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

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

BMJ 2009; 339 doi: https://doi.org/10.1136/bmj.b4170 (Published 27 October 2009) Cite this as: BMJ 2009;339:b4170
  1. Kevin A Deans, specialist registrar1,
  2. Vladimir Bezlyak, biostatistician2,
  3. Ian Ford, director2,
  4. G David Batty, Wellcome Trust fellow345,
  5. Harry Burns, chief medical officer for Scotland6,
  6. Jonathan Cavanagh, senior lecturer in psychiatry7,
  7. Eric de Groot, medical director of research and development8,
  8. Agnes McGinty, research sister1,
  9. Keith Millar, professor of medical psychology9,
  10. Paul G Shiels, senior lecturer10,
  11. Carol Tannahill, director11,
  12. Yoga N Velupillai, public health programme manager11,
  13. Naveed Sattar, professor of metabolic medicine12,
  14. Chris J Packard, professor of vascular biochemistry1
  1. 1Department of Vascular Biochemistry, Glasgow Royal Infirmary, Glasgow G31 2ER
  2. 2Robertson Centre for Biostatistics, University of Glasgow, Glasgow G12 8QQ
  3. 3Medical Research Council Social and Public Health Sciences Unit, Glasgow G12 8RZ
  4. 4The George Institute for International Health, University of Sydney, Sydney, Australia
  5. 5Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh EH8 9JZ
  6. 6Scottish Government, Edinburgh EH1 3DG
  7. 7Sackler Institute of Psychobiological Research, Section of Psychological Medicine, Medical Faculty—University of Glasgow, Glasgow G51 4TF
  8. 8Department of Vascular Medicine and Vascular Imaging, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
  9. 9Section of Psychological Medicine, Medical Faculty—University of Glasgow, Glasgow G12 0XH
  10. 10University Department of Surgery, Faculty of Medicine, University of Glasgow, Glasgow Royal Infirmary, Glasgow G31 2ER
  11. 11Glasgow Centre for Population Health, Glasgow G2 4DL
  12. 12Division of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow Royal Infirmary, Glasgow G31 2ER
  1. Correspondence to: K A Deans kevindeans{at}nhs.net
  • Accepted 2 June 2009

Abstract

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.

Footnotes

  • We thank W Hanselaar and J Gort in the Department of Vascular Medicine and W Stok in the Department of Physiology, Academic Medical Centre, Amsterdam, The Netherlands, for advice relating to carotid ultrasound and for use of the eTrack software. We also thank Prof GD Lowe and Dr A Rumley in the Department of Vascular Medicine, University of Glasgow and colleagues in the Department of Vascular Biochemistry, University of Glasgow and the Department of Clinical Biochemistry, Glasgow Royal Infirmary, for analysis of blood samples. Thanks finally to staff in the Robertson Centre for Biostatistics for data input and statistical analysis, staff in the Glasgow Centre for Population Health for administrative support, staff in the general practices from whom the participants were drawn, and, above all, the participants.

  • Contributors: KAD analysed the carotid scans and wrote the original manuscript draft. KAD, IF, GDB, HB, JC, EdG, KM, PGS, CT, YNV, NS, and CJP contributed equally to the conception and design of the study, and had final approval of the version to be published. VB performed the statistical analysis. AM supervised the recruitment of participants and data collection, and performed the majority of the carotid ultrasound scans. CJP is guarantor.

  • Funding: This study was funded by the Glasgow Centre for Population Health, a partnership between NHS Greater Glasgow and Clyde, Glasgow City Council, and the University of Glasgow and supported by the Scottish Government. All study data were held by the Robertson Centre for Biostatistics and remained blinded until after data lock after the end of data collection. Study data were then unblinded and analysed by the Robertson Centre for Biostatistics. Furthermore, the Glasgow Centre for Population Health had no competing interest (financial or otherwise) related to the findings of the study.

  • Competing interests: None declared.

  • Ethical approval: The study was reviewed and approved by the Glasgow Royal Infirmary Research Ethics Committee; all participants gave written informed consent.

  • Data sharing: No additional data available.

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