[Are fluctuations in health status related to socioeconomic factors among the Polish population?]

Abstract

Several studies indicated that prevalence of ischaemic heart disease (IHD) rose with increasing wealth of the population and previously higher IHD prevalence was observed in the higher social strata. Later, the IHD prevalence was higher in lower social class because the higher social class faster followed the recommendation connected with IHD prevention. Currently, in majority of wealthy countries the higher IHD prevalence is connected with lower social class. To assess the relationship between analyzed social factors (social background, education of father and subject himself and character of activity at work), marital status and self evaluation of the health status on the one hand and on the other hand classical IHD risk factors and death both total and cardiovascular. The basis of analyses constituted the results of examined in 1984, 1988 and 1993 independent 3 random samples of Warsaw population aged 35-64 years, the study conducted within the framework of the Pol-MONICA Warsaw Project. The screened population was followed up to 1998 from the death and its cause point of view. To the lower social class were included persons with peasant or blue collar worker social background, subjects, whose father's or himself had not finished the elementary education, and whose employment required very heavy physical work. Separately the analysis dealt with marital status and self assessment of health status. The lower social class was characterized by higher BMI and higher prevalence of obesity, higher heart frequency, higher level of systolic, diastolic and pulse pressure as well as prevalence of hypertension and higher HDL-C level. Higher social class was characterized by higher height and higher prevalence of cigarettes smoking. Married persons were characterized by higher weight and height as well as BMI. Persons who evaluated health status as bad or poor had lower height but higher systolic, diastolic and pulse pressure as well as prevalence of hypertension than the reference characteristics. Regardless that 18 characteristics (social factors and classical risk factors) were introduced previously into the regression model to evaluate the risk of death, in female population only lack of employment and poor assessments of health status out of social factors increased the overall risk of death; the risk of cardiovascular death increased with higher level of education, employment required heavy physical activity, not--maried status and poor or bad evaluation of health status, while compared with risk of reference characteristics. Among men the overall risk of death was connected with blue collar type of work, widow or divorced status, employment required heavy physical activity and poor or bad evaluation of health status. The risk of IHD death was connected with widow or not--married status, education at least college and poor or bad assessment of health status. One should conclude that currently in Poland the higher risk of death began to be transferred to lower social class.