Income-related inequalities in cardiovascular disease from mid-life to old age in a Northern Swedish cohort: a decomposition analysis
2016 (English)In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 149, 135-144 p.Article in journal (Refereed) Published
While the social determinants of cardiovascular disease (CVD) are fairly well-known, the determinants of socioeconomic inequalities in CVD are scarcely studied and almost completely based on cross-sectional designs in which the changing circumstances across the life course are not taken into account. The present study seeks to incorporate a life course approach to the social determinants of socioeconomic inequalities in CVD. The specific aims were to 1) examine how income-related inequalities in CVD change over two decades of the mid-late life course, and 2) identify the key social determinants of the inequalities at each time period. The cohort (N = 44,039) comprised all individuals aged 40-60 years in 1990 who during 1990-2010 were enrolled in the county-wide preventive effort :"Västerbotten Intervention Program" (VIP). The cohort was followed over these two decades by Swedish population register data linked within the Umeå SIMSAM Lab micro data infrastructure. First-time hospitalization for CVD and mean earned income were used to calculate the concentration index (C) during four periods of 5-6 years. The C for each period was decomposed by sociodemographic factors, using Wagstaff-type decomposition analysis. Results suggest that inequalities in CVD increase gradually from mid-life to old age; from initially non-significant to particularly marked among the elderly. The decomposition showed that, from middle to old age, educational and employment inequalities underwent a transition from initially dominant to a moderate role in explaining the health inequalities, coupled with an increasing importance of age and a stable role of income. In conclusion, the study illustrates the need for incorporating a dynamic life course perspective into research, policy and practice concerned with equity in health.
Place, publisher, year, edition, pages
Elsevier, 2016. Vol. 149, 135-144 p.
Cardiovascular disease, Income inequality, Concentration index, Decomposition. Life course, Cohort design, Sweden
Public Health, Global Health, Social Medicine and Epidemiology
IdentifiersURN: urn:nbn:se:umu:diva-115244DOI: 10.1016/j.socscimed.2015.12.017ISI: 000369208500015PubMedID: 26717560OAI: oai:DiVA.org:umu-115244DiVA: diva2:899530
FunderForte, Swedish Research Council for Health, Working Life and Welfare
Errata Social Science & Medicine (2016) 160 p. 128 DOI:10.1016/j.socscimed.2016.05.0312016-02-022016-02-022016-08-01Bibliographically approved