Psychosocial and biological determinants of ill health in relation to deprivation

Background: Despite public health campaigns and improvements in healthcare, socioeconomic gradients in health and life expectancy persist, and in many cases are becoming more marked – the gradient in coronary heart disease being a prime example. Classic cardiovascular risk factors (e.g. smoking, cholesterol and blood pressure) only partially explain the deprivation effect, and attempts to narrow the health gap by focussing on such risk factors do not appear to be succeeding. There also appear to be socioeconomic differences in uptake of healthy lifestyle advice. The work described in this thesis aimed to expand current understanding of the deprivation-based gap in health and life expectancy, focussing particularly on the socioeconomic gradient in cardiovascular risk. Methods: Using a cross-sectional, population-based study design based in the Greater Glasgow area, 666 participants were selected on the basis of area-level social deprivation (Scottish Index for Multiple Deprivation ranking). The study was designed to include approximately equal numbers from most deprived and least deprived areas; equal numbers of male and female participants and equal numbers of participants from each age group studied (35-44; 45-54 and 55-64 years). Participants completed an extensive questionnaire on health, lifestyle and early life experiences. Anthropometric measures (height, leg length, weight, waist, hip and thigh circumferences) were recorded. Blood pressure, heart rate and parameters of lung function (Forced Expiratory Volume in 1 second [FEV1] and Forced Vital Capacity [FVC]) were recorded. Psychological assessments (General Health Questionnaire-28, Generalised Self-Efficacy Scale, Sense of Coherence Scale, Beck Hopelessness Scale, Eysenck Personality Scale and Rosenberg Self-Esteem Scale) and assessments of cognitive function (Auditory Verbal Learning Test, Choice Reaction Time and Stroop Test) were undertaken. Fasting blood samples were obtained for classic and emerging cardiovascular risk factors including lipid profile, glucose, insulin, leptin, adiponectin, C-reactive protein, interleukin-6, soluble intercellular adhesion molecule-1, von Willebrand Factor, fibrinogen, D-dimer and tissue plasminogen activator antigen. Carotid ultrasound assessment of intima-media thickness (cIMT), plaque score and arterial stiffness was performed. Results: Total and low density lipoprotein cholesterol were significantly higher in the least deprived group (both p56.3 years). Plaque score showed a much more highly significant deprivation difference in the group as a whole (p