Socioeconomic Status and Mortality in Swedish Women: Opposing Trends for Cardiovascular Disease and Cancer

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Abstract
We examined relations between socioeconomic status and cardiovascular disease, cancer, and diabetes mellitus in a 24-year prospective study of 1,462 Swedish women. Two socioeconomic indicators were used: the husband’s occupational category for married women and a composite indicator combining women’s educational level with household income for all women. The husband’s occupational category was strongly associated with cardiovascular disease and cancer mortality in opposite directions, independent of age and other potential confounders. Women with husbands of lower occupational categories had an increased risk of cardiovascular disease mortality [relative risk (RR) = 1.60; 95% confidence interval (95% CI) = 1.09–2.33] while experiencing lower rates of all-site cancer mortality (RR = 0.69; 95% CI = 0.50–0.96). A similar relation was seen with the composite variable: women with low socioeconomic status had an increased risk of cardiovascular disease (RR = 1.37; 95% CI = 1.01–1.84) but a somewhat lower risk for cancer of all sites (RR = 0.86; 95% CI = 0.66–1.11). Finally, morbidity data (diabetes mellitus, stroke, and breast cancer) yielded results that were consistent with the mortality trends, and breast cancer appeared to account for a major part of the association between total cancer and high socioeconomic status. In summary, higher socioeconomic status was associated with decreased cardiovascular disease mortality and excess cancer mortality, in such a way that only a weak association was seen for all-cause mortality.