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Debbie A. Lawlor, PhD, Georgina Ronalds, MSc, Sally Macintyre, PhD, Heather Clark, MSc and David A. Leon, PhD

Debbie A. Lawlor is with the Department of Social Medicine, University of Bristol, Bristol, England. Georgina Ronalds and David A. Leon are with the Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, England. Sally Macintyre is with the Medical Research Council Social and Public Health Sciences Unit, University of Glasgow, Glasgow, Scotland. Heather Clark is with the Dugald Baird Centre for Research on Women’s Health, University of Aberdeen, Aberdeen, Scotland.

Correspondence: Requests for reprints should be sent to Debbie A. Lawlor, PhD, Department of Social Medicine, University of Bristol, Canynge Hall, Whiteladies Road, Bristol BS8 2PR, United Kingdom (e-mail: d.a.lawlor{at}bristol.ac.uk).

Objectives. We assessed the association of father’s social class, recorded at the time of birth, with coronary heart disease and stroke in a British cohort of 11106 individuals born in the 1950s.

Methods. Survival analysis was used to relate social class at birth to the occurrence of either fatal or nonfatal coronary heart disease or stroke.

Results. Rates of coronary heart disease and stroke increased across the social class distribution from highest to lowest, and patterns of association were similar for the 2 outcomes. The gender-adjusted hazard ratio of experiencing either coronary heart disease or stroke comparing the manual and nonmanual social class categories was 1.52 (95% confidence interval [CI]=1.14, 2.02). This ratio fell to 1.41 (95% CI = 1.05, 1.88) after adjustment for indicators of intrauterine and childhood growth. Further adjustment for educational attainment reduced the ratio to 1.28 (95% CI=0.94, 1.75).

Conclusions. We found that social class at birth was associated with risk of fatal and nonfatal cardiovascular disease among individuals born in the 1950s, a period of relative prosperity and after the introduction of the welfare state in Britain. This relation appeared to be mediated in part through educational attainment.

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