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This Article Figures Only Full Text Full Text (PDF) All Versions of this Article: AJPH.2005.061853v1 96/1/152    most recent Submit a response View Shopping Cart Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Similar articles in this journal Similar articles in ISI Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via ISI Web of Science (3) Citing Articles via Google Scholar Google Scholar Articles by Song, Y.-M. Articles by Davey Smith, G. Search for Related Content PubMed PubMed Citation Articles by Song, Y.-M. Articles by Davey Smith, G. Related Collections Epidemiology Prevention Asians Socioeconomic Factors Men's Health Cardiovascular Disease

Yun-Mi Song, MD, MPH, PhD, Robert L. Ferrer, MD, MPH, Sung-il Cho, MD, ScD, Joohon Sung, MD, MPH, PhD, Shah Ebrahim, DM, FRCP and George Davey Smith, DSc, FFPHM

Yun-Mi Song is with the Department of Family Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea. Robert L. Ferrer is with the Department of Family and Community Medicine, University of Texas Health Science Center, San Antonio. Sung-il Cho is with the Department of Epidemiology, School of Public Health and Institute of Health and Environment, Seoul National University, Seoul. Joohon Sung is with the Department of Genetics, Southwest Foundation for Biomedical Research, San Antonio, and the Department of Preventive Medicine, Kangwon National University College of Medicine, Kangwon-Do, South Korea. Shah Ebrahim and George Davey Smith are with the Department of Social Medicine, University of Bristol, Bristol, England.

Correspondence: Requests for reprints should be sent to Yun-Mi Song, MD, MPH, PhD, Dept of Family Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Irwondong 50, Gangnamgu, Seoul, Korea, 135–710 (e-mail: ymsong{at}smc.samsung.co.kr).

Objectives. We examined the association between socioeconomic status (SES) and myocardial infarction and stroke subtypes, including the possible mediating influence of cardiovascular risk factors.

Methods. We evaluated data on 578756 Korean male public servants aged 30 to 58 years from August 1, 1990, to July 31, 2001.

Results. SES had inverse associations with mortality because of myocardial infarction and stroke subtypes, which were not changed by an adjustment for, or stratification by, cardiovascular risk factors. For nonfatal events, SES had positive, null, and inverse associations with myocardial infarction, ischemic stroke, and hemorrhagic stroke, respectively. The association between SES and nonfatal myocardial infarction depended on the presence of risk factors and was positive only among men who had cardiovascular risk factors. Case-fatality after hospital admission for cardiovascular diagnoses was significantly lower among higher SES groups, even after risk factor adjustment.

Conclusions. Inverse SES associations with cardiovascular diseases were not mediated by cardiovascular risk factors among men who were undergoing economic transition. Socioeconomically patterned access to medical care may partly explain these socioeconomic gradients.

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