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Changing social patterns of risk factors for cardiovascular disease in a Swedish community intervention programme
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.ORCID iD: 0000-0003-3025-2690
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
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1993 (English)In: International Journal of Epidemiology, ISSN 0300-5771, E-ISSN 1464-3685, Vol. 22, no 6, 1026-1037 p.Article in journal (Refereed) Published
Abstract [en]

Since 1985 a small-scale community-based cardiovascular disease (CVD) preventive programme has been in operation in an inland municipality, Norsjö, in Northern Sweden. The aim of this study was to assess the development of the relationship between social position and CVD risk factors in repeated cross-sectional surveys (1985-1990) among all men and women aged 30, 40, 50 and 60 years in the study area, using an age-stratified random sample from the Northern Sweden MONICA Study of 1986 and 1990 as reference population. These multiple cross-sectional surveys comprised a self-administered questionnaire and a health examination. Of the study population 95% (n = 1499) and 80% of those in the reference area (n = 3208) participated. Subjects were classified with regard to demographic, structural and social characteristics in relation to CVD risk factors and self-reported health status. Time trends in classical risk factor occurrence were assessed in terms of age- and sex- adjusted odds ratios using Mantel-Haenszel procedures. When simultaneously adjusting for several potential confounders we used a logistic regression analysis. Initially, more than half of the study population, both males and females, had and elevated (> or = 6.5 mmol/l) serum cholesterol level. After adjustments had been made for age and social factors it was found that the relative risk of hypercholesterolaemia dropped substantially and significantly among both sexes during the 6 years of CVD intervention in the study area. However, the probability of being a smoker was significantly reduced only in highly educated groups. Among other risk factors no single statistically significant change over time could be found. In the reference area there were no changes over time for the selected CVD risk factors. People in the study area had a less favourable perception of their health than those in the reference area. Social differences were found when perceived good health was measured, especially in variables indicating emotional and social support. When sex, age and social factors had been accounted for there was not clear change over the years in perceived good health.

Place, publisher, year, edition, pages
Oxford University Press, 1993. Vol. 22, no 6, 1026-1037 p.
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
URN: urn:nbn:se:umu:diva-64713DOI: 10.1093/ije/22.6.1026PubMedID: 8144283OAI: oai:DiVA.org:umu-64713DiVA: diva2:602450
Available from: 2013-02-01 Created: 2013-02-01 Last updated: 2017-12-06Bibliographically approved
In thesis
1. Community participation and social patterning in cardiovascular disease intervention
Open this publication in new window or tab >>Community participation and social patterning in cardiovascular disease intervention
1993 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

This study addresses health policy and public health in the field of cardiovascular disease (CVD) on the local level in Sweden. The overall aim is to contribute to the assessment of structural and social conditions within public health by analysing participation processes and outcome patterns in a local health programme. The northern Swedish MONICA study served as a reference area. The research strategy has been to integrate quantitative and  qualitative methodologies and, thereby, focus on different aspects of the health programme under study.

The mortality rate was excessive in the study area of Norsjö relative to both provincial and national figures over a period of more than 10 years. This finding formed the basis for a tenyear comprehensive and community-based health programme towards the prevention of CVD and diabetes.

Even in this seemingly homogeneous area it was found that socio-economic circumstances were associated with the public health. Almost half of the study population had hypercholesterolaemia (;>6.5 mmol/1), 19% of men and 25% of women were smokers and 30% and 29%, respectively, had high blood pressure. Age had a strong impact on all outcome measures. After adjustments for age and social factors it was found that the relative risk of having hypercholesterolaemia dropped significantly in both sexes during the six years of intervention. The probability of being a smoker was significantly reduced only in highly educated groups. No statistically significant change over time could be found for the risk of suffering high blood pressure. In the reference area of northern Sweden there were no changes over time for any of the selected risk factors. The likelihood of self-assessed good health decreased with increasing risk factor load, with the exception of hypercholesterolaemia , in all social strata.

The authorities, including the health and medical staff, were the main actors on the mediastage. Men in manual occupations were least affected by the media coverage. The actors and the public as well as the media viewed the health programme as orientated towards individual lifestyles. Community participation was mainly defined by the actors based on the medical and health planning approach. Differences in interpretations, social interests, personal conflicts and ideological constraints among the actors at local level were observed. Some critical attitudes towards the organization and management of the health programme were also noted among the citizens. However, a majority of the public wanted the health programme to continue. The present study underlines the importance of considering age, gender and social differences in the planning and evaluation of CVD preventive programmes.

Place, publisher, year, edition, pages
Umeå: Umeå Universitet, 1993. 49 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 383
Keyword
cardiovascular disease, diabetes, prevention, social factors, evaluation, social epidemiology, folkhälsovetenskap
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Epidemiology; Public health
Identifiers
urn:nbn:se:umu:diva-7544 (URN)91-7174-816-4 (ISBN)
Public defence
1993-11-19, Tandläkarhögskolan, Rosa salen, 9tr., Umeå universitet, Umeå, 09:00 (Swedish)
Opponent
Supervisors
Projects
digitalisering@umu
Available from: 2008-01-10 Created: 2008-01-10 Last updated: 2013-03-05Bibliographically approved
2. Partnership for health: on the role of primary health care in a community intervention programme
Open this publication in new window or tab >>Partnership for health: on the role of primary health care in a community intervention programme
1997 (English)Doctoral thesis, comprehensive summary (Other academic)
Place, publisher, year, edition, pages
Umeå: Umeå Universitet, 1997. 61 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 531
Keyword
Community intervention, primaiy health care, prevention of cardiovascular disease, selection bias, social factors, perceived health, Lp(a)
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-7534 (URN)91-7191-388-2 (ISBN)
Public defence
1997-12-05, Aulan, sjukhusadministrationen, Norrlands Universitetssjukhus i Umeå, Umeå universitet, Umeå, 09:30
Supervisors
Projects
digitalisering@umu
Note

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Available from: 2008-01-10 Created: 2008-01-10 Last updated: 2015-04-29Bibliographically approved

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