited. Scand J Soc Med. 1997, 25 (1): 28-32.PubMed
23.
Peter R, Gässler H, Geyer S: Socioeconomic status, status inconsistency and risk of ischaemic heart disease: a prospective study among members of a statutory health insurance company. J Epidemiol Community Health. 2007, 61 (7): 605-611. 10.1136/jech.2006.047340.CrossRefPubMedPubMedCentral
24.
Parker DA, Parker SE, Harford TC, Brody JA: Status inconsistency and drinking patterns among working men and women. Alcoholism. 1978, 2 (2): 101-105.CrossRefPubMed
25.
Ribet C, Zins M, Gueguen A, Bingham A, Goldberg M, Ducimetiere P, Lang T: Occupational mobility and risk factors in working men: selection, causality or both? Results from the GAZEL study. J Epidemiol Community Health. 2003, 57: 901-906. 10.1136/jech.57.11.901.CrossRefPubMedPubMedCentral
26.
Boeing H, Korfmann A, Bergmann MM: Recruitment procedures of EPIC-Germany. Ann Nutr Metab. 1999, 43: 205-215.CrossRefPubMed
27.
Bergmann MM, Bussas U, Boeing H: Follow-Up Procedures in EPIC-Germany. Ann Nutr Metab. 1999, 43: 225-234. 10.1159/000012789.CrossRefPubMed
28.
Nagel G, Peter R, Braig S, Hermann S, Rohrmann S, Linseisen J: The impact of education on risk factors and the occurrence of multimorbidity in the EPIC-Heidelberg cohort. BMC Public Health. 2008, 8: 384-10.1186/1471-2458-8-384.CrossRefPubMedPubMedCentral
29.
Wareham NJ, Jakes RW, Rennie KL, Schuit J, Mitchell J, Hennings S, Day NE: Validity and repeatability of a simple index derived from the short physical activity questionnaire used in the European Prospective Investigation into Cancer and Nutrition (EPIC) study. Public Health Nutr. 2003, 6: 407-413. 10.1079/PHN2002439.CrossRefPubMed
30.
31.
Löwel H, Meisinger C, Heier M, Hörmann A: The population-based acute myocardial infarction (AMI) registry of the MONICA/KORA study region Augsburg. Gesundheitswesen. 2005, 67: S1:S31-7.
32.
Wiesner G, Grimm J, Bittner E: Zum Herzinfarktgeschehen in der Bundesrepublik Deutschland: Prävalenz, Inzidenz, Trend, Ost-West-Vergleich. (Concerning heart attack in the Federal Republic of Germany: Prevalence, incidence, trends, East-west-comparison). Gesundheitswesen. 1999, 61 (Sonderheft 2): S72-S78.PubMed
33.
Wiesner G, Grimm J, Bittner E: Schlaganfall: Prävalenz, Inzidenz, Trend, Ost-West-Vergleich. Erste Ergebnisse aus dem Bundesgesundheitssurvey 1998. (Stroke: prevalence, incidence, trends, east-west-comparison. First results of the "Bundesgesundheitssurvey 1998"). Gesundheitswesen. 1999, 61 (Sonderheft 2): S79-S84.PubMed
34.
Hart CL, Smith GD, Blane D: Social mobility and 21 year mortality in a cohort of Scottish men. Soc Sci Med. 1998, 47: 1121-1130. 10.1016/S0277-9536(98)00061-6.CrossRefPubMed
35.
Buchmann AF, Laucht M, Schmid B, Wiedemann K, Mann K, Zimmermann US: Cigarette craving increases after a psycholsocial stress test and is related to cortisol stress response but not to dependence scores in daily smokers. J Psychopharmacol. 2008, 1-9.
36.
Kouvonen A, Kivimäki M, Cox SJ, Cox T, Vahtera J: Relationship between work stress and body mass index among 45,810 female and male employees. Psychosom Med. 2005, 67: 577-583. 10.1097/01.psy.0000170330.08704.62.CrossRefPubMed
37.
Siegrist J, Rödel A: Work stress and health risk behavior. Scand J Work Environ Health. 2006, 32 (6 special): 473-481.CrossRefPubMed
38.
Mateju P, Kreidl M: Social Trends. The Crystallization of Social Status in the Post-Communist Society. 1998
39.
Simpson JH: Status Inconsistency and Moral Issues. J Sci Stud Relig. 1985, 24 (2): 155-162. 10.2307/1386339.CrossRef
40.
Zhang X: Status inconsistency revisted: An improved statistical model. Eur Sociol Rev. 2008, 24 (2): 155-158. 10.1093/esr/jcm048.CrossRef
41.
Metadata
Title
The impact of social status inconsistency on cardiovascular risk factors, myocardial infarction and stroke in the EPIC-Heidelberg cohort
Authors
Stefanie Braig
Richard Peter
Gabriele Nagel
Silke Hermann
Sabine Rohrmann
Jakob Linseisen
Publication date
01-12-2011
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2011
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/1471-2458-11-104

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