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Cause specific mortality among women who have never smoked: does social position make a difference

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Occupation/ husband's occupation. Place of residence. Blood pressure. Height and weight ... III NM. I & II. Deaths and social class. Strong social class trend ... – PowerPoint PPT presentation

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Title: Cause specific mortality among women who have never smoked: does social position make a difference


1
Cause specific mortality among women who have
never smoked does social position make a
difference?
  • Laurence Gruer, Carole Hart, David Gordon, Graham
    Watt
  • NHS Health Scotland and University of Glasgow

2
The Midspan Cohort
  • 7049 men and 8353 women living in Renfrew and
    Paisley
  • Aged 45-64 when recruited in 1972-76
  • About 80 of that age group
  • Detailed questionnaire and clinical exam
  • All deaths recorded since then

3
At screening
  • Smoking status
  • Occupation/ husbands occupation
  • Place of residence
  • Blood pressure
  • Height and weight
  • FEV1
  • Serum cholesterol
  • ECG

4
Smoking status at recruitment
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6
Conclusion of first study
  • Smoking itself is a greater cause of health
    inequalities than social position
  • Existing social class gradient largely explained
    by higher smoking rates in lower social positions
  • A social class gradient still exists among never
    smokers

7
Study question
  • What is the relationship between cause of death
    and social position among people who have never
    smoked?
  • Male never smokers 1182
  • Female never smokers 3827
  • Not enough men in the study
  • Focus only on female never smokers
  • No published study looking at socio-economic
    health inequalities among never smokers.

8
Risk factors by social class among 3652 women who
never smoked
9
Deaths
  • Dates causes of death provided by GROS
  • all cause
  • all cardiovascular disease, coronary heart
    disease, stroke
  • respiratory disease
  • cancer, smoking-related cancers and breast cancer

10
Deaths
  • Analysis of deaths over 28 years of follow-up
  • 50 of women died ½ from CVD, ¼ from cancer
  • Results presented for social class results by
    deprivation category of residence very similar
  • Risk factor adjustment
  • age, systolic blood pressure, cholesterol, body
    mass index, height, predicted FEV1, angina, ECG
    ischaemia and bronchitis

11
Deaths during 28 years of follow-up
12
Deaths and social class
  • Strong social class trend
  • all-cause mortality, CVD, CHD, stroke and lung
    disease
  • Adjustment for risk factors attenuated these for
    social class and eliminated them for deprivation
  • No social class trend
  • all cancers, smoking related cancers and breast
    cancer

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18
Conclusions
  • Among never smoking women in Renfrew and Paisley
  • There is a clear social class gradient for death
    by CVD but not cancer
  • When adjusted for conventional risk factors, the
    social class gradient for all cause and CVD
    mortality is diminished and the depcat gradient
    eliminated

19
Conclusions
  • Rates of overweight and obesity were surprisingly
    high in this 1970s cohort
  • There was a marked social class gradient for
    obesity
  • Increasing BMI was associated with marked
    increase in all-cause and CVD mortality, less for
    cancer
  • Adjusting for social class did not reduce BMI
    gradient
  • The social patterning of obesity appears to be an
    important contributor to health inequalities in
    this population

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21
Age adjusted relative mortality rates
22
Age and all risk factor adjusted relative
mortality rates
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