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

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 and Salvatore Panico

PLOS ONE, 2016, vol. 11, issue 10, 1-15

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.

Date: 2016
References: View references in EconPapers View complete reference list from CitEc
Citations:

Downloads: (external link)
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0164130 (text/html)
https://journals.plos.org/plosone/article/file?id= ... 64130&type=printable (application/pdf)

Related works:
This item may be available elsewhere in EconPapers: Search for items with the same title.

Export reference: BibTeX RIS (EndNote, ProCite, RefMan) HTML/Text

Persistent link: https://EconPapers.repec.org/RePEc:plo:pone00:0164130

DOI: 10.1371/journal.pone.0164130

Access Statistics for this article

More articles in PLOS ONE from Public Library of Science
Bibliographic data for series maintained by plosone ().