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Health behaviors explain 40% of occupational class CVD inequality in Helsinki municipal employeesUnhealthy habits explained part of heart disease risk linked to lower job status in this Finnish study

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Key Takeaway
Consider that health behaviors explain only part of occupational class CVD disparities; broader social factors dominate.

This longitudinal study followed municipal employees from Helsinki, Finland, aged 40-60 at baseline, from 2000-2002 to 2022. It examined the contribution of health behaviors (excessive alcohol consumption, smoking, unhealthy diet, insufficient physical activity) to occupational class inequalities in cardiovascular disease events, including hospitalizations, long-term sickness absence, disability pensions, and mortality.

During follow-up, 50% of participants in the low occupational class and 46% in the high occupational class experienced a CVD event. All unhealthy behaviors except heavy alcohol use were more common in the low occupational class. Health behaviors collectively explained approximately 40% of the excess risk of CVD when moving from high to low occupational class. Insufficient physical activity was the strongest individual predictor, with a hazard ratio of 1.44 (95% CI 1.35-1.54). Notably, unhealthy diet was more strongly associated with CVD in the high occupational class.

The study's key limitation is that most (approximately 60%) of the occupational class inequality in CVD remained unexplained, highlighting the role of broader social determinants beyond individual behaviors. As an observational study, it cannot establish causality between occupational class, health behaviors, and CVD outcomes. No specific safety or tolerability data were reported.

For practice, this evidence suggests that while promoting healthy behaviors—particularly physical activity—may partially address CVD disparities linked to occupational class, clinicians should recognize that most inequality stems from factors beyond individual control. These findings support population-level interventions targeting social determinants alongside individual counseling.

Researchers tracked municipal employees in Helsinki, Finland, who were between 40 and 60 years old when the study began. They followed these workers from the year 2000 through 2022 to look at how their job class and daily habits influenced cardiovascular disease events. These events included hospitalizations, long-term sickness absence, disability pensions, and death.

The group with lower occupational class had a slightly higher rate of heart disease events compared to the higher class. Unhealthy behaviors such as smoking, poor diet, and not enough physical activity were more common in the lower class, while heavy alcohol use was an exception. Insufficient physical activity stood out as the strongest predictor of heart disease risk overall.

Interestingly, unhealthy diet was more strongly linked to heart disease in the higher occupational class. While these habits accounted for about 40% of the risk difference between job groups, the majority of the inequality could not be explained by lifestyle alone. This highlights that broader social and economic factors likely contribute significantly to health gaps between different job classes.

Readers should understand that while changing habits is important, fixing diet and exercise alone will not close the gap in heart disease rates between social groups. More research is needed to fully understand the other causes of these health differences.

What this means for you:
Unhealthy habits explained 40% of heart disease risk differences between job classes, but most inequality remains unexplained.

Study Details

EvidenceLevel 5
PublishedApr 2026
View Original Abstract ↓
Background: Cardiovascular diseases (CVD) are more common in lower occupational classes, but the mediating role of health behaviours remains unclear. This study aimed to quantify the extent to which health behaviours mediate the association between occupational class and CVD, evaluate their relative contributions to CVD risk, and assess occupational class differences in the effects of health behaviours. Methods: Municipal employees from Helsinki, aged 40-60 at baseline, were followed from 2000-2002 (response rate 67%) to 2022. CVD events were identified from national registers, including hospitalizations, long-term sickness absence, disability pensions, and mortality. Counterfactual mediation analysis using additive survival regression was used to assess the contribution of health behaviours - excessive alcohol consumption, smoking, unhealthy diet, and insufficient physical activity - to the association of occupational class and CVD. Occupational class differences in the effects of health behaviours were assessed with Cox regression. Results: During follow-up, 50% of participants in the low occupational class and 46% in the high occupational class had a CVD event. All unhealthy behaviours except heavy alcohol use were more common in the low occupational class. Health behaviours explained approximately 40% of the excess risk of CVD when moving from high occupational class to low occupational class. Insufficient physical activity (HR 1.44, 95% CI 1.35-1.54) was the strongest predictor of CVD. Unhealthy diet was more strongly associated with CVD in the high occupational class. Conclusion: Health behaviours explained a part of occupational class inequalities in CVD, but most of the inequality remained unexplained, highlighting broader social determinants.
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