Social class, health behaviour, and mortality among men and women in eastern Finland

Abstract

Objective: To evaluate the associations between social class as defined by occupation, health behaviour, and mortality from all causes and coronary heart disease among middle aged men and women in eastern Finland. Design: Prospective observational study of two independent, random population samples examined in 1972 and 1977. Setting: North Karelia and Kuopio, Finland. Subjects: 8967 men and 9694 women aged 30-64 years at the beginning of the follow up study. The subjects were followed up for mortality up till 1987 by using the National Death Registry. Measurements and main results: Altogether 1429 men and 620 women died during the follow up, 603 men and 164 women of coronary heart disease. Among both sexes, compared with white collar workers unskilled blue collar workers had more adverse risk factors and also higher mortality due to coronary heart disease, other cardiovascular diseases, cancer, violent causes, and all other causes. Among men the age adjusted relative risk for all cause mortality in unskilled blue collar workers v white collar workers was reduced from 1.86 (95% confidence interval 1.55 to 2.22) to 1.47 (1.23 to 1.77) when adjusted for smoking, serum cholesterol concentration, hypertension, body mass index, and physical activity in leisure time. Among women the corresponding reduction in hazard ratio was from 1.49 (1.15 to 1.92) to 1.39 (1.07 to 1.81). The respective hazard ratios for coronary heart disease were 1.54 (1.16 to 2.02) and 1.22 (0.92 to 1.61) among men and 1.74 (1.05 to 2.90) and 1.66 (0.99 to 2.79) among women. Conclusions: Unfavourable cardiovascular risk factors and high mortality are concentrated among lower social classes in Finland. Among men about half of the excess coronary and all cause mortality among unskilled blue collar workers was associated with their unfavourable risk factor profile. The association was smaller in women.