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Impact of Coronary Heart Disease on Health Functioning in an Aging Population: Are There Differences According to Socioeconomic Position?

From the Department of Epidemiology and Public Health, University College London, London, United Kingdom.

Address correspondence and reprint requests to Amanda Sacker, Institute for Social and Economic Research (ISER) University of Essex Wivenhoe Park, Colchester, CO4 3SQ, UK. E-mail: asacker{at}essex.ac.uk

Objective: To examine differences in the effect of coronary heart disease (CHD) on health functioning according to socioeconomic position. Research on social inequality in health has tended to concentrate on differences in disease prevalence and mortality rather than on the impact of disease on functioning. As outcomes improve for those with CHD, it is important to know how their health is affected in the long term.

Methods: The analysis uses questionnaire data from phase 3 (1991–1993) to phase 7 (2003–2005) of the Whitehall II Study of civil servants (n = 8292). Differences between those in higher and lower employment grades in the relationship between CHD and physical and mental health functioning were measured according to the Short Form 36 General Health Survey (SF-36). A growth curve model of change in SF-36 physical and mental health from five repeated-measures over the 12-year period was then estimated.

Results: The differences in SF-36 health between those with and without preexisting CHD depended on employment grade. For those with CHD, physical health was initially poorer in lower grades than in higher ones; this difference persisted throughout. The mental health of respondents with CHD in the lowest grades deteriorated over time whereas for members of the higher grades, the prevailing trend was for improving mental health.

Conclusions: CHD has a more detrimental effect on physical and mental health functioning among those in more disadvantaged socioeconomic positions.

Key Words: coronary heart disease • aging • cohort studies • cost of illness • longitudinal studies • socioeconomic factors

Abbreviations: CHD = coronary heart disease; GCM = growth curve model; ECG = electrocardiogram; ML = maximum likelihood; SF-36 = Short Form 36 General Health Survey; PCS = physical health component score; MCS = mental health component score.