Executive Summary: "Is the Association between Socioeconomic Position and Coronary Heart Disease Stronger in Women than in Men?" by Lisa F. Berkman, Ichiro Kawachi, Laura D. Kubzansky, and Rebecca C. Thurston

            Research abounds which shows that the poor are more likely to suffer from health problems than the wealthy.  On the other hand, little is known about the effects of gender on the relationship between wealth and health.  Are poor women and poor men equally at risk for disease?  In their paper, Rebecca C. Thurston, Laura D. Kubzansky, Ichiro Kawachi and Lisa F. Berkman investigate whether men or women have different risks of coronary heart disease depending upon their socioeconomic status.

            Thurston et al. draw on data from the First National Health and Nutrition Surveys (1982-1992) to get a nationally representative sample.  6025 participants (2750 men and 3275 women) aged 25-74 underwent medical exams and assessment regarding social, economic and psychological conditions  in personal and telephone interviews.  Participants  contributed information on their educational attainment and household income levels.  The categories of educational attainment were less than high school; high school graduate, some college and college graduate or more.  To determine household income, participants were divided into those with less than 100 percent of the 1973 poverty line, those between 100-200 percent poverty line and those with 200 percent or more poverty wages.  Additional psychological and social measures included describing one’s status as a single parent, employment status and one’s symptoms of depression.

            The paper finds that although, overall men have a higher absolute risk of coronary heart disease, women with low education and low income  have higher relative risks of  developing  the disease than do men of comparable backgrounds.  The relative risk of developing coronary heart disease for women with less than a high school education was 2.15 compared with a risk of 1.58 for men with less than a high school education.  The study’s results also show that women with less than a high school education struggled with more social and psychological risks including depression, single parenthood and unemployment.  Where 13.5 percent of women with less than a high school education had 2 or more risk factors, 46.6 percent of women at this educational level lived with 1 or more risk factors.  In comparison, 5.6 percent of men with less than high school had 2 or more risk factors and only 29.8 percent of men at this education level struggled with 1 or more risks.

            In addition to companion risks of social and psychological factors, the authors found that certain cardiovascular risk factors explained the gender differences in the educational gradient in coronary heart disease.  Where the presence of behavioral and medical risk factors like smoking, alcohol use, aerobic exercise, high blood pressure and hypertension explained little or none of the gender gap, having high cholesterol, diabetes and in particular, high body mass index (BMI) explained a great deal of the educational gradient in cardiovascular disease for women.  This study showed that women with a high school diploma or less had 1.43 and 2.44 kg/m2 higher BMI than college educated women. Men who completed high school or less had only 0.76/m2 higher BMI than men with a college degree.  These metabolic risks largely explained the gender differences in the educational gradient in coronary heart disease.