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Veronesi, G.* ; Kee, F.* ; Hicks, B.* ; Forrest, H.* ; Tunstall-Pedoe, H.* ; Kuulasmaa, K.* ; Sans, S.* ; Salomaa, V.* ; Thorand, B. ; Di Castelnuovo, A.* ; Söderberg, S.* ; Cesana, G.* ; Bobak, M.* ; De Ponti, R.* ; Iacoviello, L.* ; Palmieri, L.* ; Zeller, T.* ; Blankenberg, S.* ; Ferrario, M.M.*

Decomposing the educational gradient in allostatic load across European populations. What matters the most: Differentials in exposure or in susceptibility?

J. Epidemiol. Community Health 74, 1008-1015 (2020)
DOI PMC
Open Access Green as soon as Postprint is submitted to ZB.
Background: We investigate whether socially disadvantaged individuals are more susceptible to the detrimental effects of smoking and alcohol intake on allostatic load (AL), a marker of physiological â wear and tear', resulting from adaptation to chronic stress. Methods: In a cross-sectional analysis, 27 019 men and 26 738 women aged 35-74 years were identified from 21 European cohorts in the BiomarCaRE consortium. We defined three educational classes (EDs) according to years of schooling and an AL score as the sum of z-scores of eight selected biomarkers from the cardiovascular, metabolic and inflammatory systems. We used the Oaxaca-Blinder decomposition to disentangle the ED gradient in AL score into the differential exposure (DE, attributable to different distribution of smoking and alcohol intake across EDs) and the differential susceptibility (DS, attributable to a different effect of risk factors on AL across EDs) components. Results: Less-educated men (mean AL difference: 0.68, 95% CI 0.57 to 0.79) and women (1.52, 95% CI 1.40 to 1.64) had higher AL scores. DE accounted for 7% and 6% of the gradient in men and women, respectively. In men, combining smoking and alcohol intake, DS accounted for 42% of the gradient (smoking DS coefficient=0.177, 26% of the gradient; alcohol DS coefficient=0.109; 16%, not statistically significant). DS contribution increased to 69% in metabolic markers. DS estimates were consistent across age groups, irrespective of comorbidities and robust to unmeasured confounding. No DS was observed in women. Conclusions: In men, a DS mechanism substantially contributes to the educational class gradient in allostatic load.
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Publication type Article: Journal article
Document type Scientific Article
Corresponding Author
Keywords Epidemiological Methods ; Epidemiology Of Cardiovascular Disease ; Social Inequalities ; Stress
ISSN (print) / ISBN 0143-005X
e-ISSN 1470-2738
Journal Journal of Epidemiology and Community Health
Quellenangaben Volume: 74, Issue: 12, Pages: 1008-1015 Article Number: , Supplement: ,
Publisher BMJ Publishing Group
Publishing Place British Med Assoc House, Tavistock Square, London Wc1h 9jr, England
Non-patent literature Publications
Reviewing status Peer reviewed
Institute(s) Institute of Epidemiology II (EPI2)
Grants Medical Research Council London
EU FP7 project CHANCES
EU Seventh Framework Programme (FP7/2007-2013)