Skip to main content
Journal of Epidemiology and Community Health logoLink to Journal of Epidemiology and Community Health
. 2003 Aug;57(8):622–627. doi: 10.1136/jech.57.8.622

Continuing inequality: gender and social class influences on self perceived health after a heart attack

E Lacey 1, S Walters 1
PMCID: PMC1732552  PMID: 12883071

Abstract

Study objective: To investigate the effect of social class and gender on self perceived health status for those recovering from an acute myocardial infarction.

Design: A longitudinal survey design was used, collecting both qualitative and quantitative data. Quantitative data are reported in this article, obtained by questionnaire over the first year after the event. SF-36 and EQ-5D (EuroQol) were used to measure self perceived health status.

Setting: Community based study in a city in the north of England.

Participants: A consecutive sample of 229 people discharged from hospital after acute myocardial infarction.

Main results: Overall gain in health status was found to be statistically significant over the year. Improvements were greatest in domains relating to role fulfilment and pursuit of normal and social activities. When analysed by gender, women showed poorer improvement than men, particularly in the domains relating to physical and social functioning. Analysed by social class, those without educational qualifications showed poorer improvement in pain experience and vitality. Access to a car was significant in avoiding physical limitations and promoting general health.

Conclusions: Existing gradients between the health of women and men, and between the social classes, are maintained and probably exacerbated by the experience of acute illness, and health professionals need to be made aware of social groups who are at risk of poor rehabilitation.

Full Text

The Full Text of this article is available as a PDF (179.0 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Brazier J. E., Harper R., Jones N. M., O'Cathain A., Thomas K. J., Usherwood T., Westlake L. Validating the SF-36 health survey questionnaire: new outcome measure for primary care. BMJ. 1992 Jul 18;305(6846):160–164. doi: 10.1136/bmj.305.6846.160. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Brezinka V., Kittel F. Psychosocial factors of coronary heart disease in women: a review. Soc Sci Med. 1996 May;42(10):1351–1365. doi: 10.1016/0277-9536(95)00284-7. [DOI] [PubMed] [Google Scholar]
  3. Gardner K., Chapple A. Barriers to referral in patients with angina: qualitative study. BMJ. 1999 Aug 14;319(7207):418–421. doi: 10.1136/bmj.319.7207.418. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Lindholm C., Burström B., Diderichsen F. Class differences in the social consequences of illness? J Epidemiol Community Health. 2002 Mar;56(3):188–192. doi: 10.1136/jech.56.3.188. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Marmot M. G., Bosma H., Hemingway H., Brunner E., Stansfeld S. Contribution of job control and other risk factors to social variations in coronary heart disease incidence. Lancet. 1997 Jul 26;350(9073):235–239. doi: 10.1016/s0140-6736(97)04244-x. [DOI] [PubMed] [Google Scholar]
  6. Marmot M., Ryff C. D., Bumpass L. L., Shipley M., Marks N. F. Social inequalities in health: next questions and converging evidence. Soc Sci Med. 1997 Mar;44(6):901–910. doi: 10.1016/s0277-9536(96)00194-3. [DOI] [PubMed] [Google Scholar]
  7. Payne N., Saul C. Variations in use of cardiology services in a health authority: comparison of coronary artery revascularisation rates with prevalence of angina and coronary mortality. BMJ. 1997 Jan 25;314(7076):257–261. doi: 10.1136/bmj.314.7076.257. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Tod A. M., Read C., Lacey A., Abbott J. Barriers to uptake of services for coronary heart disease: qualitative study. BMJ. 2001 Jul 28;323(7306):214–214. doi: 10.1136/bmj.323.7306.214. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Walters S. J., Munro J. F., Brazier J. E. Using the SF-36 with older adults: a cross-sectional community-based survey. Age Ageing. 2001 Jul;30(4):337–343. doi: 10.1093/ageing/30.4.337. [DOI] [PubMed] [Google Scholar]
  10. Ware J. E., Jr, Sherbourne C. D. The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care. 1992 Jun;30(6):473–483. [PubMed] [Google Scholar]
  11. Wiles R. Patients' perceptions of their heart attack and recovery: the influence of epidemiological "evidence" and personal experience. Soc Sci Med. 1998 Jun;46(11):1477–1486. doi: 10.1016/s0277-9536(97)10140-x. [DOI] [PubMed] [Google Scholar]

Articles from Journal of Epidemiology and Community Health are provided here courtesy of BMJ Publishing Group

RESOURCES