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

Roles of allostatic load, lifestyle and clinical risk factors in mediating the association between education and coronary heart disease risk in Europe.

J. Epidemiol. Community Health 75, 1147-1154 (2021)

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Background Previous studies have shown that differential exposure to lifestyle factors may mediate the association between education and coronary heart diseases (CHD). However, few studies have examined the potential roles of allostatic load (AL) or differential susceptibility. Methods 25 310 men and 26 018 women aged 35–74 and CHD free at baseline were identified from 21 European cohorts and followed for a median of 10 years, to investigate the mediating role of AL, as well as of smoking, alcohol use and body mass index (BMI), on educational differences in CHD incidence, applying marginal structural models and three-way decomposition. Results AL is a mediator of the association between educational status and CHD incidence, with the highest proportion mediated observed among women and largely attributable to differential exposure, (28% (95% CI 19% to 44%)), with 8% (95% CI 0% to 16%) attributable to differential susceptibility. The mediating effects of smoking, alcohol and BMI, compared with AL, were relatively small for both men and women. Conclusion Overall, the educational inequalities in CHD incidence were partially mediated through differential exposure to AL. By contrast, the mediation of the educational gradient in CHD by investigated lifestyle risk factors was limited. As differential susceptibility in men was found to have a predominant role in the accumulation of AL in low educational classes, the investigation of AL-related risk factors is warranted.

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Publication type Article: Journal article

Document type Scientific Article

Corresponding Author

Keywords Cardiovascular Diseases ; Education ; Health Inequalities; Socioeconomic Position; Exposure; Stress; Misclassification

ISSN (print) / ISBN 0143-005X

e-ISSN 1470-2738

Journal Journal of Epidemiology and Community Health

Quellenangaben Volume: 75, Issue: 12, Pages: 1147-1154

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 (EPI)

Grants State of Bavaria
Helmholtz Zentrum Munchen-German Research Center for Environmental Health - German Federal Ministry of Education and Research (BMBF)
Medical Research Council London
EU