Social circumstances and health

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Social circumstances and health
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20th century trends in life expectancy in
Scotland and 16 other Western European countries
Males
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Health Inequalities

• Are they due to
• Poverty?
• Diet ?
• Tobacco?

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Deprivation in 1981
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Deprivation in 1991
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Deprivation in 2001
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Excess Standardised Mortality not explained by
deprivation(Scotland v. EW)
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Coronary heart disease mortalityMen aged 15-74
years
Age-standardised mortality per 100,000
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World Health Organization (1997 and 2003)

www.heartstats.org
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Smoking prevalence - Europe
Males
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Smoking prevalence - Europe
Females
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Comparison of lung cancer mortality in West of
Scotland and 3 major cohorts
West of Scotland
Average annual death rate /100,000
American Cancer Society volunteers
UK doctors
US veterans
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100
80
manual
60
Rate per 10,000
40
non-manual
20
0
never
1-14
15-24
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daily cigarette consumption
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Risk of death - by level of hopelessness
RHR
Everson et al 1996
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Carotid artery thickening
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STRESS AND GRADE OF EMPLOYMENT MEN
Salivary Cortisol
Time of Day
Steptoe et al. 2003, Psychosomatic Medicine, 65,
461-470
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EFFECT OF JOB INSECURITY AND UNEMPLOYMENT ON
HEALTH
Source Ferrie et al. BMJ,2001,322 647-651
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Environmental determinants of inflammatory status
CRP (median) mg/dl
affluent
deprived
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hs-CRP and Risk of Future MI in Apparently
Healthy Men
P Trend lt0.001
Plt0.001
Plt0.001
P0.03
Relative Risk of MI
1
2
3
4
Quartile of hs-CRP (Range, mg/dL)
Ridker. N Engl J Med. 1997336973979.
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Inflammation in plaques
cytokines
MMP
Lumen
Inflammatory Cells
Degraded matrix
SMC apoptosis
Cap
Core
Inflammatory cells MMPs, IL-6, IL-15, IL-18,
CRP
Thin Fibrous Cap
Unstable
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CRP and cumulative risk of type 2 diabetes
diabetic
Q5 gt 4.18 mg/l
5
4
3
2
1
Q1 lt0.66 mg/l
0
0
0.5
1
1.5
2
2.5
3
3.5
4
4.5
5
Years in study
Freeman et al. Diabetes 2002,511596
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Adipocyte programming insulin resistance,
inflammation and ALP
skeletal muscle
Insulin resistance
triglyceride
Atherogenic Lipoprotein Phenotype
NEFAs
Low HDL small LDL
Adipose stores
liver
IL-6/IL-6sR
CRP SAA
Pro-inflammatory state
TNF-a/ TNF-a sR-I
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Opportunity to escape poverty, decent housing,
social networks, self esteem and sense of
control Consistent parenting, safe, nurturing
early years, supportive education
Health related behaviours