Determinants of coronary heart disease risk for women on a low income: Literature review

Aim. This paper is a report of a literature review of the determinants of health and health behaviour relevant to coronary heart disease risk for women living on a low income. Background. Coronary heart disease is now recognized as the biggest killer of women in both developed and developing countries. As in men, women's mortality rates for coronary heart disease seem to be directly related to income inequality and social deprivation. Method. The Medline, British Nursing Index, CINAHL, Cochrane Library, Psychinfo and Web of Science databases were searched from 1996 to 2006 using the search terms 'women and CHD risk', 'women and health behaviour', 'women low income and health behaviour', 'women low income and smoking', 'women low income and diet' and 'women low income and exercise'. In relation to the wider determinants of health 'women low income and CHD', 'women education and CHD', 'women employment and CHD' and 'women housing and CHD'. Seminal research reports before this period were included if they proved highly influential on later research. A narrative review was conducted. Findings. All the wider determinants of health considered had a negative impact on heart disease risk for women living on low incomes. The latter also appears to have a negative impact on health behaviour. Conclusion. Although the impact of the wider determinants of health on coronary heart disease risk are well-understood, their impact on health behaviour (specifically diet, exercise and smoking) is less well-understood. If effective interventions are to be designed to tackle inequalities in health, then this deficiency needs to be addressed urgently.