Sex Differences in Cardiovascular Disease Risk by Socioeconomic Status (SES) of Workers Using National Health Information Database

Abstract

The socioeconomic status (SES) and health behaviors of workers are associated with the risks of developing obesity, diabetes, hypertension, hyperlipidemia, and other cardiovascular diseases. Herein, we investigated the factors influencing cardiovascular disease (CVD) risk based on the SES of male and female workers. This cross-sectional analysis used the National Health Information Database to assess the associations between gender, SES (income level, residential area), health behaviors, and CVD-related health status of workers, through multinomial logistic regression. Upon analysis of a large volume of data on workers during 2016, the smoking and drinking trends of male and female workers were found to differ, causing different odds ratio (OR) tendencies of the CVD risk. Also, while for male workers, higher ORs of obesity or abdominal obesity were associated with higher incomes or residence in metropolitan cities, for female workers, they were associated with lower incomes or residence in rural areas. Additionally, among the factors influencing CVD risk, lower income and residence in rural areas were associated with higher CVD risk for male and female workers. The study findings imply the importance of developing gender-customized intervention programs to prevent CVD, due to gender-specific associations between CVD-related health status and health behaviors according to SES.

Keywords: cardiovascular disease; health behavior; risk; sex difference; socioeconomic status; worker.

Figure 1

Flow diagram showing study sample and sampling method. N was the total number of the insured workers and n was the number of subjects selected according to the sampling process.

Figure 2

Odds Ratio (OR) of CVD-related health status by income level: (a) OR of obesity by income level, (b) OR of central obesity by income level, (c) OR of hypertension by income level, (d) OR of high FG by income level, (e) OR of high TC by income level, (f) OR of high TG by income level, (g) OR of Low HDL-C by income level, (h) OR of high LDL-C by income level, and (i) OR of high CVD risk by income level. † CVD risk only includes persons older than 30 years and excludes the 58,308 subjects with either a related medical history or currently taking medicines related to CVDs, such as stroke and heart disease. Adjusted for age, region, smoking, alcohol consumption, and frequency of walking, moderate exercise, and vigorous exercise. Abbreviations: OR, odds ratio; CI, confidence interval; Q, Quintile; FG, fasting glucose; TC, total cholesterol; TG, triglyceride; HDL-C, high-density lipoprotein-cholesterol; LDL-C, low-density lipoprotein-cholesterol; CVD, cardiovascular disease. Error bars indicate 95% CI.

Figure 3

Odds Ratio (OR) of CVD-related health status by residential area. (a) OR of obesity by residential area, (b) OR of abdominal obesity by residential area, (c) OR of hypertension by residential area, (d) OR of high FG by residential area, (e) OR of high TC by residential area, (f) OR of high TG by residential area, (g) OR of low HDL-C by residential area, (h) OR of high LDL-C by residential area, and (i) OR of high CVD risk by residential area. † CVD risk only includes persons older than 30 years and excludes the 58,308 subjects with either a related medical history or currently taking medicines related to CVDs, such as stroke and heart disease. Adjusted for age, income level, smoking, alcohol consumption, and frequency of walking, moderate exercise, and vigorous exercise. Abbreviations: OR, odds ratio; CI, confidence interval; FG, fasting glucose; TC, total cholesterol; TG, triglyceride; HDL-C, high density lipoprotein-cholesterol; LDL-C, low density lipoprotein-cholesterol; CVD, cardiovascular disease. Error bars indicate 95% CI.