Published 27 October 2009, doi:10.1136/bmj.b4170
Cite this as: BMJ 2009;339:b4170

Research

Differences in atherosclerosis according to area level socioeconomic deprivation: cross sectional, population based study

¹ Department of Vascular Biochemistry, Glasgow Royal Infirmary, Glasgow G31 2ER, ² Robertson Centre for Biostatistics, University of Glasgow, Glasgow G12 8QQ, ³ Medical Research Council Social and Public Health Sciences Unit, Glasgow G12 8RZ, ⁴ The George Institute for International Health, University of Sydney, Sydney, Australia, ⁵ Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh EH8 9JZ, ⁶ Scottish Government, Edinburgh EH1 3DG, ⁷ Sackler Institute of Psychobiological Research, Section of Psychological Medicine, Medical Faculty—University of Glasgow, Glasgow G51 4TF, ⁸ Department of Vascular Medicine and Vascular Imaging, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands, ⁹ Section of Psychological Medicine, Medical Faculty—University of Glasgow, Glasgow G12 0XH, ¹⁰ University Department of Surgery, Faculty of Medicine, University of Glasgow, Glasgow Royal Infirmary, Glasgow G31 2ER, ¹¹ Glasgow Centre for Population Health, Glasgow G2 4DL, ¹² Division of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow Royal Infirmary, Glasgow G31 2ER

Objectives To examine the relation between area level social deprivation and ultrasound markers of atherosclerosis (common carotid intima-media thickness and plaque score), and to determine whether any differences can be explained by "classic" (currently recognised) or "emerging" (novel) cardiovascular risk factors.

Design Cross sectional, population based study.

Setting NHS Greater Glasgow Health Board area.

Participants 666 participants were selected on the basis of how their area ranked in the Scottish Index of Multiple Deprivation 2004. Approximately equal numbers of participants from the most deprived areas and the least deprived areas were included, as well as equal numbers of men and women and equal numbers of participants from each age group studied (35-44, 45-54, and 55-64 years).

Main outcome measures Carotid intima-media thickness and plaque score, as detected by ultrasound.

Results The mean age and sex adjusted intima-media thickness was significantly higher in participants from the most deprived areas than in those from the least deprived areas (0.70 mm (standard deviation (SD) 0.16 mm) v 0.68 mm (SD 0.12 mm); P=0.015). On subgroup analysis, however, this difference was only apparent in the highest age tertile in men (56.3-66.5 years). The difference in unadjusted mean plaque score between participants from the most deprived and those from the least deprived areas was more striking than the difference in intima-media thickness (least deprived 1.0 (SD 1.5) v most deprived 1.7 (SD 2.0); P<0.0001). In addition, a significant difference in plaque score was apparent in the two highest age tertiles in men (46.8-56.2 years and 56.3-66.5 years; P=0.0073 and P<0.001) and the highest age tertile in women (56.3-66.5 years; P<0.001). The difference in intima-media thickness between most deprived and least deprived males remained significant after adjustment for classic risk factors, emerging risk factors, and individual level markers of socioeconomic status (P=0.010). Adjustment for classic risk factors and emerging cardiovascular risk factors, either alone or in combination, did not abolish the deprivation based difference in plaque presence (as a binary measure; adjusted odds ratio of 1.73, 95% confidence interval 1.07 to 2.82). However, adjustment for classic risk factors and individual level markers of early life socioeconomic status abolished the difference in plaque presence between the most deprived and the least deprived individuals (adjusted odds ratio 0.94, 95% CI 0.54 to 1.65; P=0.84).

Conclusions Deprivation is associated with increased carotid plaque score and intima-media thickness. The association of deprivation with atherosclerosis is multifactorial and not adequately explained by classic or emerging risk factors.

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: http://creativecommons.org/licenses/by-nc/2.0/ and http://creativecommons.org/licenses/by-nc/2.0/legalcode.

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