Socio-economic position and coronary heart disease risk factors in children and young people – evidence from UK epidemiological studies

Dr G. David Batty

Lecturer in Epidemiology

Professor David A. Leon

Professor of Epidemiology

These tables are taken from a report commissioned by the National Heart Forum, a distilled version of which appeared in the European Journal of Public Health (2002; 12: 263-272 - http://pubmed.oupjournals.org/) 

Table 1 summarises all the studies that met our inclusion criteria and is a more detailed version of that appearing in the journal article.  Subsequent tables (tables 2 to 8), which refer to the association between indices of socio-economic (e.g., occupational social class, education, income) and individual risk factors (e.g., smoking, fat consumption, etc), did not appear in the journal article.

If you have any queries, observations or corrections regarding this work please contact David Batty (david.batty@lshtm.ac.uk).

Table 1.  Overview of publications of UK studies relating indicators of socioeconomic position in

children and young adults to CHD risk factors, according to period of data collection

Study name and reference	Description^†	Year of risk factor measurement	Age at risk factor measurement (years)	Indicator of socioeconomic position	Diet	Cigarette smoking	Physical activity/ fitness	Blood pressure	Blood cholesterol	Adiposity	Height
Conducted in 1990 to 1999:
Scottish Health Survey^32	Nationally representative sample of 3,892 children	1998	2-15	Occupational social class	●		●	●		●
Health Survey for England^31	3,142 children from randomly sampled households	1998	2-15	Occupational social class Household income						●
National Diet and Nutrition Survey: Young People Aged 4 to 18 years^35;36	Nationally representative sample of 2,672 young people in Britain	1997	4-18	Occupational social class Household income Receipt of state benefits	●		●	●	●	●	●
Department of Health Ninth National Survey of Smoking in Secondary School Children^44	2,854 secondary schoolchildren in England and Scotland	1996	11-15	Home amenities (car, PC, dishwasher) Housing tenure Educational aspirations Predicted  GCSE exam results		●
Teenage Smoking Attitudes in 1996^46	3,657 secondary schoolchildren in England	1996	11-15	Number of cars in family Housing tenure Educational aspirations Expectation that GCSE exams will be taken Predicted GCSE exam results		●
Health Survey for England^29	Aggregated data from three surveys of 18,298 children and young adults in England	1995/97	2-24	Occupational social class Household income	●	●	●	●		●
Ten Towns Study^99	Mixed longitudinal study. 2,650 primary schoolchildren from 10 towns in England and Wales	1994	8-11	Occupational social class	●
National Study of Health and Growth^106	Mixed longitudinal study. Random sample of 1,662 children in England and Scotland	1992/93	9	Father’s occupational social class Mother’s educational attainment Number of siblings				●	●
National Diet and Nutrition Survey of Pre-school Children^34	Nationally representative sample of 2,101 pre-school children in Britain	1992/93	1.5-4.5	Occupational social class Receipt of state benefits Educational attainment	●					●	●

^† Study design is cross-sectional unless otherwise stated.

Table 1.  Overview of publications of UK studies relating indicators of socioeconomic position in

children and young adults to CHD risk factors, according to period of data collection (continued)

Study name and reference	Description^†	Year of risk factor measurement	Age at risk factor measurement (years)	Indicator of socioeconomic position	Diet	Cigarette smoking	Physical activity/ fitness	Blood pressure	Blood cholesterol	Adiposity	Height
National Study of Health and Growth^102	Mixed longitudinal study. Random sample of 581 children in England and Scotland	1992	8-9	Father’s occupational social class Father’s employment status Mother’s educational attainment Number of siblings			●
National Fitness Survey^40	Random sample of 1,308 adults in England	1990	16-34	Occupational social class Educational attainment Housing tenure			●
Ten Towns Study^107	Mixed longitudinal study. (QUERY Please check if this is a longitudinal study. Abstract implies it is cross-sectional. Note to editor: it was both: a series of x-sectional studies that captured some, but not all, of the previous study’s participants) 3,360 primary schoolchildren from 10 towns in England and Wales	1990	5-7.5	Maternal occupational social class Educational attainment Father’s occupational social class				●
Ten Towns Study^38	Mixed cross-sectional study. 3,842 primary schoolchildren from 10 towns in England and Wales.	1990	5-7.5	Occupational social class of the head of household				●		●	●
Conducted in 1981to 1989:
Young Hearts Project^47	Longitudinal study. Random sample of 1,015 boys and girls	1989/90 1992/93 (follow-up of 12 year olds)	12 and 15	Occupational social class of head of household	●	●	●	●	●	●	●
Young People’s Leisure and Lifestyles Project^60	Random sample of 1,171 children from secondary school catchment areas in Scotland	1989	16-22	Occupational social class Parent’s educational attainment		●
Nine Towns Study^81	5,006 primary schoolchildren from nine towns in England and Wales	1987/88	5-7.5	Occupational social class							●
Department of Health survey^45	Longitudinal study. 4,165 children (based on sample in 1988) taken from a random sample of secondary schools in England and Wales	1986/87/88	11-15	Expected school educational level		●
Department of Health survey on the diets of British schoolchildren^120	Representative sample of 2,678 schoolchildren in England and Scotland	1983	10-11 and 14-15	Occupational social class	●						●
Ministry of Agriculture, Fisheries and Food Dietary Survey^58	Quasi representative sample of approx. 1,000 young adults from Scotland and Wales	1982	15-25	Occupational social class	●	●	●				●
National Child Development Study (1958 birth cohort)^88	Longitudinal study. 6,133 men and 6,141 women born in England, Scotland and Wales in early March 1958	1981	23	Occupational social class						●

^†Study design is cross-sectional unless otherwise stated.

Table 1.  Overview of publications of UK studies relating indicators of socioeconomic position in

children and young adults to CHD risk factors, according to period of data collection (continued)

Study name and reference	Description^†	Year of risk factor measurement	Age at risk factor measurement (years)	Indicator of socioeconomic position	Diet	Cigarette smoking	Physical activity/ fitness	Blood pressure	Blood cholesterol	Adiposity	Height
Conducted in or before 1980
DHSS survey of British adults^121	Representative sample of 1,121 adults in England, Scotland and Wales	1980	16-24	Occupational social class of head of household			●			●	●
Child Health and Education Study (1970 birth cohort)^98	Longitudinal study. Approx. 15,000 children born in England, Scotland and Wales in early April 1970	1980	10	Occupational social class	●
National Study of Health and Growth^87	Mixed longitudinal study. Random sample of 9,815 children in England and Scotland	1972	5-11	Occupational social class Number of siblings Father’s employment status Mother’s educational attainment						●
National Study of Health and Growth^79	Mixed longitudinal study. Random sample of 9,815 children in England and Scotland	1972	5-11.5	Occupational social class Father’s employment status Number of siblings							●
Government social survey^56	5,601 boys from a stratified random sample of secondary schools in England and Wales	1966	11-15	Father’s occupational social class Perception of father’s occupational social class Headteacher's rating of child’s academic ability Child’s perception of position in class based on academic performance Vocabulary test		●
National Diet and Nutrition Survey of pre-school children^33	Nationally representative sample of 1,254 pre-school children in Britain	1967/68	0.5-4.5	Occupational social class Number of siblings Income Mother’s educational attainment	●						●
National Child Development Study (1958 birth cohort)^122	Longitudinal study. 13,127 men and women born in England, Scotland and Wales in early March 1958	1965	7	Occupational social class							●
National Survey of Health and Development (1946 birth cohort)^123	Longitudinal study. 1,570 men and 1,456 women born in England, Scotland and Wales in the first week of March 1946	1953/57/61	7, 11, 15	Occupational social class Number of siblings							●

^† Study design is cross-sectional unless otherwise stated.

Table 1.  Overview of publications of UK studies relating indicators of socioeconomic position in

children and young adults to CHD risk factors according to period of data collection (continued)

Study name and reference

Description^†

Year of risk factor measurement

Age at risk factor measurement (years)

Indicator of socioeconomic position

Diet

Cigarette smoking

Physical activity/ fitness

Blood pressure

Blood cholesterol

Adiposity

Height

National Survey of Health and Development (1946 birth cohort) and National Child Development Study (1958 birth cohort) combined^80

Longitudinal study. Men and women born in England, Scotland and Wales in early March of 1946 and of 1958. (Sample size varies according to study and period of follow-up.)

1953/57 (1946 cohort) 1965/69 (1958 cohort)

7, 11

Occupational social class

●

National Survey of Health and Development (1946 birth cohort) and National Child Development Study (1958 birth cohort) combined^90

Longitudinal study. Men and women born in England, Scotland and Wales in early March of 1946 and of 1958. (Sample size varies according to study)

1953/57/62 (1946 cohort) 1965/69/74 (1958 cohort)

7, 11 and 16

Occupational social class

●

National Survey of Health and Development (1946 birth cohort)^124

Longitudinal study. 4,599 men and women born in England, Scotland and Wales in the first week of March 1946

1950

4

Occupational social class

●

^† Study design is cross-sectional unless otherwise stated.

Table 2.  Publications of UK studies relating socioeconomic position to cigarette smoking in children and young adults

Study name and reference	Year of risk factor measurement	Age at risk factor measurement (years)	Findings
Department of Health Ninth National Survey of Smoking in Secondary School Children^44	1996	11-15	Smoking inversely associated with number of cars (girls only). Children from homes with a computer were less likely to smoke than those without. Higher prevalence of smoking in children whose parents rented their dwelling than in those whose parents were owner-occupiers. Children who expected to stay at school after their GCSEs and children who expected to pass more than five GCSEs were less likely to smoke than those planning to leave school after their GCSEs and those who did not expect to pass five GCSEs, respectively.
Teenage Smoking Attitudes in 1996^46	1996	11-15	Number of cars positively associated with smoking. No association between housing tenure and smoking. Children who expected to stay at school after their GCSEs, children who planned to sit their GCSEs, and children who expected to pass more than five GCSEs were less likely to smoke than those planning to leave school after their GCSEs, those who planned not to sit their GCSEs and those who did not expect to pass five GCSEs, respectively.
Health Survey for England^29	1995/7	2-24	Occupational social class associated with both cotinine and self-reported levels of cigarette smoking in children and young adults, with the highest levels seen in the lower social groups. Cotinine levels in 4-15 year olds negatively associated with equivalised income and accommodation tenure (i.e. children in social housing had higher cotinine levels than children whose parents owned their accommodation). Too few data on cotinine levels in 16-24 year olds to facilitate analyses.
Young People’s Leisure and Lifestyles Project^60	1989	16-22	In females aged 20-22, occupational social class and parental educational attainment associated with self-reported levels of smoking. In males aged 16-18, parental educational attainment negatively associated with smoking. In other age groups no association seen.
Young Hearts Project^47	1989/90 1992/93	12 15	Occupational social class of head of household associated with cigarette smoking in 15 year olds, such that the highest levels apparent in the lower social groups. Insufficient data on 12 year olds to facilitate cross-sectional or longitudinal analyses.
Department of Health Survey^45	1986/87/88	11-15	Expected school educational level negatively associated with smoking.
Ministry of Agriculture, Fisheries and Food Dietary Survey^58	1982	15-25	Occupational social class associated with self-reported levels of cigarette smoking in the above direction.
Government social survey^56	1966	11-15	Occupational social class associated with smoking in the above direction, but relation breaks down in lower social groups. Headteacher's rating of child’s academic ability, child’s perception of position in class based on academic performance, and vocabulary test scores all inversely related to smoking; associations strongest in older groups.

Table 3.  Publications of UK studies relating socioeconomic position to height in children and young adults

Study name and reference	Year of risk factor measurement	Age at risk factor measurement (years)	Findings
National Diet and Nutrition Survey^35	1997	4-18	Household income (males and females) and occupational social class (females only) associated with height, with the taller children coming from more affluent backgrounds.
National Diet and Nutrition Survey^34	1992/93	1.5-4.5	Occupational social class associated with height in males, with the taller children coming from more affluent backgrounds; no association in females. Boys from households where head was employed were taller than those where head was unemployed/economically inactive.
Ten Towns Study^81	1990	5-7.5	Occupational social class associated with height, with the taller children coming from more affluent backgrounds.
Young Hearts Project^47	1989/90 1992/93	12 15	Occupational social class associated with height in 15 year olds, with the taller children coming from more affluent backgrounds.
Nine Towns Study^81	1987/88	5-7.5	Occupational social class associated with height, with the taller children coming from more affluent backgrounds.
Department of Health survey of the diets of British schoolchildren^120	1983	10-11 and 14-15	In both age groups, boys and girls in social class I were taller then those in social class V.
Ministry of Agriculture, Fisheries and Food Dietary Survey^58	1982	15-25	Occupational social class associated with height in males and females, with the taller children coming from more affluent backgrounds.
DHSS survey of British adults^121	1980	16-24	Occupational social class positively associated with height in males and females, with the taller children coming from more affluent backgrounds.
National Study of Health and Growth^79	1972	5-11.5	Height associated with occupational social class in the above direction and negatively associated with number of siblings.
National Diet and Nutrition Survey of pre-school children^33	1967/68	0.5-4.5	Negative association between family size and height in girls but not boys. Evidence in some age groups and sexes that income and educational attainment are negatively associated with height although, when stratified, these analyses are based on small numbers.
National Child Development Study (1958 birth cohort)^122	1965	7	Height associated with occupational social class in the expected direction and negatively associated with number of siblings.
National Survey of Health and Development (1946 birth cohort) ^123	1953/57/61	7, 11, 15	Height associated with occupational social class in the above direction and negatively associated with number of siblings.
National Survey of Health and Development (1946 birth cohort) and National Child Development Study (1958 birth cohort)^80	1953/7 (1946 cohort) 1965/9 (1958 cohort)	7, 11	Height associated with occupational social class, with the taller children coming from more affluent backgrounds.

Table 4.  Publications of UK studies relating socioeconomic position to adiposity in children and young adults

Study name and reference	Year of risk factor measurement	Age at risk factor measurement (years)	Findings
Scottish Health Survey^32	1998	2-15	No association between occupational social class and BMI in boys or girls in any age group.
Health Survey for England^31	1998	2-15	Occupational social class and household income not related to BMI.
National Diet and Nutrition Survey^35	1997	4-18	Occupational social class, household income, and receipt of state benefits not associated with BMI or waist to hip ratio.
Health Survey for England^29	1995/97	2-24	No association between occupational social class and prevalence of obesity (i.e. the proportion of participants in the top BMI quintile) in younger (2-15 year old) males and females. Lowest prevalence of obesity seen in higher social class grouping in 16-24 year olds; stronger association in  females than males. No association with income in either sex or age group.
National Diet and Nutrition Survey^34	1992/93	1.5-4.5	In males, no association between BMI and occupational social class, employment status of head of household, state benefits or mother’s educational attainment. In females, obesity more common in lower social groups but positively associated with educational attainment of mother. No association with employment status or benefits.
Ten Towns Study^81	1990	5-7.5	No association between occupational social class and BMI.
Young Hearts Project^47	1989/90 1992/93	12 15	Occupational social class not associated with either BMI or sum of skinfold thickness in 12 or 15 year olds.
National Child Development Study (1958 birth cohort)^88	1981	23	Occupational social class associated with prevalence of obesity with most favourable levels seen in higher social groups.
DHSS survey of British adults^121	1980	16-24	Weak association between occupational social class and BMI, such that higher BMI apparent in higher social groups.
National Study of Health and Growth^87	1972	5-11	Occupational social class associated with weight for height (i.e., weight adjusted for height and age) in boys, such that the most favourable levels seen in higher social groups; no association in girls. Number of siblings positively associated with weight for height in girls; no association in boys. Father’s employment status and mother’s educational attainment  not related to weight for height. No association between occupational social class and tricep skinfold thickness. Negative association between number of siblings and tricep skinfold thickness in girls and boys.
National Survey of Health and Development (1946 birth cohort) and National Child Development Study (1958 birth cohort) combined^90	1953/57/62 (1946 cohort) 1965/69/74 (1958 cohort)	7, 11 and 16	In females, association between occupational social class and prevalence of overweight (i.e. weight exceeding standard weight for age, sex and height by 20% or more) in both birth cohorts at various ages whereby the most favourable levels apparent in higher social groups. In males, little evidence of an association.

          BMI=body mass index

Table 5.  Publications of UK studies relating socioeconomic position to dietary characteristics in children and young adults

Study name and reference	Year of risk factor measurement	Age at risk factor measurement (years)	Findings
Scottish Health Survey^32	1998	2-15	In boys and girls, occupational social class related to the consumption of wholemeal bread, fruit, and vegetables (green, raw and root) and  fried food, with the most favourable levels evident in the higher social groups.
National Diet and Nutrition Survey^35	1997	4-18	In girls, occupational social class associated with salad, fruit, green beans, and cream and cheese consumption, with the greatest quantities eaten by the most affluent children. In boys, these associations were seen for the consumption of skimmed milk, bread,cream and cheese.
Health Survey for England^29	1995/97	2-24	Occupational social class and income associated with fruit, vegetable, crisp and chip consumption in 2-15 year old boys and girls with the most favourable levels evident in the higher social groups. No association seen in older group.
Ten Towns Study^99	1994	8-11	Occupational social class associated with fruit consumption in girls and boys, with the higher levels seen in the more affluent children.
Young Hearts Project^47	1989/90 1992/93	12 15	In 12 year olds: occupational social class associated with polyunsaturates : saturates ratio (boys only) and total energy intake. In 15 year olds: occupational social class associated with fat and  fruit intake. In all cases the most favourable levels seen in the higher social groups
National Diet and Nutrition Survey^34	1992/93	1.5-4.5	Occupational social class and income associated with absolute fat consumption with higher levels reported in the poorer groups. Fat consumption also higher in the children of parents who received state benefits (i.e., family credit and income support) in comparison with those who did not.
Department of Health survey of the diets of British schoolchildren^120	1983	10-11 and 14-15	Occupational social class associated with fat consumption in same direction as above.
Ministry of Agriculture, Fisheries and Food Dietary Survey^58	1982	15-25	Association between occupational social class and fat consumption same direction as above but  stronger in females than males.
Child Health and Education Study (1970 birth cohort)^98	1980	10	Occupational social class associated with chocolate, cheese and brown bread consumption with highest levels seen in the lower social groups.
National Diet and Nutrition Survey of pre-school children^33	1967/68	0.5-4.5	Fat consumption higher in children from households where head is in manual compared with non-manual employment. Positive association of income of head of the household, but not educational attainment of the mother, with fat consumption.
National Survey of Health and Development (1946 birth cohort)^124	1950	4	Occupational social class associated with fruit, vegetable, and cake consumption with highest levels seen in the highest social groups.  Chip consumption levels most favourable in more affluent children.

Table 6.  Publications of UK studies relating socioeconomic position to

physical activity and/or cardiorespiratory fitness in children and young adults

Study name and reference	Year of risk factor measurement	Age at risk factor measurement (years)	Findings
Scottish Health Survey^32	1998	2-15	Occupational social class not consistently associated with physical activity in boys or girls.
National Diet and Nutrition Survey^35	1997	4-18	Occupational social class and household income not associated with physical activity.
Health Survey for England^29	1995/97	2-24	No clear pattern of association between physical activity, occupational social class and household income. .
National Study of Health and Growth^102	1992	8-9	No association of cardiorespiratory fitness with any of the indicators of socioeconomic position with the exception of number of siblings (in girls only).
National Fitness Survey^40	1990	16-34	Occupational social class and educational attainment associated with physical activity, such that higher levels reported in men who were more affluent or better educated. Council house tenants less likely to be active than owner occupiers or those in privately rented accommodation.
Young Hearts Project^47	1989/90 1992/93	12 15	Occupational social class associated with physical activity in girls but unrelated to cardiorespiratory fitness in either sex.
Ministry of Agriculture, Fisheries and Food Dietary Survey^58	1982	15-25	Prevalence of no exercise greatest in lower occupational groups.
Department of Health survey of British adults^121	1980	16-34	Quantity of recreational exercise greatest in higher social groups.

Table 7.  Publications of UK studies relating socioeconomic position to blood pressure in children and young adults

Study name and reference	Year of risk factor measurement	Age at risk factor measurement (years)	Findings
Scottish Health Survey^32	1998	2-15	No association between occupational social class and systolic or diastolic blood pressure in boys or girls.
National Diet and Nutrition Survey^35	1997	4-18	Occupational social class, household income and household benefit status not associated with mean blood pressure.
Health Survey for England^29	1995/97	2-24	No association between occupational social class and height-adjusted systolic blood pressure in children or young adults. Income negatively associated with height-adjusted systolic blood pressure in 5-15 year old females but not males. No association in young adults.
National Study of Health and Growth^106	1992/93	9	Occupational social class associated with diastolic blood pressure, whereby lowest levels seen in children from affluent backgrounds.
Ten Towns Study^107	1990	5-7.5	No association of mother’s or father’s occupational social class or educational attainment with systolic blood pressure.
Young Hearts Project^47	1989/90 1992/93	12 15	No association between occupational social class and systolic or diastolic blood pressure in boys or girls.

Table 8.  Publications of UK studies relating socioeconomic position to blood cholesterol in children and young adults

Study name and reference	Year of risk factor measurement	Age at risk factor measurement (years)	Findings
National Diet and Nutrition Survey^35	1997	4-18	Occupational social class, household income, and receipt of state benefit not associated with plasma total cholesterol or plasma HDL cholesterol.
National Study of Health and Growth^106	1992/93	9	Number of siblings inversely associated with blood cholesterol; no association with father’s occupational social class and mother’s educational attainment.
Young Hearts Project^47	1989/90 1992/93	12 15	Inconsistent associations between occupational social class, total and HDL cholesterol.

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