The impact of social status inconsistency on cardiovascular risk factors, myocardial infarction and stroke in the EPIC-Heidelberg cohort

BackgroundSocial inequalities in cardiovascular diseases are well documented. Yet, the relation of social status inconsistency (having different ranks in two or more status indicators like education, occupational position or income) and medical conditions of heart or vessels is not clear. Status inconsistency (SI) is assumed to be stressful, and the association of psychosocial distress and health is well known. Therefore, we aimed to analyze the relationship between cardiovascular diseases (CVD) and status inconsistency. Another target was to assess the influence of behaviour related risk factors on this association.Methods8960 men and 6070 women, aged 45-65 years, from the EPIC-Heidelberg cohort (European Prospective Investigation into Cancer and Nutrition) were included. Socio-economic status was assessed by education/vocational training and occupational position at recruitment. During a median follow-up of 8.7 years, information on CVD was collected.ResultsCompared to status consistent subjects, men who were in a higher occupational position than could be expected given their educational attainment had a nearly two-fold increased incidence of CVD (Odds Ratio (OR) = 1.8, 95% Confidence Interval (CI) = 1.5; 2.4, adjusted for age). Smoking behaviour and BMI differed significantly between those who had adequate occupational positions and those who did not. Yet, these lifestyle factors, as opposed to age, did not contribute to the observed differences in CVD. No association of cardiovascular diseases and status inconsistency was found for women or in cases where education exceeded occupational position.ConclusionsStatus inconsistent men (occupational position > education) had a higher risk of cardiovascular diseases than status consistent men. However, harmful behaviour did not explain this relationship.

[1]  Andrew Steptoe,et al.  Stress and cardiovascular disease , 2012, Nature Reviews Cardiology.

[2]  James A. Geschwender Continuities in Theories of Status Consistency and Cognitive Dissonance , 1967 .

[3]  Ulrich Kohler Statusinkonsistenz und Entstrukturierung von Lebenslagen , 2005 .

[4]  C Borrell,et al.  Socioeconomic differences in the prevalence of common chronic diseases: an overview of eight European countries. , 2005, International journal of epidemiology.

[5]  Z. Freeman Stress and cardiovascular disease , 1988, The Medical journal of Australia.

[6]  D. A. Parker,et al.  Status inconsistency and drinking patterns among working men and women. , 1978, Alcoholism, clinical and experimental research.

[7]  H. Boeing,et al.  Follow-Up Procedures in EPIC-Germany – Data Quality Aspects , 1999, Annals of Nutrition and Metabolism.

[8]  W. Dressler Social consistency and psychological distress. , 1988, Journal of health and social behavior.

[9]  Ulrich Kohler STATUSINKONSISTENZ UND ENTSTRUKTURIERUNG VON LEBENSLAGEN Empirische Untersuchung zweier Individualisierungshypothesen mit Querschnittsdaten aus 28 Ländern , 2004 .

[10]  M. Zins,et al.  Occupational mobility and risk factors in working men: selection, causality or both? Results from the GAZEL study , 2003, Journal of epidemiology and community health.

[11]  I. Levav,et al.  Status inconsistency and common mental disorders in the Israel-based world mental health survey , 2008, Social Psychiatry and Psychiatric Epidemiology.

[12]  G. Nagel,et al.  The impact of education on risk factors and the occurrence of multimorbidity in the EPIC-Heidelberg cohort , 2008, BMC public health.

[13]  K. Mann,et al.  Cigarette craving increases after a psychosocial stress test and is related to cortisol stress response but not to dependence scores in daily smokers , 2010, Journal of psychopharmacology.

[14]  S. Yusuf,et al.  Association of psychosocial risk factors with risk of acute myocardial infarction in 11 119 cases and 13 648 controls from 52 countries (the INTERHEART study): case-control study , 2004, The Lancet.

[15]  Shlomo Yitzhaki,et al.  Relative Deprivation and the Gini Coefficient , 1979 .

[16]  K. Hope Models of Status Inconsistency and Social Mobility Effects , 1975 .

[17]  George A. Mensah,et al.  The atlas of heart disease and stroke , 2005 .

[18]  S. Vernon,et al.  The status of status inconsistency. , 1988, Epidemiologic reviews.

[19]  G. Lenski Status crystallization: A non-vertical dimension of social status , 1954 .

[20]  J. Simpson Status Inconsistency and Moral Issues , 1985 .

[21]  J E Keil,et al.  Socioeconomic factors and cardiovascular disease: a review of the literature. , 1993, Circulation.

[22]  R. Peter,et al.  Socioeconomic status, status inconsistency and risk of ischaemic heart disease: a prospective study among members of a statutory health insurance company , 2007, Journal of Epidemiology and Community Health.

[23]  G. Tibblin,et al.  The concept of status incongruence revisited , 1997, Scandinavian journal of social medicine.

[24]  R. Smith The Career of Status Crystallization: A Sociological Odyssey , 1996 .

[25]  W. Runciman Relative Deprivation and Social Justice , 1966 .

[26]  D. Beevers,et al.  The atlas of heart disease and stroke , 2005, Journal of Human Hypertension.

[27]  C. Hart,et al.  Social mobility and 21 year mortality in a cohort of Scottish men. , 1998, Social science & medicine.

[28]  N. Wareham,et al.  Occupational social class, risk factors and cardiovascular disease incidence in men and women: a prospective study in the European Prospective Investigation of Cancer and Nutrition in Norfolk (EPIC-Norfolk) cohort , 2008, European Journal of Epidemiology.

[29]  D. Lawlor,et al.  Socioeconomic position, co-occurrence of behavior-related risk factors, and coronary heart disease: the Finnish Public Sector study. , 2007, American journal of public health.

[30]  L. Rushton,et al.  Lifestyle surveys--the complete answer? , 1997, Journal of epidemiology and community health.

[31]  M. Kreidl,et al.  Rebuilding Status Consistency in a Post-communist Society. The Czech Republic, 199197 , 2001 .

[32]  C. Patterson,et al.  Cardiovascular disease risk profiles among ‘healthy’ siblings of patients with early-onset cardiovascular disease: application of the new SCORE system , 2007, European journal of cardiovascular prevention and rehabilitation : official journal of the European Society of Cardiology, Working Groups on Epidemiology & Prevention and Cardiac Rehabilitation and Exercise Physiology.

[33]  Johannes Siegrist,et al.  Work stress and health risk behavior. , 2006, Scandinavian journal of work, environment & health.

[34]  J. House,et al.  Why and When Is Status Inconsistency Stressful? , 1975, American Journal of Sociology.

[35]  M. Kivimäki,et al.  Relationship Between Work Stress and Body Mass Index Among 45,810 Female and Male Employees , 2005, Psychosomatic medicine.

[36]  Wim Groot,et al.  Are we educating too much? Overeducation in the labor market: A meta analysis , 2000 .

[37]  Xiaotian Zhang Status Inconsistency Revisited: An Improved Statistical Model , 2007 .

[38]  Peter M. Smith,et al.  When aspirations and achievements don't meet. A longitudinal examination of the differential effect of education and occupational attainment on declines in self-rated health among Canadian labour force participants. , 2005, International journal of epidemiology.

[39]  C. Meisinger,et al.  The Population-Based Acute Myocardial Infarction (AMI) Registry of the MONICA/KORA Study Region of Augsburg , 2005, Gesundheitswesen (Bundesverband der Arzte des Offentlichen Gesundheitsdienstes (Germany)).

[40]  Jo Mitchell,et al.  Validity and repeatability of a simple index derived from the short physical activity questionnaire used in the European Prospective Investigation into Cancer and Nutrition (EPIC) study , 2003, Public Health Nutrition.

[41]  H. Boeing,et al.  Recruitment Procedures of EPIC-Germany , 1999, Annals of Nutrition and Metabolism.