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• W2023375701 abstract "Alex Scott-Samuel's Sept 13 commentary1Scott-Samuel A Health inequalities recognised in UK.Lancet. 1997; 350: 753Summary Full Text Full Text PDF PubMed Scopus (2) Google Scholar on the health impact of inequalities, raises the issue of how health inequalities can be spotted and dealt with in the routine delivery of care. Socioeconomic variables are not usually included in individual medical histories in general practice, especially in Italy where there is increasing evidence of inequality,2CENSIS30° Rapporto sulla situazione sociale nel paese. Franco Angeli, Milano1996Google Scholar, 3Costa G Faggiano F L'equità nella salute in Italia. Rapporto sulle diseguaglianze sociali in sanita. Franco Angeli, Milano1994Google Scholar but little awareness of this issue. The availability of a large general-practice-based cohort of patients recruited in a primary prevention project (PPP) enabled us to explore the effect of education (an indirect, but robust indicator of socioeconomic level)4Liberators P Link BG Kelsey JL The measurement of social class in epidemiology.Epidemiol Rev. 1988; 10: 87-121PubMed Google Scholar on the profile of cardiovascular risk.PPP is a continuing, controlled, randomised trial aimed at assessing whether long-term treatment with vitamin E and low-dose aspirin, or both, reduces cardiovascular morbidity and mortality in individuals aged 50 years or older with cardiovascular risk factors, but without previous cardiovascular events. According to the protocol,5Collaborative Group of the Primary Prevention ProjectEpidemiological feasibility of cardiovascular primary prevention in general practice: a trial of vitamin E and aspirin.J Cardiovasc Risk. 1995; 2: 137-142Crossref PubMed Scopus (13) Google Scholar one of the trial's objectives is the prospective monitoring of the natural history of a population followed in routine conditions of care.We analysed the data on risk factors and lifestyle habits according to the level of education in the 3582 people who were enrolled in the PPP during the first 3 years by 303 family physicians throughout Italy. The mean age of the participants was 65 (7·5) years; 59% were women; 62·6% of participants had had no formal education or only primary school education, 18·5% had completed secondary schools, and 18·9% had finished high school or had a university degree. We assessed the independent relation between level of education and each of the cardiovascular risk factors and lifestyle habits by a multiple-logistic regression model (table). There was significant variability across education levels for most variables. Family history of premature myocardial infarction was not affected by education. The protective effect of a healthy lifestyle (physical leisure activity and intake of fruit or vegetables) was clear in the more educated strata of the population. We found that current smoking was significantly more common in individuals with more years of education, but that in this group smoking cessation also occurred more frequently (in 21%, 27%, and 31%, respectively, according to educational level). There was a strong association between higher education and protection from diabetes, obesity, and to a lesser extent, from hypertension; whereas there was only a slight correlation between hypercholesterolaemia and education.TableMultiple-logistic regression estimates of risk factors and lifestyle factors by level of education of 3582 participants in primary-prevention projectVariablesNumber of peopleRelative risk (95% CI) by educational levelNone/primary school*As reference group. MI= Myocardial infarctionSecondary schoolHigh school/universityFamily history of MI372 (10·4%)1·001·17 (0·84–1·62)1·21 (0·86–1·70)Low physical leisure activity1735 (48·4%)1·000·77 (0·62–0·95)0·58 (0·46–0·72)Low intake of fruit or vegetables189 (5·3%)1·000·65 (0·39–1·08)0·43 (0·23–0·77)Current smoking547 (15·3%)1·001·82 (1·40–2·36)1·78 (1·34–2·33)Diabetes579 (16·2%)1·000·63 (0·46–0·86)0·49 (0·35–0·70)Obesity811 (22·6%)1·000·67 (0·51–10·87)0·43 (0·32–0·58)Hypertension2409 (67·3%)1·000·98 (0·78–1·23)0·78 (0·62–0·99)Hypercholesterolaemia1351 (37·7%)1·001·34 (1·08–1·67)1·38 (1·10–1·74)* As reference group. MI= Myocardial infarction Open table in a new tab Increased awareness about socioeconomic variables could allow individuals or groups at risk to be targeted. Even if grossly simplified in a single indicator, socioeconomic factors can be assessed in terms of risk or protection in routine general practice, which is the preferred setting where epidemiological data could become clinical knowledge directly transferable to clinical (preventive or educational) care. Alex Scott-Samuel's Sept 13 commentary1Scott-Samuel A Health inequalities recognised in UK.Lancet. 1997; 350: 753Summary Full Text Full Text PDF PubMed Scopus (2) Google Scholar on the health impact of inequalities, raises the issue of how health inequalities can be spotted and dealt with in the routine delivery of care. Socioeconomic variables are not usually included in individual medical histories in general practice, especially in Italy where there is increasing evidence of inequality,2CENSIS30° Rapporto sulla situazione sociale nel paese. Franco Angeli, Milano1996Google Scholar, 3Costa G Faggiano F L'equità nella salute in Italia. Rapporto sulle diseguaglianze sociali in sanita. Franco Angeli, Milano1994Google Scholar but little awareness of this issue. The availability of a large general-practice-based cohort of patients recruited in a primary prevention project (PPP) enabled us to explore the effect of education (an indirect, but robust indicator of socioeconomic level)4Liberators P Link BG Kelsey JL The measurement of social class in epidemiology.Epidemiol Rev. 1988; 10: 87-121PubMed Google Scholar on the profile of cardiovascular risk. PPP is a continuing, controlled, randomised trial aimed at assessing whether long-term treatment with vitamin E and low-dose aspirin, or both, reduces cardiovascular morbidity and mortality in individuals aged 50 years or older with cardiovascular risk factors, but without previous cardiovascular events. According to the protocol,5Collaborative Group of the Primary Prevention ProjectEpidemiological feasibility of cardiovascular primary prevention in general practice: a trial of vitamin E and aspirin.J Cardiovasc Risk. 1995; 2: 137-142Crossref PubMed Scopus (13) Google Scholar one of the trial's objectives is the prospective monitoring of the natural history of a population followed in routine conditions of care. We analysed the data on risk factors and lifestyle habits according to the level of education in the 3582 people who were enrolled in the PPP during the first 3 years by 303 family physicians throughout Italy. The mean age of the participants was 65 (7·5) years; 59% were women; 62·6% of participants had had no formal education or only primary school education, 18·5% had completed secondary schools, and 18·9% had finished high school or had a university degree. We assessed the independent relation between level of education and each of the cardiovascular risk factors and lifestyle habits by a multiple-logistic regression model (table). There was significant variability across education levels for most variables. Family history of premature myocardial infarction was not affected by education. The protective effect of a healthy lifestyle (physical leisure activity and intake of fruit or vegetables) was clear in the more educated strata of the population. We found that current smoking was significantly more common in individuals with more years of education, but that in this group smoking cessation also occurred more frequently (in 21%, 27%, and 31%, respectively, according to educational level). There was a strong association between higher education and protection from diabetes, obesity, and to a lesser extent, from hypertension; whereas there was only a slight correlation between hypercholesterolaemia and education. Increased awareness about socioeconomic variables could allow individuals or groups at risk to be targeted. Even if grossly simplified in a single indicator, socioeconomic factors can be assessed in terms of risk or protection in routine general practice, which is the preferred setting where epidemiological data could become clinical knowledge directly transferable to clinical (preventive or educational) care." @default.
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• W2023375701 title "Health inequalities in Italy" @default.
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