Sex differences in the risk of coronary heart disease associated with socioeconomic status in Turkey

• Published in: European journal of public health Vol. 31; no. Supplement_3
• Main Authors: Turunc, O, Zwas, DR, Calderon-Margalit, R, Unal, B
• Format: Journal Article
• Language: English
• Published: Oxford Oxford University Press 20.10.2021; Oxford Publishing Limited (England)
• Subjects: Cardiovascular disease; Cardiovascular diseases; Chronic illnesses; Coronary artery disease; Education; Employment; Females; Gender aspects; Gender differences; Health risks; Heart diseases; High income; Income; Industrialized nations; Males; Men; Mental health; Public health; Regression analysis; Retirement; Risk analysis; Risk assessment; Risk factors; Risk taking; Sex differences; Socioeconomic status; Socioeconomics; Unemployment; Women; Turkey
• ISSN: 1101-1262; 1464-360X
• DOI: 10.1093/eurpub/ckab164.108

Background Studies in high-income countries have demonstrated that low SES status is associated with increased risk of CHD, with sex differences in the risk profiles. Recent evidence suggests that this association may differ in middle-income countries. Methods The database of the Chronic Diseases and Risk Factors Survey In Turkey from 2013 and 2019 was used. Education level and employment status were chosen as proxy indicators for SES. Cox regression analyses were conducted to assess the effect of SES on incident CHD controlled by age, settlement, behavioral and biological risk factors. Interaction terms were introduced to the Cox models to assess multiplicative interaction between sex and SES on the occurrence of stroke. Results The study included 13 975 participants (7 450 females (53.3%) and 6525 males (46.7%)). During 74.2±9.87 months of follow-up, 474 CHD cases occurred among females (10.28 cases per 1000 person-year) and 445 CHD cases occurred among males (11.05 cases per 1000 person-year). Incident CHD was not associated with education level among either sex. Retirement was associated with increased risk of CVD (HR = 1.31, 95%Cl: 1.18-1.66) among males. Both retirement (HR = 2.12, 95%Cl: 1.16-3.88) and unemployment (HR = 1.93, 95%Cl: 1.14-3.25) were associated with increased risk of CHD in females after adjustment for behavioral and biological risk factors. There was no multiplicative interaction between sex and employment status on the risk of CHD (p = 0.091). Conclusions This study of health outcomes in Turkey did not find sex differences in CVD in association with educational status but did show sex differences in association with employment status. This finding suggests that social determinants in middle-income countries may affect men and women differently than in high-income countries. Key messages Social determinants in middle-income countries may affect men and women differently with regards to the risk of CHD than in high-income countries. Employment status can predict the risk of CHD in middle-income countries.