Introduction and Aim

Educational inequalities in cardiovascular risk factors were analysed on specific survey years atnational level in Turkey however to our knowledge inequalities by occupational class (OC) and trends in inequalities have not been documented.

This study aims to investigate the magnitude of OC and educational level (EL) inequalities incardiovascular risk factors in Turkey from 2008 to 2016.

Materials and Methods

We used population aged 15 and older from Turkey Health Survey, a bi-annual, self-reported, cross-sectional health interview survey among a representative sample of the Turkish population. We calculated the age-standardized prevalence of cardiovascular risk factors (obesity and overweight based on body massindex, hypertension, diabetes and smoking status) by OC and EL. We summarized relative andabsolute inequalities with the Relative Index of Inequality (RII) and Slope Index of Inequality (SII), respectively. To determine whether the RII/SII changed over time we estimated a regression model with aninteraction term between survey year and OC/EL.

We didn’t seek ethical board approval based on anonymized nature of the data.

Results

We found different patterns for men and women. Among men, smoking was the only risk factor witha higher prevalence in both lower OC and EL (RII = 1.18 (95% CI: 1.08-1.28) and 1.40 (1.26-1.55), respectively). Obesity, overweight and diabetes was higher among higher OC (e.g., for overweight RII= 0.83, 95% CI 0.76-0.90) whereas obesity was higher among men in lower EL (RII = 1.32, (95% CI:1.08-1.61)) and no inequalities were found for hypertension by socioeconomic status. However, among women, all risk factors except smoking had a higher prevalence in lower OC and EL (e.g., foroverweight RII = 1.14 (1.06-1.24) and 2.98 (2.71-3.29), respectively), whereas for smoking we found ahigher prevalence in higher socioeconomic groups (RII for OC = 0.77 (95% CI: 0.65-0.90 and for EL =0.36 (0.29-0.44)). The interaction analysis suggests that relative inequalities for diabetes among men by OC tended to reverse and for smoking among women were attenuated by survey year to the disadvantage of lower socioeconomic groups.

Conclusion and Recommendations

Socioeconomic inequalities in cardiovascular risk factors are less systematic in Turkey than in most high-income countries, however our results suggests concentration of the risk factors among lower socioeconomic groups which should be monitored in the future.