Cardiovascular risk factors in Australia: trends in socioeconomic inequalities.

STUDY OBJECTIVE

To examine trends in socioeconomic inequalities in cardiovascular risk factors using educational attainment to indicate socioeconomic status.

DESIGN

Behavioural data, physical measurements, blood pressure, and lipid determination collected in three, successive multicentre cross sectional community surveys conducted in 1980, 1983, and 1989.

SETTING

The six state capital cities of Australia; Sydney, Melbourne, Brisbane, Adelaide, Perth, and Hobart.

PARTICIPANTS

A total of 19,315 randomly selected respondents stratified by age (25-44, 45-64) and sex.

RESULTS

During the 1980s, average blood pressure declined for each level of educational attainment. Dietary messages to reduce the intake of saturated fat had little effect on the lipid profile of any population group. Height and educational attainment were positively associated. Women increased in weight from between 2 to 4 kg depending on age and educational attainment while older men experienced increases of around 2.5 kg regardless of educational attainment. Advice to avoid salt was adopted across the spectrum of educational attainment but with no suggestion that the socioeconomic gradient, which favoured the more highly educated, was diminishing. Men of all education levels responded positively to the anti-smoking initiatives of the 1980s but the relative disadvantage of those of lower education was maintained. Among women, the decline in smoking was less among those in the low education group. The prevalence of moderate to heavy drinkers was higher in men of lower educational attainment but declined significantly over the period. Walking for recreation or exercise became more popular, especially among older men of low education, while the prevalence of aerobic exercise and vigorous exercise remained largely unchanged. Overall, the clear socioeconomic gradient between leisure time physical activity and education attainment remained.

CONCLUSIONS

The lower socioeconomic group has improved its risk factor profile but its relative disadvantage compared with the higher socioeconomic group persists. Health promotion activities in Australia seem to have been effective in reaching the lower socioeconomic groups but the challenge to reduce inequalities remains. The steady increase in educational attainment in Australia may have been an important factor in the general improvement in the nation's risk factor profile and in the decrease in mortality from coronary heart disease.