Socio-Economic Differences in Cardiovascular Health: Findings from a Cross-Sectional Study in a Middle-Income Country

Janko Janković; Miloš Erić; Dragana Stojisavljević; Jelena Marinković; Slavenka Janković

doi:10.1371/journal.pone.0141731

Socio-Economic Differences in Cardiovascular Health: Findings from a Cross-Sectional Study in a Middle-Income Country

PLoS One. 2015 Oct 29;10(10):e0141731. doi: 10.1371/journal.pone.0141731. eCollection 2015.

Authors

Janko Janković¹, Miloš Erić², Dragana Stojisavljević³, Jelena Marinković⁴, Slavenka Janković⁵

Affiliations

¹ Institute of Social Medicine, Faculty of Medicine, University of Belgrade, Belgrade, Serbia.
² Center for European Integration and Public Management, Faculty of Economics, Finance and Administration, Singidunum University, Belgrade, Serbia.
³ Institute of Public Health, Banja Luka, Republic of Srpska, Bosnia and Herzegovina.
⁴ Institute of Medical Statistics and Informatics, Faculty of Medicine, University of Belgrade, Belgrade, Serbia.
⁵ Institute of Epidemiology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia.

Abstract

Background: A relatively consistent body of literature, mainly from high-income countries, supports an inverse association between socio-economic status (SES) and risk of cardiovascular disease (CVD). Data from low- and middle-income countries are scarce. This study explores SES differences in cardiovascular health (CVH) in the Republic of Srpska (RS), Bosnia and Herzegovina, a middle-income country.

Methods: We collected information on SES (education, employment status and household's relative economic status, i.e. household wealth) and the 7 ideal CVH components (smoking status, body mass index, physical activity, diet, blood pressure, total cholesterol, and fasting blood glucose) among 3601 participants 25 years of age and older, from the 2010 National Health Survey in the RS. Based on the sum of all 7 CVH components an overall CVH score (CVHS) was calculated ranging from 0 (all CVH components at poor levels) to 14 (all CVH components at ideal levels). To assess the differences between groups the chi-square test, t-test and ANOVA were used where appropriate. The association between SES and CVHS was analysed with multivariate linear regression analyses. The dependent variable was CVHS, while independent variables were educational level, employment status and wealth index.

Results: According to multiple linear regression analysis CVHS was independently associated with education attainment and employment status. Participants with higher educational attainment and those economically active had higher CVHS (b = 0.57; CI = 0.29-0.85 and b = 0.27; CI = 0.10-0.44 respectively) after adjustment for sex, age group, type of settlement, and marital status. We failed to find any statistically significant difference between the wealth index and CVHS.

Conclusion: This study presents the novel information, since CVHS generated from the individual CVH components was not compared by socio-economic status till now. Our finding that the higher overall CVHS was independently associated with a higher education attainment and those economically active supports the importance of reducing socio-economic inequalities in CVH in RS.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Aged
Aged, 80 and over
Cardiovascular Diseases / epidemiology*
Cardiovascular Diseases / etiology
Cross-Sectional Studies
Developing Countries
Female
Health Status*
Health Surveys
Humans
Male
Middle Aged
Prevalence
Socioeconomic Factors
Young Adult

Grants and funding

The 2010 National Health Survey was supported by the World Bank and Ministry of Health and Social Welfare of the Republic of Srpska. Funding for this work was obtained from the Ministry of Education, Science and Technological Development of the Republic of Serbia (project No. 175025). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.