Cardiovascular diseases such as heart attacks and stroke are the leading cause of death worldwide. According to the World Health Organisation (WHO), they are responsible for around 18 million deaths each year. The causes of cardiovascular disease are diverse and complex. International studies suggest that one factor that may influence cardiovascular health is socioeconomic status (SES). SES is defined as the level of education, amount of work and income.
However, previous studies on the influence of SES on health have mainly been carried out in countries where access to health care depends on income and occupation, such as the USA. The Gutenberg Health Survey (GHS) is based on data from participants in Germany. In Germany, there is comprehensive health care, so there should be no social disadvantage. Nevertheless, the Mainz researchers found that there were significant differences in the cardiovascular health of study participants from low and high SES backgrounds.
As part of the GHS, the research team extensively investigated the influence of socio-economic factors on cardiovascular health over a period of ten years. Around 15,000 men and women aged 35 to 74 from the Rhine-Main area took part in the study. The SES of the study participants was determined using a questionnaire in a computer-assisted interview.
At the initial examination, around 4,000 people in the study had a cardiovascular disease, such as atrial fibrillation, coronary heart disease or venous thrombosis. These participants were about 19 percent more likely to suffer from an existing cardiovascular disease than participants with a high SES.
"The follow-up examination after 10 years showed that people with a low socio-economic status had a 68 percent higher risk of developing a new cardiovascular disease. Mortality was also 86 percent higher in this group than in those with a high SES. Interestingly, we found that people's education and level of employment were more important than their income," said Dr Omar Hahad, lead author of the study and a researcher at the Centre for Cardiology I at the University of Mainz.
The researchers were also able to identify the influence of SES on cardiovascular health when they looked at it independently of lifestyle-related risk factors such as alcohol consumption, smoking or physical activity.
"Our results show that more attention needs to be paid to socio-economic status - both in the care of individual patients and in clinical trials. Socio-economic factors should therefore be included in risk scores in order to improve the health prognosis and to be able to initiate preventive measures earlier," says Prof. Dr. Thomas Münzel, Director of the Centre for Cardiology at the University Hospital in Mainz.
Launched in 2007, the Gutenberg Health Study (GHS) is a large-scale, representative population study in the Rhine-Main region. Its aim is to identify the risk factors and causes of major common diseases. Based on a population sample, more than 18,000 people have been examined for their health over the last 15 years. A follow-up examination is carried out every five years. The findings are intended to help improve medical prevention, diagnosis and treatment.
Original publication: O. Hahad, D. A. Gilan, J. Chalabi, S. Al-Kindi, A. K. Schuster, F. Wicke, M. Büttner, O. Tüscher, K. J. Lackner, P. R. Galle, S. Konstantinides, A. Daiber, P. S. Wild, T. Münzel, Cumulative social disadvantage and cardiovascular disease burden and mortality, European Journal of Preventive Cardiology, 2023; zwad264., DOI: doi.org/10.1093/eurjpc/zwad264
Scientific contact: Dr. Omar Hahad (Omar.Hahad(at)unimedizin-mainz.de), Centre for Cardiology - Cardiology I, Mainz University Hospital, Germany
