Social inequality in health in married or cohabiting individuals with cardiovascular disease: a population-based study combining survey and register data

Abstract Background. Cohabitation status and educational attainment affect a number of cardiovascular disease (CVD) risk factors and also CVD incidence and mortality. However, little is known about social inequality in CVD risk factors in married or cohabiting (married/cohabiting) individuals with CVD. Following this married/cohabiting individuals with CVD and low educational attainment may be an overlooked group with an increased risk of recurrent CVD events. The aim of this study was to address social inequality in health among married/cohabiting individuals with CVD by examining educational differences in health behaviour, mental health and health literacy. Methods. Register data on CVD and cohabitation status were linked with self-reported health behaviour, mental health and one dimension of health literacy (the ability to understand health information) from the population-based health survey "How are you?" carried out in Central Denmark Region in 2017. Self-reported educational attainment was used as a marker for social position. In total, 20,585 (69%) participants aged 45 years and above completed the questionnaire. The analytical sample in this study consisted of 1,794 married/cohabiting individuals with CVD. Results. Married/cohabiting individuals with CVD and low educational attainment had higher adjusted odds for daily smoking (AOR 3.31, 95% CI 1.87;5.87), physical inactivity (AOR 2.10, 95% CI 1.37;3.22), unhealthy diet (AOR 6.37, 95% CI 3.29;12.3) and obesity (AOR 2.55, 95% CI 1.60;4.07) than their high educational attainment counterparts. Furthermore, they had higher levels of perceived stress (Aβ 2.31, 95% CI 1.19;3.43) and lower levels of health literacy (Aβ -0.26, 95% CI -0.36;-0.16) and mental health-related quality of life (Aβ -1.80, 95% CI -3.53;-0.07). Finally, they had lower adjusted odds for moderate/high risk alcohol intake (AOR 0.35, 95% CI 0.20;0.60). Conclusion. We found increased CVD risk factors and thus increased risk of recurrent CVD events in married/cohabiting individuals with CVD and low educational attainment compared to married/cohabiting individuals with CVD and high educational attainment. The social inequality in health behaviour, mental health and health literacy among married/cohabiting individuals with CVD should be addressed in both public health strategies, targeted secondary prevention, treatment and rehabilitation.