Search

This review covers the most important theoretic contributions and results of epidemiological research on the relationship between socio-economic status (SES) and coronary heart disease (CHD). Two major approaches have been identified: those of the British and American schools. In spite of differences in method, most of published contributions have shown social inequalities in the outcome of most degenerative disorders. Similar patterns have been detected for the CHD: the time trend declines documented in recent years in most industrialized countries has not filled in the gap of SES difference in the incidence and mortality for CHD, which even seems to have increased in the lower social classes. Moreover, an apparent paradox has been described: even though CHD is typical of welfare societies, its impact is higher in the lower social classes. Recent results of Italian studies are reported which investigated the relationship between CHD risk factors and SES in representative samples. The findings suggest the presence, in Italy, too, of social discrepancies in the prevalence of major risk factors, in both gender groups. This should be taken in consideration when preventive programmes are planned in populations or in work settings.

In Italy three areas have been enrolled in the MONICA Project, two being located in Northern Italy (Area Brianza and Area Friuli) and one in Central Italy (Area Latina). This report concerns the comparison of the first year mortality and registration data of two areas, Area Latina (1983) and Area Brianza (1985), for men and women aged 25-64. In Area Latina, the age-standardized mortality rates for all causes, for all coronary heart disease, and for stroke are respectively 483, 83 and 42 per 100,000 for males, and 252, 14 and 32 per 100,000 for females. In Area Brianza, the age-standardized mortality rates for all causes, for all coronary heart disease, and for stroke are respectively 541, 94 and 38 per 100,000 for males, and 249, 19 and 24 per 100,000 for females. For males the attack rate for coronary events is similar in Area Latina and Area Brianza but the distribution of events in the several diagnostic categories is different. For females the coronary attack rate is higher in Area Latina than in Area Brianza. The implications of these data are discussed mainly from the methodological point of view.

Background/objective: Almost two-thirds of the coronary death rate decrease in the northern Italian Brianza MONICA male population, between 1993-4 and 1997-8, are attributable to a reduction in 28-day myocardial infarction CMII case-fatality. The present paper investigates the factors associated with Ml case-fatality decrease and in particular the role of socio-occupational classes (SOCs). Methods: Standardised information on acute coronary care and intervention before and during the hospitalisation was collected for all coronary events In = 1817) registered in 1993-4 and in 1997-8 among 35-64-year- old male residents in Brianza. Deaths within 28 days after Ml were carefully investigated. Five SOCs were defined adopting the Erikson-Goldthorpe-Portocarero method. Differences in 28-day Ml case-fatality and in acute phase intervention and treatment over time and among SOCs in each period were assessed. Results: 28-day Ml case-fatality reduction (27.2%) can be mainly attributed to a decreased proportion of MI events that were fatal before reaching the hospital. In the lower SOCs significant changes in Ml case-fatality were detected between 1993-4 and 1997-8. Differences in acute phase intervention and treatment between the periods were observed. SOC differences both in prevalence of out-of-hospital cardiac arrest and in the pre-hospital qualified intervention score were detected in the first period only. Conclusions: In the study population Ml case-fatality reduction can be mainly attributed to a more effective and prompt management before hospitalisation and to an improvement in acute treatment during hospitalisation. This enhancement is made available to the whole population overtaking social differences. [ABSTRACT FROM AUTHOR]