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Mika Kivimäki, PhD, Debbie A. Lawlor, PhD, George Davey Smith, DSc, Anne Kouvonen, PhD, Marianna Virtanen, PhD, Marko Elovainio, PhD and Jussi Vahtera, MD

Mika Kivimäki is with the Department of Epidemiology and Public Health, University College London, London, England. Debbie A. Lawlor and George Davey Smith are with the Department of Social Medicine, University of Bristol, Bristol, England. Anne Kouvonen and Marko Elovainio are with the Department of Psychology, University of Helsinki, Helsinki, Finland. Marianna Virtanen and Jussi Vahtera are with Finnish Institute of Occupational Health, Helsinki.

Correspondence: Requests for reprints should be sent to Dr. Mika Kivimäki, Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London WC1E 6BT, UK (e-mail: m.kivimaki{at}ucl.ac.uk).

Objectives. We examined the associations between socioeconomic position, co-occurrence of behavior-related risk factors, and the effect of these factors on the relative and absolute socioeconomic gradients in coronary heart disease.

Methods. We obtained the socioeconomic position of 9337 men and 39 255 women who were local government employees aged 17–65 years from employers’ records (the Public Sector Study, Finland). A questionnaire survey in 2000–2002 was used to collect data about smoking, heavy alcohol consumption, physical inactivity, obesity, and prevalence of coronary heart disease (myocardial infarction or angina diagnosed by a doctor).

Results. The age-adjusted odds of coronary heart disease were 2.1–2.2 times higher for low-income groups than high-income groups for both men and women, and adjustment for risk factors attenuated these associations by 13%–29%. There was no further attenuation with additional adjustment for the number of co-occurring risk factors, although socioeconomic disadvantage was associated with the co-occurrence of multiple risk factors. The absolute difference in coronary heart disease risk between socioeconomic groups could not be attributed to the measured risk factors.

Conclusions. Interventions to reduce adult behavior-related risk factors may not completely remove socioeconomic differences in relative or absolute coronary heart disease risk, although they would lessen these effects.

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