It Breaks a Man's Heart - Socioeconomic Differences in the Onset of Cardiovascular Disease in Contemporary Sweden

This doctoral thesis investigates the relationship between socioeconomic status and the onset of cardiovascular disease in a contemporary population of natives and foreign-born individuals in Sweden. The complexity of individual socioeconomic characteristics and the interrelationship with other cardiovascular risk factors is the focus of the studies in this thesis. As in most developed countries, cardiovascular diseases are the main cause of death in Sweden, implying a large financial burden for the afflicted individual as well as for the healthcare system. Regarding the potentially high cost of medical intervention after the onset of cardiovascular disease, research and greater understanding of the underlying mechanisms are of essential importance. Socioeconomic characteristics have been identified as determining factors for different health outcomes in many studies. The variety of measurements and definitions of socioeconomic status provides a challenge to formulating general predictions of its impact on individual health. This thesis analyses different measures of socioeconomic status and aims at a broader understanding of the impact mechanism behind the relationship between status and health. The focus on the onset of cardiovascular diseases limits the amount of feedback effects from impaired health conditions on socioeconomic status, which is an important obstacle in the field of social epidemiology. A common finding in this thesis is the interrelationship between different characteristics of socioeconomic status as well as correlations with other health factors. While the amount of work stress has an independent effect on individual risk for cardiovascular diseases, the effect mechanism varies strongly depending on occupational class. Similarly, results showed direct health effects from intermarriage, as well as indirect effects of intermarriage for several cardiovascular risk factors. Consistent differences in cardiovascular risk are found for men and women throughout the dissertation, supporting previous research which finds lower risk for women in specific age ranges. Furthermore, the results showed different socioeconomic distributions and health behaviors for women compared with men, which can in turn have a health effect. A special emphasis was placed on the effect of ethnic background as a health factor. While the risk for cardiovascular disease is in general different between natives and immigrants, a large share of this difference could be shown to emerge from migration characteristics such as length of stay and purpose of migration, rather than from country of origin. The findings of this thesis add to the understanding of the relationship between socioeconomic status and the onset of cardiovascular disease, accounting for a variety of other risk factors which appear highly correlated with characteristics of socioeconomic status. Results from this doctoral thesis can be used to establish public health policies in order to account for differences in the socioeconomic distribution of the population and thereby provide new approaches to the prevention of cardiovascular disease