Socioeconomic status and risk of cardiovascular disease in 20 low-income, middle-income, and high-income countries: the Prospective Urban Rural Epidemiologic (PURE) study

作者：Annika Rosengren, Andrew Smyth, Sumathy Rangarajan, Chinthanie Ramasundarahettige, Shrikant I. Bangdiwala, Khalid F. AlHabib, Álvaro Avezum, Kristina Bengtsson Boström, Jephat Chifamba, Sadi Güleç, Rajeev Gupta, Ehimario Igumbor, Romaina Iqbal, Norhassim Ismail, Philip Joseph, Manmeet Kaur, Rasha Khatib, Iolanthé M. Kruger, Pablo Lamelas, Fernando Laņas, Scott A. Lear, Wei Li, Chuangshi Wang, Deren Quiang, Yang Wang, Patricio López‐Jaramillo, Noushin Mohammadifard, Viswanathan Mohan, Prem Mony, Paul Poirier, Sarojiniamma Srilatha, Andrzej Szuba, Koon Teo, Andreas Wielgosz, Karen Yeates, Khalid Yusoff, Rita Yusuf, Afzalhusein H Yusufali, Marjan Walli-Attaei, Martin McKee, Salim Yusuf · 发表于：The Lancet Global Health · 年份：2019 · DOI：10.1016/s2214-109x(19)30045-2 · 被引用次数：652 · 研究领域：Health disparities and outcomes、Cardiovascular Health and Risk Factors、Diabetes, Cardiovascular Risks, and Lipoproteins

Background Socioeconomic status is associated with differences in risk factors for cardiovascular disease incidence and outcomes, including mortality. However, it is unclear whether the associations between cardiovascular disease and common measures of socioeconomic status—wealth and education—differ among high-income, middle-income, and low-income countries, and, if so, why these differences exist. We explored the association between education and household wealth and cardiovascular disease and mortality to assess which marker is the stronger predictor of outcomes, and examined whether any differences in cardiovascular disease by socioeconomic status parallel differences in risk factor levels or differences in management. Methods In this large-scale prospective cohort study, we recruited adults aged between 35 years and 70 years from 367 urban and 302 rural communities in 20 countries. We collected data on families and households in two questionnaires, and data on cardiovascular risk factors in a third questionnaire, which was supplemented with physical examination. We assessed socioeconomic status using education and a household wealth index. Education was categorised as no or primary school education only, secondary school education, or higher education, defined as completion of trade school, college, or university. Household wealth, calculated at the household level and with household data, was defined by an index on the basis of ownership of assets and housing characteri...