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Passive smoking and coronary heart disease in women.

To the Editor: 

In a recent article by Kawachi et al,1 the differing prevalence of cardiovascular risk factors and other lifestyle variables in women with and those without tobacco smoke exposure is attributed to the lower socioeconomic status of the female passive smokers. In order not to impute the socially determined elevated coronary heart disease (CHD) risk to the passive smokers, the authors adjusted their data by standardizing for these factors. In so doing, however, they may have compounded another error, casting serious doubt on the validity of their results. They overlooked the fact that women from lower social classes in general pay far less attention to their health and visit their doctors less frequently than do women from higher social classes. This is particularly true in the United States, where financial reasons also play …