TY - JOUR
T1 - The association between educational level and cardiovascular and cerebrovascular diseases within the EPICOR study
T2 - New evidence for an old inequality problem
AU - Ricceri, Fulvio
AU - Sacerdote, Carlotta
AU - Giraudo, Maria Teresa
AU - Fasanelli, Francesca
AU - Lenzo, Giulia
AU - Galli, Matteo
AU - Sieri, Sabina
AU - Pala, Valeria
AU - Masala, Giovanna
AU - Bendinelli, Benedetta
AU - Tumino, Rosario
AU - Frasca, Graziella
AU - Chiodini, Paolo
AU - Mattiello, Amalia
AU - Panico, Salvatore
N1 - Publisher Copyright:
© 2016 Ricceri et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
PY - 2016/10
Y1 - 2016/10
N2 - 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.
AB - 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.
UR - http://www.scopus.com/inward/record.url?scp=84991458180&partnerID=8YFLogxK
U2 - 10.1371/journal.pone.0164130
DO - 10.1371/journal.pone.0164130
M3 - Article
SN - 1932-6203
VL - 11
JO - PLoS ONE
JF - PLoS ONE
IS - 10
M1 - e0164130
ER -
