Elucidating Environmental links Between Socioeconomic Position and Heart Disease

Lead Research Organisation: London Sch of Hygiene and Trop Medicine
Department Name: Epidemiology and Population Health


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Description A brief summary of the empirical findings relevant to each of the project's key research questions follows.

(1) Does air pollution exposure explain socioeconomic gradients in heart disease?
• There are socioeconomic gradients in air pollution exposure in London. Results followed the expected general pattern of higher air pollution in more deprived areas, but there were also exceptions including reversed associations in central London and for education deprivation [Goodman et al.]
• There are associations between particulate air pollution and atherosclerosis and survival following a heart attack [Tonne et al. Epidemiology and EHJ]. There was no evidence of a greater effect of air pollution, per unit exposure, for more deprived individuals or those experiencing work place stress.
• Exposure to air pollution explained the association between income deprivation and survival following a heart attack to only a small extent [Tonne et al. EHJ].
(2) Which measures of socioeconomic position (SEP) are most relevant as confounders of the air pollution and heart disease relationship?
• Air pollution was more strongly associated with small-area measures of deprivation compared to individual SEP. Adjustment using area-based deprivation measures essentially removed the association between individual-level SEP and air pollution. This implies limited residual confounding by individual-level SEP in studies of air pollution and health with comprehensive adjustment for small-area level deprivation. [Goodman et al.]
(3) Does the physical environment explain socioeconomic gradients in physical activity?
• Objective measures of the physical environment explained to only a small extent socioeconomic gradients in walking in middle-aged adults living in London. [Pliakas et al.]
Exploitation Route Findings from this project have fed into discussions within NIHR about formulating a research call around reducing exposure to air pollution to address health inequalities and within NICE, which considered whether to formulate guidelines on air pollution exposure.
Sectors Communities and Social Services/Policy,Energy,Environment,Healthcare,Transport

Description The findings of reduced survival after heart attack linked to air pollution received wide media attention. This media coverage is likely to have raised awareness of the role of air pollution in heart disease among clinical and lay communities. Largely as a result of research activities from this project, I was invited to comment on research briefs from the National Institue of Health Research on potential interventions to reduce the health burden associated with air pollution, with specific focus on reducing health inequalities.
Sector Environment,Healthcare,Transport
Impact Types Policy & public services

Description Whitehall II Study 
Organisation University College London
Department Research Department of Epidemiology and Public Health
Country United Kingdom 
Sector Academic/University 
PI Contribution We contributed environmental data generated through the project to the ongoing cohort database for participants resident in Greater London.
Collaborator Contribution They made the data available for the research and provided expertise on the population in general and specific health outcomes (e.g. cognitive function).
Impact The main outputs are publications using the Whitehall II cohort data reported in publications.
Start Year 2009