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- Wamala, S.P, et al.
(author)
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Education and the metabolic syndrome in women
- 1999
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In: Diabetes Care. - Karolinska Inst, Dept Publ Hlth Sci, Div Prevent Med, Stockholm, Sweden. Univ Michigan, Sch Publ Hlth, Dept Epidemiol, Ann Arbor, MI 48109 USA. Beth Israel Deaconess Med Ctr, Div Cardiovasc, Boston, MA USA. Harvard Univ, Sch Publ Hlth, Dept Epidemiol, Boston, MA 02115 USA. Karolinska Hosp, Dept Cardiol, S-10401 Stockholm, Sweden. : AMER DIABETES ASSOC. - 0149-5992 .- 1935-5548. ; 22:12, s. 1999-2003
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Journal article (peer-reviewed)abstract
- OBJECTIVE - The main objective was to examine the association between the metabolic syndrome and socioeconomic position las indicated by education) among women, RESEARCH DESIGN AND METHODS - The study sample comprised healthy women (aged 30-65 years) in Sweden who were representative of the general population in a metropolitan area. Socioeconomic position was measured by educational level (mandatory [less than or equal to 9 years], high school, or college/university). The metabolic syndrome was defined as the presence of two or mon: of the following components: 1) fasting plasma glucose level greater than or equal to 7.0 mmol/l; 2) arterial blood pressure greater than or equal to 160/90 mmHg; 3) fasting plasma triglycerides greater than or equal to 1.7 mmol/l and/or HDL cholesterol <1.0 mmol/l; and 4) central obesity (waist-to-hip ratio >0.85 and/or BMI >30 kg/m(2)), RESULTS - After adjustment for age, the risk ratio for the presence of the metabolic syndrome comparing the lowest (less than or equal to 9 years) with the highest (college/university) education was 2.7 (95% CI 1.1-6.8)1 This association persisted after controlling for menopausal status, family history of diabetes, and behavioral risk factors. CONCLUSIONS - Low education is associated with increased risk for metabolic syndrome in middle-aged women. These findings show that not only are women with low socioeconomic position at increased risk for individual risk factors that are associated with cardiovascular disease and type 2 diabetes, they are also at increased risk for the metabolic clustering of risk factors.
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| 3. |
- Wamala, S. P, et al.
(author)
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Women's exposure to early and later life socioeconomic disadvantage and coronary heart disease risk : the Stockholm Female Coronary Risk Study
- 2001
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In: International Journal of Epidemiology. - Karolinska Inst, Dept Publ Hlth Sci, Div Prevent Med, S-17176 Stockholm, Sweden. Univ Michigan, Sch Publ Hlth, Dept Epidemiol, Ann Arbor, MI 48109 USA. : OXFORD UNIV PRESS. - 0300-5771 .- 1464-3685. ; 30:2, s. 275-284
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Journal article (peer-reviewed)abstract
- Background Measures of low socioeconomic position have been associated with increased risk for coronary heart disease (CHD) among women. A more complete understanding of this association is gained when socioeconomic position is conceptualized from a life course perspective where socioeconomic position is measured both in early and later life. We examined various life course socioeconomic indicators in relation to CHD risk among women. Methods The Stockholm Female Coronary Risk Study is a population-based case-control study, in which 292 women with CHD aged less than or equal to 65 years and 292 age-matched controls were investigated using a wide range of socioeconomic, behavioural, psychosocial and physiological risk factors. Socioeconomic disadvantage in early life (large family size in childhood, being born last, low education), and in later life (housewife or blue-collar occupation at labour force entry blue-collar occupation at examination, economic hardships prior to examination) was assessed. Results Exposure to early (OR = 2.65, 95% CI : 1.12-6.54) or later (OR = 5.38, 95% CI : 2.01-11.43) life socioeconomic disadvantage was associated with increased CHD risk as compared to not being exposed. After simultaneous adjustment for marital status and traditional CHD risk factors, early and later socioeconomic disadvantage, exposure to three instances of socioeconomic disadvantage in early life was associated with an increased CHD risk of 2.48 (95% CI:0.90-6.83) as compared to not being exposed to any disadvantage. The corresponding adjusted risk associated with exposure to later life disadvantage was 3.22 (95% CI : 1.02-10.53). Further analyses did not show statistical evidence of interaction effects between early and later life exposures (P = 0.12), although being exposed to both resulted in a 4.2-fold (95% CI: 1.4-12.1) increased CHD risk. Exposure to cumulative socioeconomic disadvantage (combining both early and later life), across all stages in the life course showed strong, graded associations with CHD risk after adjusting for traditional CHD risk factors. Stratification of cumulative disadvantage by body height showed that exposure to more than three periods of cumulative socioeconomic disadvantage had a 1.7- (95% CI : 0.9-3.2) and 1.9-(95% CI : 1.0-7.7) fold increased CHD risk for taller and shorter women, respectively. The combination of both short stature and more than two periods of cumulative socioeconomic disadvantage resulted in a 4.4-fold (95% CI : 1.7-9.3) increased CHD risk. Conclusions Both early and later exposure to socioeconomic disadvantage were associated with increased CHD risk in women. Later life exposure seems to be more harmful for women's cardiovascular health than early life exposure to socioeconomic disadvantage. However, being exposed to socioeconomic disadvantage in both early and later life magnified the risk for CHD in women. Cumulative exposure to socioeconomic disadvantage resulted in greater likelihood of CHD risk, even among women who were above median height. In terms of better understanding health inequalities among women, measures of socioeconomic disadvantage over the life course are both conceptually and empirically superior to using socioeconomic indicators from one point in time.
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