Hicks, Blanaid, Veronesi, Giovanni, Ferrario, Marco M, Forrest, Hannah, Whitehead, Margaret 
ORCID: 0000-0001-5614-6576, Diderichsen, Finn, Tunstall-Pedoe, Hugh, Kuulasmaa, Kari, Sans, Susana, Salomaa, Veikko et al (show 11 more authors)
(2021)
Roles of allostatic load, lifestyle and clinical risk factors in mediating the association between education and coronary heart disease risk in Europe.
JOURNAL OF EPIDEMIOLOGY AND COMMUNITY HEALTH, 75 (12).
pp. 1147-1154.
Abstract
<h4>Background</h4>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.<h4>Methods</h4>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.<h4>Results</h4>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.<h4>Conclusion</h4>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.
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | MORGAM/BiomarCaRE consortium, Humans, Coronary Disease, Risk Factors, Smoking, Life Style, Educational Status, Europe, Female, Male, Allostasis |
| Divisions: | Faculty of Health and Life Sciences Faculty of Health and Life Sciences > Institute of Population Health |
| Depositing User: | Symplectic Admin |
| Date Deposited: | 17 Dec 2021 09:46 |
| Last Modified: | 18 Jan 2023 21:19 |
| DOI: | 10.1136/jech-2020-215394 |
| Open Access URL: | https://jech.bmj.com/content/75/12/1147 |
| Related URLs: | |
| URI: | https://livrepository.liverpool.ac.uk/id/eprint/3145560 |
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