Contribution of health behaviours to cardiovascular disease by socioeconomic position in Finland

Abstract Background Health behaviours significantly contribute to the development of cardiovascular diseases (CVD). Lower socioeconomic position (SEP) is associated with higher rates of CVD, and differences in health behaviours between socioeconomic groups have been found to partly explain this association. Socioeconomic differences in health behaviours and CVD risk are well-documented. The aim of this study was to assess whether the same health behaviours have a different risk on CVD depending on SEP. Methods We followed a cohort of 40-60 year old municipal employees from Helsinki, Finland, from 2000-2002 (response rate 67%) until 2022 (N = 5993, 78% women). SEP was measured by occupational class. The outcome was all-cause CVD, identified from national administrative registers: 1) hospitalizations, 2) long-term sickness absence, 3) disability pensions, and 4) mortality. Using Cox regression, we calculated hazard ratios to assess whether health behaviours - excessive alcohol consumption, smoking, unhealthy diet, and insufficient physical activity - are differently associated with CVD risk between socioeconomic groups. Results Health behaviours were associated with CVD largely similarly between SEP groups. Unhealthy diet was more strongly associated with higher CVD risk in the higher SEP group (HR 1.32, 95 % CI 1.19-1.46 versus 1.13, 95 % CI 1.03-1.24 in the lower SEP group), while excessive alcohol use tended towards slightly stronger association with higher CVD risk in the lower SEP group (HR 1.12, 95 % CI 0.99-1.26, versus 0.98, 95 % CI 0.89-1.09 in the higher SEP group). Socioeconomic differences in the associations of all the other assessed health behaviours with subsequent cardiovascular events were small. Conclusions Unhealthy diet was more detrimental for CVD in the higher SEP group. Public health interventions targeting CVD should consider the socioeconomic differences in the effects of health behaviours. Key messages • Unhealthy diet was more detrimental for cardiovascular disease in higher socioeconomic positions. • Publiv health interventions targeting cardiovascular disease should consider the socioeconomic differences in the effects of health behaviours.