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The influence of socioeconomic factors on cardiovascular disease risk factors in the context of economic development in the Samoan archipelago

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  • Ezeamama, Amara E.
  • Viali, Satupaitea
  • Tuitele, John
  • McGarvey, Stephen T.

Abstract

Early in economic development there are positive associations between socioeconomic status (SES) and cardiovascular disease (CVD) risk factors, and in the most developed market economy societies there are negative associations. The purpose of this report is to describe cross-sectional and longitudinal associations between indicators of SES and CVD risk factors in a genetically homogenous population of Samoans at different levels of economic development. At baseline 1289 participants 25-58Â yrs, and at 4-year follow-up, 963 participants were studied in less economically developed Samoa and in more developed American Samoa. SES was assessed by education, occupation, and material lifestyle at baseline. The CVD risk factors, obesity, type-2 diabetes and hypertension were measured at baseline and 4-year follow-up, and an index of any incident CVD risk factor at follow-up was calculated. Sex and location (Samoa and American Samoa) specific multivariable logistic regression models were used to test for relationships between SES and CVD risk factors at baseline after adjustment for age and the other SES indicators. In addition an ordinal SES index was constructed for each individual based on all three SES indicators, and used in a multivariable model to estimate the predicted probability of CVD risk factors across the SES index for the two locations. In both the models using specific SES measures and CVD risk factor outcomes, and the models using the ordinal SES index and predicted probabilities of CVD risk factors, we detected a pattern of high SES associated with: (1) elevated odds of CVD risk factors in less developed Samoa, and (2) decreased odds of CVD risk factors in more developed American Samoa. We conclude that the pattern of inverse associations between SES and CVD risk factors in Samoa and direct associations in American Samoa is attributable to the heterogeneity across the Samoas in specific exposures to social processes of economic development and the natural history of individual CVD risk factors. The findings suggest that interventions on non-communicable diseases in the Samoas must be devised based on the level of economic development, the socio-economic context of risk factor exposures, and individual characteristics such as age, sex and education level.

Suggested Citation

  • Ezeamama, Amara E. & Viali, Satupaitea & Tuitele, John & McGarvey, Stephen T., 2006. "The influence of socioeconomic factors on cardiovascular disease risk factors in the context of economic development in the Samoan archipelago," Social Science & Medicine, Elsevier, vol. 63(10), pages 2533-2545, November.
    • Handle: RePEc:eee:socmed:v:63:y:2006:i:10:p:2533-2545
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    1. Mary Schooling, C. & Lau, Elaine W.L. & Tin, Keith Y.K. & Leung, Gabriel M., 2010. "Social disparities and cause-specific mortality during economic development," Social Science & Medicine, Elsevier, vol. 70(10), pages 1550-1557, May.
    2. C Mary Schooling & Tai Hing Lam & G Neil Thomas & Benjamin J Cowling & Michelle Heys & Edward D Janus & Gabriel M Leung & for the Hong Kong Cardiovascular Risk Factor Prevalence Study Steering Committ, 2007. "Growth Environment and Sex Differences in Lipids, Body Shape and Diabetes Risk," PLOS ONE, Public Library of Science, vol. 2(10), pages 1-9, October.
    3. Ahmad Bahonar & Nizal Sarrafzadegan & Roya Kelishadi & Shahin Shirani & Mohammad Ramezani & Mohammad Taghdisi & Mojgan Gharipour, 2011. "Association of socioeconomic profiles with cardiovascular risk factors in Iran: the Isfahan Healthy Heart Program," International Journal of Public Health, Springer;Swiss School of Public Health (SSPH+), vol. 56(1), pages 37-44, February.
    4. Akanksha Srivastava & Sanjay K Mohanty, 2013. "Age and Sex Pattern of Cardiovascular Mortality, Hospitalisation and Associated Cost in India," PLOS ONE, Public Library of Science, vol. 8(5), pages 1-13, May.
    5. Michael J. Duncan & Susana Vale & Maria Paula Santos & José Carlos Ribeiro & Jorge Mota, 2012. "The Association between Cardiovascular Disease Risk and Parental Educational Level in Portuguese Children," IJERPH, MDPI, vol. 9(12), pages 1-10, November.

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