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The European Journal of Public Health Advance Access originally published online on October 26, 2006
The European Journal of Public Health 2007 17(4):340-347; doi:10.1093/eurpub/ckl247
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© The Author 2007. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.

Health Inequalities

The role of low grade inflammation as measured by C-reactive protein levels in the explanation of socioeconomic differences in carotid atherosclerosis

M Rosvall1, G Engström2, L Janzon2, G Berglund2 and B Hedblad2

1 Department of Health Sciences, Lund University Malmö, Sweden
2 Department of Clinical Sciences, Lund University Malmö, Sweden

Correspondence: Maria Rosvall, Department of Health Sciences, Malmö University Hospital, SE-205 02 Malmö, Sweden, tel: + 46 40 33 10 00, fax: + 46 40 33 70 96, e-mail: maria.rosvall{at}smi.mas.lu.se

Received March 22, 2006 , accepted September 27, 2006

Background: The role of inflammation as part of the explanation of socioeconomic differences in carotid atherosclerosis has not been specifically investigated. Methods and Results: The associations between socioeconomic position (SEP), C-reactive protein (CRP), and preclinical carotid atherosclerosis were investigated in a general population sample of 3921 middle-aged Swedish men and women. Common carotid intima-media thickness (IMT) and presence of carotid plaque (focal IMT > 1.2 mm) were determined by B-mode ultrasound. The results showed that low SEP was associated with increased levels of CRP, independently of established risk factors. Furthermore, common carotid IMT increased with increasing CRP-levels. Presence of carotid plaque increased with increasing CRP-levels in men, but not in women. While the socioeconomic differences in carotid IMT were weak, there were associations between low educational level and carotid plaque prevalence with an age- and sex-adjusted odds ratio (OR) of 1.39 (95% CI: 1.21, 1.59). A similar association was seen for having a manual occupation, OR = 1.23 (95% CI: 1.07, 1.42). The age- and sex-adjusted absolute differences in carotid plaque prevalence were 9% with regard to educational level and 7% with regard to occupational status. Adjustment for CRP caused only a minor attenuation of the association between SEP and carotid atherosclerosis. Conclusions: The association between SEP and carotid atherosclerosis as measured by carotid IMT and carotid plaque could only to a minor extent be referred to differences in low grade inflammation as measured by CRP.

Keywords: atherosclerosis, carotid arteries, c-reactive protein, socioeconomic position


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