Cardiovascular disease and socioeconomic status

Between 1982 and 1992, the Canadian provincial heart health surveys were conducted as part of the Canadian Heart Health Initiative, a collaborative program of the provincial departments of health and Health Canada (then the Department of National Health and Welfare) to provide a database for planning and evaluating demonstration programs to prevent cardiovascular disease (CVD). In this CMAJ supplement, Potvin and co-authors (page S5) and Choinière and colleagues (page S13) report the results of analyses conducted to determine the relationship between socioeconomic factors (education, income level and occupation) and the prevalence of risk factors for CVD and the public's ability to identify those risk factors (fat in food, smoking, lack of exercise, excess weight, elevated blood cholesterol and high blood pressure).

The measures of socioeconomic status (SES) are admittedly limited, but the general findings in both analyses are remarkably consistent: people of low socioeconomic status, particularly when educational achievement is considered, not only had the highest prevalence of most risk factors for CVD but also were less able to identify the risk factors. This inverse relationship between SES and prevalence of risk factors was particularly strong for smoking and excess weight, but less obvious for lack of exercise and elevated blood cholesterol levels. Similarly, those who had completed university were more likely than those with only elementary school education to be able to identify CVD risk factors. In spite of the clear differences between those with the most education and those with the least, the prevalence and lack of knowledge about CVD risk factors, even among those at the highest socioeconomic level, is disappointingly high.

The results of these analyses have clear implications for federal and provincial governments and nongovernmental agencies that are charged with addressing CVD and, indeed, for all who provide health care to Canadians. There is an urgent need for effective strategies to reduce the risk of CVD targeted at the least educated and poorest segments of the population, but there is also still a significant need to improve the heart health of all Canadians. The rates of morbidity and death attributed to CVD have been declining in Canada and elsewhere for several decades now, but the battle is not won. The results presented in these 2 papers provide a valuable baseline from which to measure future gains or losses.