Ethnic disparities in educational and occupational gradients of estimated cardiovascular disease risk: The Healthy Life in an Urban Setting study

Scand J Public Health. 2018 Mar;46(2):204-213. doi: 10.1177/1403494817718906. Epub 2017 Jul 12.


Background: European societies are becoming increasingly ethnically diverse. This may have important implications for socio-economic inequalities in health due to the often disadvantaged position of ethnic minority groups in both socio-economic status (SES) and disease, especially cardiovascular disease (CVD).

Objective: The aim of this study was to determine whether the socio-economic gradient of estimated CVD risk differs between ethnic groups.

Methods: Using the Healthy Life in an Urban Setting study, we obtained data on SES and CVD risk factors among participants from six ethnic backgrounds residing in Amsterdam. SES was measured using educational level and occupational level. CVD risk was estimated based on the occurrence of CVD risk factors using the Dutch version of the systematic coronary risk evaluation algorithm. Ethnic disparities in socio-economic gradients for estimated CVD risk were determined using the relative index of inequality (RII).

Results: Among Dutch-origin men, the RII for estimated CVD risk according to educational level was 6.15% (95% confidence interval [CI] 4.35-7.96%), indicating that those at the bottom of the educational hierarchy had a 6.15% higher estimated CVD risk relative than those at the top. Among Dutch-origin women, the RII was 4.49% (CI 2.45-6.52%). The RII was lower among ethnic minority groups, ranging from 0.83% to 3.13% among men and -0.29% to 5.12% among women, indicating weaker associations among these groups. Results were similar based on occupational level.

Conclusions: Ethnic background needs to be considered in associations between SES and disease. The predictive value of SES varies between ethnic groups and may be quite poor for some groups.

Keywords: Cardiovascular disease; cardiovascular risk factors; educational inequalities; ethnic inequalities; occupational inequalities; prevention; socio-economic inequalities.

MeSH terms

  • Adult
  • Cardiovascular Diseases / ethnology*
  • Cohort Studies
  • Educational Status*
  • Ethnicity / statistics & numerical data*
  • Female
  • Health Status Disparities*
  • Humans
  • Male
  • Middle Aged
  • Netherlands / epidemiology
  • Occupations / statistics & numerical data*
  • Risk Factors
  • Urban Population / statistics & numerical data