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Two tales of cardiovascular risks-middle-aged women living in Sweden and Scotland: a cross-sectional comparative study
Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
Public Health Observatory Division, NHS Health Scotland, Edinburgh, UK..
Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Primary Care Center, Primary Health Care Center Vikbolandet.
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2017 (English)In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 7, no 8, article id e016527Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: To compare cardiovascular risk factors as well as rates of cardiovascular diseases in middle-aged women from urban areas in Scotland and Sweden.

DESIGN: Comparative cross-sectional study.

SETTING: Data from the general population in urban areas of Scotland and the general population in two major Swedish cities in southeast Sweden, south of Stockholm.

PARTICIPANTS: Comparable data of middle-aged women (40-65 years) from the Scottish Health Survey (n=6250) and the Swedish QWIN study (n=741) were merged together into a new dataset (n=6991 participants).

MAIN OUTCOME MEASURE: We compared middle-aged women in urban areas in Sweden and Scotland regarding risk factors for cardiovascular disease (CVD), CVD diagnosis, anthropometrics, psychological distress and lifestyle.

RESULTS: In almost all measurements, there were significant differences between the countries, favouring the Swedish women. Scottish women demonstrated a higher frequency of alcohol consumption, smoking, obesity, low vegetable consumption, a sedentary lifestyle and also more psychological distress. For doctor-diagnosed coronary heart disease, there were also significant differences, with a higher prevalence among the Scottish women.

CONCLUSIONS: This is one of the first studies that clearly shows that Scottish middle-aged women are particularly affected by a worse profile of CVD risks. The profound differences in CVD risk and outcome frequency in the two populations are likely to have arisen from differences in the two groups of women's social, cultural, political and economic environments.

Place, publisher, year, edition, pages
London: BMJ Publishing Group Ltd, 2017. Vol. 7, no 8, article id e016527
Keywords [en]
cardiovascular risk factors, comparative study, lifestyle, middle-aged women, psychological distress, public health
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
URN: urn:nbn:se:liu:diva-140935DOI: 10.1136/bmjopen-2017-016527ISI: 000411802700172PubMedID: 28790040Scopus ID: 2-s2.0-85027162863OAI: oai:DiVA.org:liu-140935DiVA, id: diva2:1142103
Note

Funding agencies: Swedish Heart and Lung Association [E136-15/E106/13]; Clinic ALF funds, Region Ostergotland, Sweden [LiO-446241]; Research and PhD studies Committee (FUN), Linkoping University, Sweden [LiU-2014-020251]

Available from: 2017-09-18 Created: 2017-09-18 Last updated: 2018-05-03Bibliographically approved
In thesis
1. Risks for cardiovascular disease in middle-aged women in different social environments
Open this publication in new window or tab >>Risks for cardiovascular disease in middle-aged women in different social environments
2017 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: The importance of the social environment and human life conditions for public health was early recognized in community medicine. Despite major reductions in recent decades, cardiovascular diseases (CVD) is one of the leading causes of mortality and morbidity for both genders in all European countries. 

Aim: The overall aim of this thesis was to increase our knowledge of factors in the social environment and of individual psychosocial factors that could explain why some women in working ages are affected by cardiovascular diseases.

Methods: The Swedish sample comes from the urban population in two major cities in a region in the south-east of Sweden, the Twin cities. According to their social history they could be labelled a “blue-collar” and a “white-collar” city. Cardiovascular morbidity data in all papers for the Twin cities was derived from a computerized population-based administrative Health Care Register (HCR). In Paper IV, we made a comparative study between Sweden and Scotland, the Scottish data comes from the Scottish Health Survey.

Results: In Paper I, the cumulative incidence of different cardiovascular diagnoses for younger and also elderly men and women were significantly higher in the population of the blue collar city in all ages and for both sexes. The qualitative interviews of women after an MI, in Paper II, the findings revealed a broad picture of social factors, life circumstances, personalities and, not least, psychosocial factors that are important to middle-aged women who have suffered an MI. Paper III demonstrated that women with a high level of the personality trait “being a Good Girl” reported significantly more psychosocial risk factors for CVD and more commonly report chest pain without seeking medical care, no increased incidence for various CVD-diagnoses were found. The comparative study (Paper IV) clearly showed that Scottish middle-aged women are – relative to Swedish women - particularly affected by a worse profile of CVD risks, even after adjustment for education.  

Conclusions: The social environment is of importance for cardiovascular risks and cardiovascular morbidity and mortality. This has been shown in Swedish Twin cities context and also in comparative studies between Swedish and Scottish women. The thesis gives strong implications for an upstream public health approach initiating long-term community intervention program in the blue collar city and among Scottish middle-aged women.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2017. p. 91
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1577
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:liu:diva-140934 (URN)10.3384/diss.diva-140934 (DOI)9789176854976 (ISBN)
Public defence
2017-09-29, Belladonna, ing 76/78, Campus Valla, Linköping, 13:00 (English)
Opponent
Supervisors
Funder
The Swedish Heart and Lung Association, E136-15/E106/13
Available from: 2017-09-18 Created: 2017-09-18 Last updated: 2019-10-28Bibliographically approved

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Wennerholm, CarinaJohansson, AnnaKarinNilsson, StaffanFaresjö, Tomas

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