Types: Doctoral thesis
According to the World Health Organization (WHO), 17·3 million people died from cardiovascular disease worldwide in 2008 and more than 23 million people will die annually from cardiovascular disease by 2030. In the UK, the prevalence of cardiovascular disease is high — over 3 million people currently suffer from this disorder. There are a number of cardiovascular researchers in the UK population who access the National Health Services, but little evidence has been gathered from those who access the private medical insurance. According to figures from the Association of British Insurers, the number of people covered by private medical insurance rose to 6 million in 2008—about 10% of the UK’s population. Due to an increasing large number of this population, there is an urgent need to investigate their health, especially cardiovascular health in this affluent group. This PhD study used a retrospective cross-sectional design, and aimed to examine the modifiable cardiovascular risk factors—BMI, waist circumference, WHR, systolic blood pressure, diastolic blood pressure, total cholesterol, HDL cholesterol, and LDL cholesterol—in a population who attended Nuffield Health, a private medical insurance company. The dataset provided by Nuffield Health is one of the largest UK datasets specifically in a commercial setting. When examining the association of socioeconomic status and cardiovascular risk factors in this affluent population, the findings show that the likelihood of having high blood pressure was lower in the most deprived area than in the least deprived area. The likelihood of having low HDL cholesterol was not significantly different between groups, but the likelihood of having high total cholesterol and LDL cholesterol was statistically significantly lower in more deprived groups. In the study assessing the effect of geographical variations on cardiovascular risk factors, no North-South effect was detected in this relatively affluent population. This finding might be generalisable to affluent populations in other European countries. In order to see the difference between this affluent population and another population from an affluent region in England, data provided by Hampshire Health Record were analysed. Although the two datasets are comparable, people living in the south England region were more likely to develop obesity and hypertension, but less likely to have elevated cholesterol and LDL, as well as low HDL, compared with those from Nuffield Health on the basis of socioeconomic status. Evidence-based population-wide policy interventions exist, and these interventions should now be urgently implemented to tackle persistent inequalities of cardiovascular health in the UK effectively.
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