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Educational inequality in cardiovascular diseases: a sibling approach

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@article{3aebd26978a24186adfef6b074b9c182,
title = "Educational inequality in cardiovascular diseases: a sibling approach",
abstract = "AIMS: Educational inequality in diseases in the circulatory system (here termed cardiovascular disease) is well documented but may be confounded by early life factors. The aim of this observational study was to examine whether the associations between education and all cardiovascular diseases, ischaemic heart disease and stroke, respectively, were explained by family factors shared by siblings.METHODS: The study population included all individuals born in Denmark between 1950 and 1979 who had at least one full sibling born in the same period. Using Cox regression, data were analysed in conventional cohort and within-sibship analyses in which the association was examined within siblings discordant on education. Assuming that attenuation of associations in the within-sibship as compared with the cohort analyses would indicate confounding from factors shared within families.RESULTS: A lower educational status was associated with a higher risk of cardiovascular disease, ischaemic heart disease and stroke. All associations attenuated in the within-sibship analyses, in particular in the analyses on ischaemic heart disease before age 45 years. For instance, in the cohort analyses, the hazard rate of ischaemic heart disease among women less than 45 years who had a primary school education was 94{\%} (hazard ratio 1.94 (1.78-2.12) higher than among those with a vocational education, while it attenuated to 51{\%} (hazard ratio 1.51 (1.34-1.71)) in the within-sibship analysis.CONCLUSIONS: Confounding from factors shared by siblings explained the associations between education and the cardiovascular disease outcomes but to varying degrees. This should be taken into account when planning interventions aimed at reducing educational inequalities in the development of cardiovascular disease, ischaemic heart disease and stroke.",
keywords = "Journal Article",
author = "Grethe S{\o}ndergaard and Dalton, {Susanne Oksbjerg} and Mortensen, {Laust Hvas} and Merete Osler",
year = "2018",
doi = "10.1177/1403494817734775",
language = "English",
volume = "46",
pages = "83--91",
journal = "Scandinavian Journal of Public Health",
issn = "1403-4948",
publisher = "Sage Publications Ltd",
number = "1",

}

RIS

TY - JOUR

T1 - Educational inequality in cardiovascular diseases

T2 - a sibling approach

AU - Søndergaard, Grethe

AU - Dalton, Susanne Oksbjerg

AU - Mortensen, Laust Hvas

AU - Osler, Merete

PY - 2018

Y1 - 2018

N2 - AIMS: Educational inequality in diseases in the circulatory system (here termed cardiovascular disease) is well documented but may be confounded by early life factors. The aim of this observational study was to examine whether the associations between education and all cardiovascular diseases, ischaemic heart disease and stroke, respectively, were explained by family factors shared by siblings.METHODS: The study population included all individuals born in Denmark between 1950 and 1979 who had at least one full sibling born in the same period. Using Cox regression, data were analysed in conventional cohort and within-sibship analyses in which the association was examined within siblings discordant on education. Assuming that attenuation of associations in the within-sibship as compared with the cohort analyses would indicate confounding from factors shared within families.RESULTS: A lower educational status was associated with a higher risk of cardiovascular disease, ischaemic heart disease and stroke. All associations attenuated in the within-sibship analyses, in particular in the analyses on ischaemic heart disease before age 45 years. For instance, in the cohort analyses, the hazard rate of ischaemic heart disease among women less than 45 years who had a primary school education was 94% (hazard ratio 1.94 (1.78-2.12) higher than among those with a vocational education, while it attenuated to 51% (hazard ratio 1.51 (1.34-1.71)) in the within-sibship analysis.CONCLUSIONS: Confounding from factors shared by siblings explained the associations between education and the cardiovascular disease outcomes but to varying degrees. This should be taken into account when planning interventions aimed at reducing educational inequalities in the development of cardiovascular disease, ischaemic heart disease and stroke.

AB - AIMS: Educational inequality in diseases in the circulatory system (here termed cardiovascular disease) is well documented but may be confounded by early life factors. The aim of this observational study was to examine whether the associations between education and all cardiovascular diseases, ischaemic heart disease and stroke, respectively, were explained by family factors shared by siblings.METHODS: The study population included all individuals born in Denmark between 1950 and 1979 who had at least one full sibling born in the same period. Using Cox regression, data were analysed in conventional cohort and within-sibship analyses in which the association was examined within siblings discordant on education. Assuming that attenuation of associations in the within-sibship as compared with the cohort analyses would indicate confounding from factors shared within families.RESULTS: A lower educational status was associated with a higher risk of cardiovascular disease, ischaemic heart disease and stroke. All associations attenuated in the within-sibship analyses, in particular in the analyses on ischaemic heart disease before age 45 years. For instance, in the cohort analyses, the hazard rate of ischaemic heart disease among women less than 45 years who had a primary school education was 94% (hazard ratio 1.94 (1.78-2.12) higher than among those with a vocational education, while it attenuated to 51% (hazard ratio 1.51 (1.34-1.71)) in the within-sibship analysis.CONCLUSIONS: Confounding from factors shared by siblings explained the associations between education and the cardiovascular disease outcomes but to varying degrees. This should be taken into account when planning interventions aimed at reducing educational inequalities in the development of cardiovascular disease, ischaemic heart disease and stroke.

KW - Journal Article

U2 - 10.1177/1403494817734775

DO - 10.1177/1403494817734775

M3 - Journal article

VL - 46

SP - 83

EP - 91

JO - Scandinavian Journal of Public Health

JF - Scandinavian Journal of Public Health

SN - 1403-4948

IS - 1

ER -

ID: 52397603