Deans, K.A. et al. (2009) Differences in atherosclerosis according to area level socioeconomic deprivation: cross sectional, population based study. British Medical Journal, 339, b4170. (doi: 10.1136/bmj.b4170)
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Abstract
<b>Objectives</b>: to examine the relationship between area-level social deprivation and ultrasound markers of atherosclerosis (carotid intima-media thickness and plaque); to determine if any differences are explained on the basis of classical or novel cardiovascular risk factors. <b>Design</b>: Cross-sectional study Setting: Population study in the Greater Glasgow Health Board area <b>Participants</b>: 666 participants selected on basis of Scottish Index for Multiple Deprivation (SIMD) ranking; approximately equal numbers from most and least deprived areas; equal numbers of male and female participants and participants from each age group studied (35-44; 45-54 and 55-64 years). <b>Main outcome measures</b>: Carotid intima-media thickness (cIMT) and plaque score; anthropometric measurements (waist, hip and mid-thigh circumferences, standing and sitting height, weight), blood pressure, fasting lipid profile, glucose, insulin, leptin, adiponectin, C-reactive protein, interleukin-6, intercellular adhesion molecule-1, von Willebrand Factor, fibrinogen, D-dimer and tissue Plasminogen Activator antigen. <b>Results</b>: Age and sex adjusted carotid intima-media thickness (cIMT) was significantly higher in the most deprived group (least deprived 0.68 [0.12]mm; most deprived 0.70 [0.16]mm; p=0.015), but on subgroup analysis this difference was only apparent in the highest age tertile in males (>56.3 years). Plaque score showed a much more highly significant deprivation difference in the group as a whole (least deprived 1.0 [1.5]; most deprived 1.7 [2.0]; p<0.0001) and consistent with this, significant difference was apparent in the two highest age tertiles in males (46.8-56.2 and >56.3 years) and the 3 highest age tertile in females (>56.3 years). Neither adjustment for classical nor emerging cardiovascular risk factors, either alone or in combination, abolished the area-level deprivation-based difference in plaque presence (as a binary measure); adjusted odds ratio of 1.73 (95% confidence intervals 1.07 to 2.82) for plaque presence in most deprived versus least. Area-level deprivation persisted even in the presence of markers of individual-level socioeconomic status as a significant explanatory factor for differences in cIMT in males (F-test p value = 0.01 for most versus least deprived carotid intima-media thickness after adjusting for classical and emerging risk factors and markers of individual-level socioeconomic status). <b>Conclusions</b>: Deprivation is associated with increased plaque score and carotid intima-media thickness (cIMT). The association of deprivation with atherosclerosis is multifactorial and not adequately explained by classical or emerging risk factors.
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