Education and Coronary Heart Disease Risk Associations May be Affected by Early-Life Common Prior Causes: A Propensity Matching Analysis

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• 作者：Eric B. Loucks ; PhD^a ; ^{eric.loucks@brown.edu} ; Stephen L. Buka ; ScD^a ; Michelle L. Rogers ; PhD^a ; Tao Liu ; PhD^b ; Ichiro Kawachi ; MD ; PhD^c ; Laura D. Kubzansky ; PhD^c ; Laurie T. Martin ; ScD^d ; Stephen E. Gilman ; ScD^c
• 关键词：Coronary Heart Disease ; Educational Status ; Longitudinal Studies ; Social Class ; Socioeconomic Factors
• 刊名：Annals of Epidemiology
• 出版年：2012
• 期刊代码：15_10472797
• 类别：med
• 出版时间：April, 2012
• 卷：22
• 期：4
• 页码：221-232
• 文件大小：388 K

摘要

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Purpose

Education is inversely associated with coronary heart disease (CHD); however whether this聽is attributable to causal effects of schooling rather than potential confounders existing before school entry (eg, childhood intelligence, childhood economic circumstances, childhood chronic illness, parental mental health) remains unknown. We evaluated whether education is associated with 10-year CHD risk independent of 21 prospectively assessed childhood conditions, in participants ages 38-47 years.

Methods

Using linear regression analyses, we evaluated associations of education with 10-year CHD risk, the latter calculated by use of the validated Framingham risk algorithm incorporating diabetes, blood pressure, total and high-density lipoprotein cholesterol, smoking, age, and sex. Propensity score matching incorporated 21 early-life potential confounders.

Results

Regression analyses demonstrated college graduation was associated with 鈭?7.9%lower (95%CI, 鈭?6.2, 鈭?8.6%) 10-year CHD risk compared with 鈮igh school after matching on propensity score that included age, sex and race (n = 272); addition of 21 early life potential confounders resulted in effect size of 鈭?3.1%(95%CI, 鈭?3.4, 13.4; mean n = 110).

Conclusions

Participants with college degree had substantially lower risk of CHD (27.9%) after accounting for demographics; the addition of early life potential confounders resulted in a moderate effect size (13.1%), suggesting potential importance of early life factors in explaining observed associations between education and CHD risk.