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Risks for cardiovascular disease in middle-aged women in different social environments
Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
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: urn:nbn:se:liu:diva-140934DOI: 10.3384/diss.diva-140934ISBN: 9789176854976 (print)OAI: oai:DiVA.org:liu-140934DiVA, id: diva2:1142124
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/E106/13Available from: 2017-09-18 Created: 2017-09-18 Last updated: 2019-10-28Bibliographically approved
List of papers
1. Cardiovascular disease occurrence in two close but different social environments
Open this publication in new window or tab >>Cardiovascular disease occurrence in two close but different social environments
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2011 (English)In: INTERNATIONAL JOURNAL OF HEALTH GEOGRAPHICS, ISSN 1476-072X, Vol. 10, no 5Article in journal (Refereed) Published
Abstract [en]

Background: Cardiovascular diseases estimate to be the leading cause of death and loss of disability-adjusted life years globally. Conventional risk factors for cardiovascular diseases only partly account for the social gradient. The purpose of this study was to compare the occurrence of the most frequent cardiovascular diseases and cardiovascular mortality in two close cities, the Twin cities. Methods: We focused on the total population in two neighbour and equally sized cities with a population of around 135 000 inhabitants each. These twin cities represent two different social environments in the same Swedish county. According to their social history they could be labelled a "blue-collar" and a "white-collar" city. Morbidity data for the two cities was derived from an administrative health care register based on medical records assigned by the physicians at both hospitals and primary care. The morbidity data presented are cumulative incidence rates and the data on mortality for ischemic heart diseases is based on official Swedish statistics. Results: The cumulative incidence of different cardiovascular diagnoses for younger and also elderly men and women revealed significantly differences for studied cardiovascular diagnoses. The occurrence rates were in all aspects highest in the population of the "blue-collar" twin city for both sexes. Conclusions: This study revealed that there are significant differences in risk for cardiovascular morbidity and mortality between the populations in the studied different social environments. These differences seem to be profound and stable over time and thereby give implication for public health policy to initiate a community intervention program in the "blue-collar" twin city.

Place, publisher, year, edition, pages
BioMed Central, 2011
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-66880 (URN)10.1186/1476-072X-10-5 (DOI)000286525800001 ()
Note
Original Publication: Carina Wennerholm, Björn Grip, AnnaKarin Johansson, Hans Nilsson, Marja-Liisa Honkasalo and Tomas Faresjö, Cardiovascular disease occurrence in two close but different social environments, 2011, INTERNATIONAL JOURNAL OF HEALTH GEOGRAPHICS, (10), 5. http://dx.doi.org/10.1186/1476-072X-10-5 Licensee: BioMed Central http://www.biomedcentral.com/Available from: 2011-03-22 Created: 2011-03-21 Last updated: 2017-09-18
2. Life before myocardial infarction - a qualitative study of middle-aged women
Open this publication in new window or tab >>Life before myocardial infarction - a qualitative study of middle-aged women
2014 (English)In: Health, ISSN 1949-4998, E-ISSN 1949-5005, Vol. 6, p. 2765-2774Article in journal (Refereed) Published
Abstract [en]

The health burden of myocardial infarction is rising for middle-aged women and they are underrepresented in research of cardiovascular diseases. The aim of this qualitative study was to explore how life had been for middle-aged women before they suffered a myocardial infarction (MI). Through a health care register, we identified all women (n = 46) under 65 years of age in a defined region in southeast Sweden who had suffered an MI the past 2 years and a strategic selection of n = 16 women from these was made. These selected women were interviewed and their narratives were interpreted by qualitative content analysis. The qualitative interviews generated five general themes: “Serious life events”, “Negative affectivity”, “Loneliness”, “Being a good girl” and “Lack of control”. The interviews revealed that many of these women had been exposed to extreme and repeated traumatic life events in their lives. Many had a cynical attitude towards others, felt lonely and experienced a lack of social support. Many of these women endeavored to “be a good girl”, which was a special psychosocial phenomenon found. This study uncovered that these women before they suffered an MI were affected by a variety of psychosocial factors. The study stresses the importance of psychosocial risk factors in the assessment of middle-aged women’s risk profile for MI. A general conclusion for clinical practice is that in the assessment of the individual risk for myocardial infarction for middle-aged women, potential psychosocial factors might also be considered.

Place, publisher, year, edition, pages
Wuhan, Hubei Province, China: Scientific Research Publishing, 2014
National Category
General Practice
Identifiers
urn:nbn:se:liu:diva-115734 (URN)10.4236/health.2014.620316 (DOI)
Available from: 2015-03-18 Created: 2015-03-18 Last updated: 2018-01-11Bibliographically approved
3. Two tales of cardiovascular risks-middle-aged women living in Sweden and Scotland: a cross-sectional comparative study
Open this publication in new window or tab >>Two tales of cardiovascular risks-middle-aged women living in Sweden and Scotland: a cross-sectional comparative study
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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
Keywords
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:nbn:se:liu:diva-140935 (URN)10.1136/bmjopen-2017-016527 (DOI)000411802700172 ()28790040 (PubMedID)2-s2.0-85027162863 (Scopus ID)
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

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