Six psychosocial and socioeconomic factors, including unemployment and depression, were independently associated with increased risk of cardiovascular death with hazard ratios ranging from 1.26 to 1.81.
Cohort (n=20,867)
Yes
Are psychosocial and socioeconomic factors associated with cardiovascular mortality in Eastern European populations?
Psychosocial and socioeconomic factors, including unemployment, low material amenities, depression, being single, and infrequent social contacts, are independently associated with increased cardiovascular mortality.
Effect estimate: HR 1.26-1.81 (95% CI 1.14-1.40 to 1.24-2.64)
p-value: p=0.00001 < p < 0.007
BACKGROUND: Eastern European countries have some of the highest rates of cardiovascular disease (CVD) mortality, much of which cannot be adequately accounted for by conventional CVD risk factors. Psychosocial and socioeconomic factors may affect risk of CVD, but relatively few studies on this issue have been undertaken in Eastern Europe. We investigated whether various psychosocial factors are associated with CVD mortality independently from each other and whether they can help explain differences in CVD mortality between Eastern European populations. METHODS: Participants were from the Health, Alcohol and Psychological factors in Eastern Europe (HAPIEE) cohort study in Russia, Poland and the Czech Republic, including a total of 20,867 men and women aged 43-74 years and free of CVD at baseline examination during 2002-2005. Participants were followed-up for CVD mortality after linkage to national mortality registries for a median of 7.2 years. RESULTS: During the follow-up, 556 participants died from CVD. After mutual adjustment, six psychosocial and socioeconomic factors were associated with increased risk of CVD death: unemployment, low material amenities, depression, being single, infrequent contacts with friends or relatives. The hazard ratios HRs for these six factors ranged between 1.26 95% confidence interval 1.14-1.40 and 1.81 95% confidence interval 1.24-2.64, fully adjusted for each other, and conventional cardiovascular risk factors. Population-attributable fractions ranged from 8% 4%-13% to 22% 11%-31% for each factor, when measured on average across the three cohorts. However, the prevalence of psychosocial and socioeconomic risk factors and their HRs were similar between the three countries. Altogether, these factors could not explain why participants from Russia had higher CVD mortality when compared to participants from Poland/Czech Republic. Limitations of this study include measurement error that could lead to residual confounding; and the possibilities for reverse causation and/or unmeasured confounding from observational studies to lead to associations that are not causal in nature. CONCLUSIONS: Six psychosocial and socioeconomic factors were associated with cardiovascular mortality, independent of each other. Differences in mortality between cohorts from Russia versus Poland or Check Republic remained unexplained.
Tillmann et al. (Wed,) conducted a cohort in Cardiovascular disease (n=20,867). Psychosocial and socioeconomic risk factors vs. Absence of risk factors was evaluated on Cardiovascular mortality (HR 1.26-1.81, 95% CI 1.14-1.40 to 1.24-2.64, p=0.00001 < p < 0.007). Six psychosocial and socioeconomic factors, including unemployment and depression, were independently associated with increased risk of cardiovascular death with hazard ratios ranging from 1.26 to 1.81.