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. 2005 Dec;59(12):1080–1085. doi: 10.1136/jech.2005.036848

Income as mediator of the effect of occupation on the risk of myocardial infarction: does the income measurement matter?

I Andersen 1, M Gamborg 1, M Osler 1, E Prescott 1, F Diderichsen 1
PMCID: PMC1732959  PMID: 16286499

Abstract

Aim: To investigate whether the effect of occupational grade on the risk of myocardial infarction (MI) is mediated by income with different aspects of income taken into account.

Methods: Data were used from three prospective population studies conducted in Copenhagen. A total of 16 665 employees, 43% women, aged 20–75 years, with an initial examination between 1974 and 1992 were followed up until 1999 for incident (hospital admission or fatal) MI. Register based information on job categories and income was used.

Results: During follow up, 855 subjects were diagnosed with a MI: 708 men and 147 women (in total 47% fatal). The hazards by household and individual income showed a graded effect with a hazard ratio (HR) of 1.43 (95% CI 1.12 to1.83) for the lowest household income group compared with the highest, whereas equivalent income showed an inverse "J shape" effect with a HR of 1.55 (95% CI 1.25 to1.82) for the third income group compared with the highest. HR for unskilled workers as compared with executive managers was reduced from 1.55 (95% CI 1.24 to1.93) to 1.42 (95% CI 1.12 to1.81) after adjustment for household income.

Conclusions: Occupation and income are not mutually exclusive, but at least partly explained by or mediated through the other on the risk of MI. The mediating effect of income is independent of the choice of an income indicator. Income is not a big contributor to inequality in MI; probably because of the rather even income distribution in Denmark.

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Selected References

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  1. Andersen I., Burr H., Kristensen T. S., Gamborg M., Osler M., Prescott E., Diderichsen F. Do factors in the psychosocial work environment mediate the effect of socioeconomic position on the risk of myocardial infarction? Study from the Copenhagen Centre for Prospective Population Studies. Occup Environ Med. 2004 Nov;61(11):886–892. doi: 10.1136/oem.2004.013417. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Beebe-Dimmer Jennifer, Lynch John W., Turrell Gavin, Lustgarten Stephanie, Raghunathan Trivellore, Kaplan George A. Childhood and adult socioeconomic conditions and 31-year mortality risk in women. Am J Epidemiol. 2004 Mar 1;159(5):481–490. doi: 10.1093/aje/kwh057. [DOI] [PubMed] [Google Scholar]
  3. Benzeval M., Judge K. Income and health: the time dimension. Soc Sci Med. 2001 May;52(9):1371–1390. doi: 10.1016/s0277-9536(00)00244-6. [DOI] [PubMed] [Google Scholar]
  4. Ditlevsen Susanne, Christensen Ulla, Lynch John, Damsgaard Mogens Trab, Keiding Niels. The mediation proportion: a structural equation approach for estimating the proportion of exposure effect on outcome explained by an intermediate variable. Epidemiology. 2005 Jan;16(1):114–120. doi: 10.1097/01.ede.0000147107.76079.07. [DOI] [PubMed] [Google Scholar]
  5. Ecob R., Smith G. D. Income and health: what is the nature of the relationship? Soc Sci Med. 1999 Mar;48(5):693–705. doi: 10.1016/s0277-9536(98)00385-2. [DOI] [PubMed] [Google Scholar]
  6. Fritzell Johan, Nermo Magnus, Lundberg Olle. The impact of income: assessing the relationship between income and health in Sweden. Scand J Public Health. 2004;32(1):6–16. doi: 10.1080/14034950310003971. [DOI] [PubMed] [Google Scholar]
  7. Hagerup L., Eriksen M., Schroll M., Hollnagel H., Agner E., Larsen S. The Glostrup population studies. Collection of epidemiologic tables. Reference values for use in cardiovascular population studies. Scand J Soc Med Suppl. 1981;20:1–112. [PubMed] [Google Scholar]
  8. Hein H. O., Suadicani P., Gyntelberg F. Alcohol consumption, serum low density lipoprotein cholesterol concentration, and risk of ischaemic heart disease: six year follow up in the Copenhagen male study. BMJ. 1996 Mar 23;312(7033):736–741. doi: 10.1136/bmj.312.7033.736. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Kawachi I., Kennedy B. P. The relationship of income inequality to mortality: does the choice of indicator matter? Soc Sci Med. 1997 Oct;45(7):1121–1127. doi: 10.1016/s0277-9536(97)00044-0. [DOI] [PubMed] [Google Scholar]
  10. Lahelma E., Martikainen P., Laaksonen M., Aittomäki A. Pathways between socioeconomic determinants of health. J Epidemiol Community Health. 2004 Apr;58(4):327–332. doi: 10.1136/jech.2003.011148. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Liberatos P., Link B. G., Kelsey J. L. The measurement of social class in epidemiology. Epidemiol Rev. 1988;10:87–121. doi: 10.1093/oxfordjournals.epirev.a036030. [DOI] [PubMed] [Google Scholar]
  12. Lynch J. W., Smith G. D., Kaplan G. A., House J. S. Income inequality and mortality: importance to health of individual income, psychosocial environment, or material conditions. BMJ. 2000 Apr 29;320(7243):1200–1204. doi: 10.1136/bmj.320.7243.1200. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Madsen Mette, Davidsen Michael, Rasmussen Søren, Abildstrom Steen Z., Osler Merete. The validity of the diagnosis of acute myocardial infarction in routine statistics: a comparison of mortality and hospital discharge data with the Danish MONICA registry. J Clin Epidemiol. 2003 Feb;56(2):124–130. doi: 10.1016/s0895-4356(02)00591-7. [DOI] [PubMed] [Google Scholar]
  14. Martikainen Pekka, Bartley Mel, Lahelma Eero. Psychosocial determinants of health in social epidemiology. Int J Epidemiol. 2002 Dec;31(6):1091–1093. doi: 10.1093/ije/31.6.1091. [DOI] [PubMed] [Google Scholar]
  15. Rahkonen O., Arber S., Lahelma E., Martikainen P., Silventoinen K. Understanding income inequalities in health among men and women in Britain and Finland. Int J Health Serv. 2000;30(1):27–47. doi: 10.2190/VBJT-5LFB-62Y0-4Y29. [DOI] [PubMed] [Google Scholar]
  16. Stronks K., van de Mheen H. D., Mackenbach J. P. A higher prevalence of health problems in low income groups: does it reflect relative deprivation? J Epidemiol Community Health. 1998 Sep;52(9):548–557. doi: 10.1136/jech.52.9.548. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. The World Health Organization MONICA Project (monitoring trends and determinants in cardiovascular disease): a major international collaboration. WHO MONICA Project Principal Investigators. J Clin Epidemiol. 1988;41(2):105–114. doi: 10.1016/0895-4356(88)90084-4. [DOI] [PubMed] [Google Scholar]
  18. Theorell T., Tsutsumi A., Hallquist J., Reuterwall C., Hogstedt C., Fredlund P., Emlund N., Johnson J. V. Decision latitude, job strain, and myocardial infarction: a study of working men in Stockholm. The SHEEP Study Group. Stockholm Heart epidemiology Program. Am J Public Health. 1998 Mar;88(3):382–388. doi: 10.2105/ajph.88.3.382. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Virtanen Simo V., Notkola Veijo. Socioeconomic inequalities in cardiovascular mortality and the role of work: a register study of Finnish men. Int J Epidemiol. 2002 Jun;31(3):614–621. doi: 10.1093/ije/31.3.614. [DOI] [PubMed] [Google Scholar]
  20. Yngwe M. A., Diderichsen F., Whitehead M., Holland P., Burström B. The role of income differences in explaining social inequalities in self rated health in Sweden and Britain. J Epidemiol Community Health. 2001 Aug;55(8):556–561. doi: 10.1136/jech.55.8.556. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. van Doorslaer E., Wagstaff A., Bleichrodt H., Calonge S., Gerdtham U. G., Gerfin M., Geurts J., Gross L., Häkkinen U., Leu R. E. Income-related inequalities in health: some international comparisons. J Health Econ. 1997 Feb;16(1):93–112. doi: 10.1016/s0167-6296(96)00532-2. [DOI] [PubMed] [Google Scholar]

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