[Of course this recalls John Lynch's finding that material conditions of
childhood predicts adult control beliefs]

Social Science & Medicine
Volume 60, Issue 4 , February 2005, Pages 737-745
 Low control beliefs, classical coronary risk factors, and socio-economic
differences in heart disease in older persons

H. Bosma, , a, C. H. M. Van Jaarsveldb, J. Tuinstrab, R. Sandermanb, A. V.
Ranchorb, J. Th. M. Van Eijka and G. I. J. M. Kempena

a Health Care Studies, Medical Sociology, Maastricht University, P.O. Box
616, 6200 MD, Maastricht, The Netherlands
b Department of Public Health and Health Psychology, Northern Centre for
Healthcare Research (NCH), University of Groningen, P.O. Box 196, 9700 AD,
Groningen, The Netherlands

Available online 20 July 2004.

Abstract
The objective of this study was to examine whether it is through their low
control beliefs that low socio-economic status groups have higher risks of
heart disease, and to examine whether this mechanism is more substantial
than and independent of the mechanism via classical coronary risk factors.
In a population-based prospective cohort study, participants were selected
from 27 general practices in the north-eastern part of The Netherlands. In
1993, there were 3888 men and women, 57 years and older, who were without
prevalent heart disease. During the 5-year follow-up period, 287 cases of
incident heart disease (acute myocardial infarction and/or congestive heart
failure) were registered (7%). Persons with a low socio-economic status had
higher risks of heart disease (RR = 1.45 (95% CI: 1.06 – 1.99)) compared
with their high status counterparts. On average, 4 percent of the
socio-economic differences were accounted for by the classical coronary
risk factors (e.g. smoking, hypertension) compared with 30 perce
nt by the control beliefs. The contribution of the latter was largely
independent of the former. Our findings support the hypothesis that
socio-economic inequalities in heart disease—at least in middle-aged and
older persons—may be based upon differences in control beliefs, more than
upon differences in smoking rates and other classical risk factors.

Author Keywords: Social class; Heart disease; Coronary risk factors;
Perceived control; The Netherlands


Corresponding author. Tel.: +31-43-388-2818; fax: +31-43-388-4169

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