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The Association between Educational Level and Cardiovascular and Cerebrovascular Diseases within the EPICOR Study: New Evidence for an Old Inequality Problem

Author

Listed:
  • Fulvio Ricceri
  • Carlotta Sacerdote
  • Maria Teresa Giraudo
  • Francesca Fasanelli
  • Giulia Lenzo
  • Matteo Galli
  • Sabina Sieri
  • Valeria Pala
  • Giovanna Masala
  • Benedetta Bendinelli
  • Rosario Tumino
  • Graziella Frasca
  • Paolo Chiodini
  • Amalia Mattiello
  • Salvatore Panico

Abstract

Background: A consistent association has been reported between low socioeconomic status (SES) and cardiovascular events (CE), whereas the association between SES and cerebrovascular events (CBVD) is less clear. The aim of this study was to investigate the association between SES (measured using education) and CE/CBVD in a cohort study, as well as to investigate lifestyle and clinical risk factors, to help to clarify the mechanisms by which SES influences CE/CBVD. Material and Methods: We searched for diagnoses of CE and CBVD in the clinical records of 47,749 members of the EPICOR cohort (average follow-up time: 11 years). SES was determined by the relative index of inequality (RII). Results: A total of 1,156 CE and 468 CBVD were found in the clinical records. An increased risk of CE was observed in the crude Cox model for the third tertile of RII compared to the first tertile (hazard ratio [HR] = 1.39; 95% confidence interval [CI] 1.21–1.61). The increased risk persisted after adjustment for lifestyle risk factors (HR = 1.19; 95%CI 1.02–1.38), clinical risk factors (HR = 1.35; 95%CI 1.17–1.56), and after full adjustment (HR = 1.17; 95%CI 1.01–1.37). Structural equation model showed that lifestyle rather than clinical risk factors are involved in the mechanisms by which education influences CE. No significant association was found between education and CBVD. A strong relationship was observed between education and diabetes at baseline. Conclusion: The most important burden of inequality in CE incidence in Italy is due to lifestyle risk factors.

Suggested Citation

  • Fulvio Ricceri & Carlotta Sacerdote & Maria Teresa Giraudo & Francesca Fasanelli & Giulia Lenzo & Matteo Galli & Sabina Sieri & Valeria Pala & Giovanna Masala & Benedetta Bendinelli & Rosario Tumino &, 2016. "The Association between Educational Level and Cardiovascular and Cerebrovascular Diseases within the EPICOR Study: New Evidence for an Old Inequality Problem," PLOS ONE, Public Library of Science, vol. 11(10), pages 1-15, October.
    • Handle: RePEc:plo:pone00:0164130
    DOI: 10.1371/journal.pone.0164130
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    References listed on IDEAS

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    1. Winkleby, M.A. & Jatulis, D.E. & Frank, E. & Fortmann, S.P., 1992. "Socioeconomic status and health: How education, income, and occupation contribute to risk factors for cardiovascular disease," American Journal of Public Health, American Public Health Association, vol. 82(6), pages 816-820.
    2. Kivimäki, M. & Lawlor, D.A. & Smith, G.D. & Kouvonen, A. & Virtanen, M. & Elovainio, M. & Vahtera, J., 2007. "Socioeconomic position, co-occurrence of behavior-related risk factors, and coronary heart Disease: The finnish public sector study," American Journal of Public Health, American Public Health Association, vol. 97(5), pages 874-879.
    3. Frampton, Geoff K. & Shepherd, Jonathan & Dorne, Jean-Lou C.M., 2009. "Demographic data in asthma clinical trials: A systematic review with implications for generalizing trial findings and tackling health disparities," Social Science & Medicine, Elsevier, vol. 69(8), pages 1147-1154, October.
    4. Mackenbach, Johan P., 2012. "The persistence of health inequalities in modern welfare states: The explanation of a paradox," Social Science & Medicine, Elsevier, vol. 75(4), pages 761-769.
    5. Schrijvers, C.T.M. & Stronks, K. & Van De Mheen, H.D. & Mackenbach, J.P., 1999. "Explaining educational differences in mortality: The role of behavioral and material factors," American Journal of Public Health, American Public Health Association, vol. 89(4), pages 535-540.
    6. repec:dau:papers:123456789/10510 is not listed on IDEAS
    7. Petrelli, Alessio & Gnavi, Roberto & Marinacci, Chiara & Costa, Giuseppe, 2006. "Socioeconomic inequalities in coronary heart disease in Italy: A multilevel population-based study," Social Science & Medicine, Elsevier, vol. 63(2), pages 446-456, July.
    8. Bengt Muthén, 1989. "Latent variable modeling in heterogeneous populations," Psychometrika, Springer;The Psychometric Society, vol. 54(4), pages 557-585, September.
    9. Hart, C.L. & Hole, D.J. & Smith, G.D., 2000. "The contribution of risk factors to stroke differentials, by socioeconomic position in adulthood: The Renfrew/Paisley study," American Journal of Public Health, American Public Health Association, vol. 90(11), pages 1788-1791.
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