Does occupational social class predict coronary heart disease after retirement? A 12-year follow-up study in Sweden

Aims: To examine whether socioeconomic status and coronary heart disease (CHD) risk factors remain significant predictors of CHD among people aged ≥65 years. Previous studies in this age group are few and inconsistent. Methods: Follow-up study of a simple random sample of Swedish women and men aged ≥65 years interviewed in a national survey 1988—89 and followed up until 31 December 2000, for CHD incidence rates. Cox regression was used to study the association between socioeconomic status (occupation) and CHD, after adjustment for age, sex, physical activity, smoking, BMI, diabetes, and hypertension. Participants with CHD hospitalization two years before the start of the study and those who rated their general health as poor were excluded. Results: Among manual workers and lower-level employees the risk of CHD was significantly higher than among middle-level employees and professionals (49% and 50%, respectively), after adjustment for age and sex. The association between low socioeconomic status and increased CHD risk disappeared after adjustment for the CHD risk factors, which were more prevalent among those with low socioeconomic status. All the CHD risk factors (with the exception of BMI) were associated with increased CHD incidence rates. Conclusions: Low socioeconomic status remains a significant predictor of CHD among people aged ≥65 years. Healthcare policies among elderly patients should encourage physical activity and smoking cessation in all socioeconomic groups.