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. 1989 Feb;61(2):172–177. doi: 10.1136/hrt.61.2.172

Unemployment, socioenvironmental factors, and coronary heart disease in Scotland.

I K Crombie 1, M B Kenicer 1, W C Smith 1, H D Tunstall-Pedoe 1
PMCID: PMC1216636  PMID: 2923755

Abstract

Scotland, which has one of the highest death rates in the world from coronary heart disease, also has considerable regional variation in mortality from this cause. The relation between standardised mortality ratios for coronary deaths (1979-83) for 56 local government districts and a range of socioeconomic factors from the 1981 Census as well as climatic factors and water hardness were investigated. Strong associations were seen with several measures of social disadvantage, the strongest being with percentage of male unemployment. A fitted multiple regression model with mortality from coronary heart disease in men found independent effects of two social variables (percentage male unemployment and percentage social class III-V) and one climatic factor (rainfall). The model explained much (73%) of the geographical variation in mortality from coronary heart disease, but part of the geographical pattern, in particular some of the east-west gradient in mortality, remained unexplained by it. Explanations for the geographical variation and the association with economic factors are currently being sought in terms of individual risk factors in a large screening study, the Scottish Heart Health Study.

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Selected References

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  1. Arber S. Social class, non-employment, and chronic illness: continuing the inequalities in health debate. Br Med J (Clin Res Ed) 1987 Apr 25;294(6579):1069–1073. doi: 10.1136/bmj.294.6579.1069. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Brenner M. H. Mortality and the national economy. A review, and the experience of England and Wales, 1936--76. Lancet. 1979 Sep 15;2(8142):568–573. [PubMed] [Google Scholar]
  3. Chinn S., Florey C. D., Baldwin I. G., Gorgol M. The relation of mortality in England and Wales 1969-1973 to measurements of air pollution. J Epidemiol Community Health. 1981 Sep;35(3):174–179. doi: 10.1136/jech.35.3.174. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Crawford M. D., Gardner M. J., Morris J. N. Mortality and hardness of local water-supplies. Lancet. 1968 Apr 20;1(7547):827–831. doi: 10.1016/s0140-6736(68)90297-3. [DOI] [PubMed] [Google Scholar]
  5. Crombie I. K., Smith W. C., Kenicer M. B., Tunstall-Pedoe H. Geographical variation in coronary heart disease mortality in Scotland. Health Bull (Edinb) 1986 Jul;44(4):193–202. [PubMed] [Google Scholar]
  6. Elwood P. C., St Leger A. S., Morton M. Mortality and the concentration of elements in tap water in county boroughs in England and Wales. Br J Prev Soc Med. 1977 Sep;31(3):178–182. doi: 10.1136/jech.31.3.178. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Fulton M., Adams W., Lutz W., Oliver M. F. Regional variations in mortality from ischaemic heart and cerebrovascular disease in Britain. Br Heart J. 1978 May;40(5):563–568. doi: 10.1136/hrt.40.5.563. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Gardner M. J., Crawford M. D., Morris J. N. Patterns of mortality in middle and early old age in the county boroughs of England and Wales. Br J Prev Soc Med. 1969 Aug;23(3):133–140. doi: 10.1136/jech.23.3.133. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. MORRIS J. N., CRAWFORD M. D., HEADY J. A. Hardness of local water-supplies and mortality from cardiovascular disease in the County Boroughs of England and Wales. Lancet. 1961 Apr 22;1(7182):860–862. doi: 10.1016/s0140-6736(61)90180-5. [DOI] [PubMed] [Google Scholar]
  10. Markowe H. L., Marmot M. G., Shipley M. J., Bulpitt C. J., Meade T. W., Stirling Y., Vickers M. V., Semmence A. Fibrinogen: a possible link between social class and coronary heart disease. Br Med J (Clin Res Ed) 1985 Nov 9;291(6505):1312–1314. doi: 10.1136/bmj.291.6505.1312. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Marmot M. G., Adelstein A. M., Robinson N., Rose G. A. Changing social-class distribution of heart disease. Br Med J. 1978 Oct 21;2(6145):1109–1112. doi: 10.1136/bmj.2.6145.1109. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Marmot M. G., McDowall M. E. Mortality decline and widening social inequalities. Lancet. 1986 Aug 2;2(8501):274–276. doi: 10.1016/s0140-6736(86)92085-4. [DOI] [PubMed] [Google Scholar]
  13. Moser K. A., Goldblatt P. O., Fox A. J., Jones D. R. Unemployment and mortality: comparison of the 1971 and 1981 longitudinal study census samples. Br Med J (Clin Res Ed) 1987 Jan 10;294(6564):86–90. doi: 10.1136/bmj.294.6564.86. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Pocock S. J., Cook D. G., Beresford S. A. Regression of area mortality rates on explanatory variables: what weighting is appropriate? J R Stat Soc Ser C Appl Stat. 1981;30(3):286–295. [PubMed] [Google Scholar]
  15. Pocock S. J., Shaper A. G., Cook D. G., Packham R. F., Lacey R. F., Powell P., Russell P. F. British Regional Heart Study: geographic variations in cardiovascular mortality, and the role of water quality. Br Med J. 1980 May 24;280(6226):1243–1249. doi: 10.1136/bmj.280.6226.1243. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Pocock S. J., Shaper A. G., Cook D. G., Phillips A. N., Walker M. Social class differences in ischaemic heart disease in British men. Lancet. 1987 Jul 25;2(8552):197–201. doi: 10.1016/s0140-6736(87)90774-4. [DOI] [PubMed] [Google Scholar]
  17. Roberts C. J., Lloyd S. Association between mortality from ischaemic heart-disease and rainfall in South Wales and in the county boroughs of England and Wales. Lancet. 1972 May 20;1(7760):1091–1093. doi: 10.1016/s0140-6736(72)91429-8. [DOI] [PubMed] [Google Scholar]
  18. Rose G., Marmot M. G. Social class and coronary heart disease. Br Heart J. 1981 Jan;45(1):13–19. doi: 10.1136/hrt.45.1.13. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Shaper A. G. Geographic variations in cardiovascular mortality in Great Britain. Br Med Bull. 1984 Oct;40(4):366–373. doi: 10.1093/oxfordjournals.bmb.a072006. [DOI] [PubMed] [Google Scholar]
  20. Smith W. C., Crombie I. K. Coronary heart disease and water hardness in Scotland--is there a relationship? J Epidemiol Community Health. 1987 Sep;41(3):227–228. doi: 10.1136/jech.41.3.227. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Smith W. C., Crombie I. K., Tavendale R., Irving J. M., Kenicer M. B., Tunstall Pedoe H. The Scottish Heart Health Study: objectives and development of methods. Health Bull (Edinb) 1987 Jul;45(4):211–217. [PubMed] [Google Scholar]
  22. St Leger A. S., Sweetnam P. M. Statistical problems in studying the relative specificities of association between environmental agents and different diseases: a solution suggested. Int J Epidemiol. 1979 Mar;8(1):73–77. doi: 10.1093/ije/8.1.73. [DOI] [PubMed] [Google Scholar]
  23. Tunstall-Pedoe H., Smith W. C., Crombie I. K. Level and trends of coronary heart disease mortality in Scotland compared with other countries. Health Bull (Edinb) 1986 May;44(3):153–161. [PubMed] [Google Scholar]
  24. Uemura K., Pisa Z. Recent trends in cardiovascular disease mortality in 27 industrialized countries. World Health Stat Q. 1985;38(2):142–162. [PubMed] [Google Scholar]
  25. West R. R., Lloyd S., Roberts C. J. Mortality from ischaemic heart disease--association with weather. Br J Prev Soc Med. 1973 Feb;27(1):36–40. doi: 10.1136/jech.27.1.36. [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. West R. R., Lowe C. R. Mortality from ischaemic heart disease--inter-town variation and its association with climate in England and Wales. Int J Epidemiol. 1976 Jun;5(2):195–201. doi: 10.1093/ije/5.2.195. [DOI] [PubMed] [Google Scholar]

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