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From the Institute for Clinical Evaluative Sciences (Lee, Chiu, Manuel, K. Tu, Wang, Austin, Mattern, Mitiku, J. Tu), Toronto, Ont.; the Division of Cardiology (Lee) and the Department of Family Medicine (K. Tu), University Health Network, Toronto, Ont.; the Institute of Medical Science (Chiu) and the Department of Health Policy, Management and Evaluation (Austin, J. Tu), University of Toronto, Toronto, Ont.; the Department of Community Health and Epidemiology (Mitiku), Queen’s University, Kingston, Ont.; Alberta Health and Wellness (Svenson), Edmonton, Alta.; the School of Public Health (Svenson), University of Alberta, Edmonton, Alta.; Community Health Services (Svenson), University of Calgary, Calgary, Alta.; the Department of Family Medicine (Putnam), Dalhousie University, Halifax, NS; Statistics Canada (Flanagan), Ottawa, Ont.; and the Department of Medicine (J. Tu), Sunnybrook Health Sciences Centre, Toronto, Ont.
Correspondence to: Dr. Douglas S. Lee, Institute for Clinical Evaluative Sciences, Rm. G-106, 2075 Bayview Ave., Toronto ON M4N 3M5; fax 416 480-6048; dlee{at}ices.on.ca
Background: Temporal trends in risk factors for cardiovascular disease and the impact of socio-economic status on these risk factors remain unclear.
Methods: Using data from the National Population Health Survey and the Canadian Community Health Survey, we examined national trends in heart disease, hypertension, diabetes mellitus, obesity and smoking prevalence from 1994 to 2005, adjusting for age and sex. We stratified data by income adequacy category, body mass index and region of residence.
Results: An estimated 1.29 million Canadians reported having heart disease in 2005, representing increases of 19% for men and 2% for women, relative to 1994. Heart disease increased significantly in the lowest income category (by 27%), in the lower middle income category (by 37%) and in the upper middle income category (by 12%); however, it increased by only 6% in the highest income group. Diabetes increased in all but the highest income group: by 56% in the lowest income group, by 93% in the lower middle income group and by 59% in the upper middle income group. Hypertension increased in all income groups: by 85% in the lowest income group, by 80% in the lower middle income group, by 91% in the upper middle income group and by 117% in the highest income group. Obesity also increased in all income groups: by 20% in the lowest income group, by 25% in the lower middle income group, by 33% in the upper middle income group and by 37% in the highest income group. In addition to socio-economic status, obesity and overweight also modified the trends in risk factors. Diabetes increased to a greater extent among obese participants (61% increase) and overweight participants (25% increase), as did hypertension, which increased by 80% among obese individuals and by 74% among overweight individuals. Trends in diabetes, hypertension and obesity were consistent for all provinces.
Interpretation: During the study period, heart disease, hypertension, diabetes and obesity increased for all or most income groups in Canada. Further interventions supporting modification of lifestyle and risk factors are needed to prevent future cardiovascular disease.
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