Life course socioeconomic circumstances and cardiovascular disease risk in Central and Eastern Europe
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This thesis investigated the influences of early life socioeconomic circumstances (SEC) on cardiovascular disease (CVD) risk in Russia, Poland and the Czech Republic. Early life SEC are inversely associated with CVD risk factors and outcomes in western countries, but the same relationships have not been evaluated in Central and Eastern Europe. CVD is a major cause of morbidity and mortality in this region. I used data from the first round of the HAPIEE (Health, Alcohol and Psychosocial factors In Eastern Europe) study, which randomly selected men and women aged 45 to 69 years from population registers in Novosibirsk (Russia), Krakow (Poland) and six towns in the Czech Republic. Nearly 29,000 people were recruited, with an overall response rate of 61%. Blood pressure (systolic and diastolic blood pressure, hypertension), lipids (total and HDL cholesterol), adiposity (BMI, waist circumference, waist to hip ratio), smoking habits (starting and quitting) and CVD risk, as measured by SCORE, were assessed in relation to retrospectively collected direct and proxy measures of early life SEC. The reliability of adult anthropometric measures (height, leg length and trunk length) as proxy markers of early life SEC was confirmed by investigating the relationships with three direct measures of early life SEC (maternal and paternal education and household ownership of six assets at age ten years). Higher childhood SEC were linked to an increased likelihood of women starting smoking, a decreased likelihood of men quitting smoking, and reduced adiposity in both genders. The remaining CVD risk factors and overall CVD risk did not appear to be consistently influenced by childhood SEC. The results of the thesis suggest that early life socioeconomic influences on classical CVD risk may not be consistent across cultures, and that they may vary by the stage of the epidemiological transition and by local context.
THES
Philosophy Department
Webb, Elizabeth Alice
2009
Doctor of Philosophy
University College London
2054
