Lower education level was associated with a 21% higher risk of CVD and 17% higher risk of CHD in men, and 41% and 61% higher risks in women, compared to the highest education level.
Cohort (n=132,686)
Yes
Does lower education level increase the risk of incident CVD and CHD, and what is the mediating role of behavioral and biological risk factors?
Lower education level is associated with a significantly higher risk of incident CVD and CHD, with behavioral and biological risk factors strongly mediating this disparity, particularly in men.
Hazard Ratio: 1.21
BACKGROUND AND AIMS: Behavioral and biological risk factors (BBRF) explain part of the variability in socioeconomic differences in health. The present study aimed at evaluating education differences in incidence of cardiovascular disease (CVD) and coronary heart disease (CHD) in Italy and the role of BBRF. METHODS AND RESULTS: All subjects aged 30-74 years (n = 132,686) who participated to the National Health Interview Surveys 2000 and 2005 were included and followed-up for ten years. Exposure to smoking, physical activity, overweight/obesity, diabetes and hypertension at baseline was considered. Education level was used as an indicator of socioeconomic status. The outcomes were incident cases of CVD and CHD. Hazard ratios by education level were estimated, adjusting for sociodemographic covariates and stratifying by sex and geographic area. The contribution of BBRF to education inequalities was estimated by counterfactual mediation analysis, in addition to the assessment of the risk attenuation by comparing the models including BBRF or not. 22,214 participants had a CVD event and 6173 a CHD event. After controlling for sociodemographic factors, the least educated men showed a 21% higher risk of CVD and a 17% higher risk of CHD compared to the most educated (41% and 61% among women). The mediating effect (natural indirect effect) of BBRF between extreme education levels was 52% for CVD and 84% for CHD among men (16% among women for CVD). CONCLUSIONS: More effective strategies aiming at reducing socioeconomic disparities in CVD and CHD are needed, through programs targeting less educated people in combination with community-wide initiatives.
Petrelli et al. (Wed,) conducted a cohort in Cardiovascular disease and coronary heart disease (n=132,686). Low education level vs. High education level was evaluated on Incident cases of CVD (HR 1.21). Lower education level was associated with a 21% higher risk of CVD and 17% higher risk of CHD in men, and 41% and 61% higher risks in women, compared to the highest education level.
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