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Lebenbaum M, de Oliveira C, Gagnon F, Laporte A. Child health and its effect on adult social capital accumulation. HEALTH ECONOMICS 2024; 33:844-869. [PMID: 38236659 DOI: 10.1002/hec.4792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 11/15/2023] [Accepted: 11/28/2023] [Indexed: 04/04/2024]
Abstract
Although studies have demonstrated important effects of poor health in childhood on stocks of human and health capital, little research has tested economic theories to investigate the effect of child health on social capital in adulthood. Studies on the influence of child health on adult social capital are mixed and have not used sibling fixed effects models to account for unmeasured family and genetic characteristics, that are likely to be important. Using the Add-Health sample, health in childhood was assessed as self-rated health, the occurrence of a physical health condition or mental health condition, while social capital in adulthood was measured as volunteering, religious service attendance, team sports participation, number of friends, social isolation, and social support. We used sibling fixed effects models, which attenuated several associations to non-significance. In sibling fixed effects models there was significant positive effects of greater self-rated health on participation in team sports and social support, and negative effect of mental health in childhood on social isolation in adulthood. These results suggest that children with poor health require additional supports to build and maintain their stock of social capital and highlight further potential benefits to efforts that address poor child health.
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Affiliation(s)
- Michael Lebenbaum
- Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, Ontario, Canada
- Canadian Centre for Health Economics, Toronto, Ontario, Canada
- Center for Demography of Health and Aging, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Claire de Oliveira
- Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, Ontario, Canada
- Canadian Centre for Health Economics, Toronto, Ontario, Canada
- Centre for Health Economics and the Hull York Medical School, University of York, York, UK
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - France Gagnon
- The Dalla Lana School of Public Health (DLSPH), University of Toronto, Toronto, Ontario, Canada
| | - Audrey Laporte
- Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, Ontario, Canada
- Canadian Centre for Health Economics, Toronto, Ontario, Canada
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Bann D, Wright L, Hughes A, Chaturvedi N. Socioeconomic inequalities in cardiovascular disease: a causal perspective. Nat Rev Cardiol 2024; 21:238-249. [PMID: 37821646 DOI: 10.1038/s41569-023-00941-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/13/2023] [Indexed: 10/13/2023]
Abstract
Socioeconomic inequalities in cardiovascular disease (CVD) persist in high-income countries despite marked overall declines in CVD-related morbidity and mortality. After decades of research, the field has struggled to unequivocally answer a crucial question: is the association between low socioeconomic position (SEP) and the development of CVD causal? We review relevant evidence from various study designs and disciplinary perspectives. Traditional observational, family-based and Mendelian randomization studies support the widely accepted view that low SEP causally influences CVD. However, results from quasi-experimental and experimental studies are both limited and equivocal. While more experimental and quasi-experimental studies are needed to aid causal understanding and inform policy, high-quality descriptive studies are also required to document inequalities, investigate their contextual dependence and consider SEP throughout the lifespan; no simple hierarchy of evidence exists for an exposure as complex as SEP. The COVID-19 pandemic illustrates the context-dependent nature of CVD inequalities, with the generation of potentially new causal pathways linking SEP and CVD. The linked goals of understanding the causal nature of SEP and CVD associations, their contextual dependence, and their remediation by policy interventions necessitate a detailed understanding of society, its change over time and the phenotypes of CVD. Interdisciplinary research is therefore key to advancing both causal understanding and policy translation.
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Affiliation(s)
- David Bann
- Centre for Longitudinal Studies, Social Research Institute, IOE, UCL's Faculty of Education and Society, University College London, London, UK.
| | - Liam Wright
- Centre for Longitudinal Studies, Social Research Institute, IOE, UCL's Faculty of Education and Society, University College London, London, UK
| | - Alun Hughes
- MRC Unit for Lifelong Health & Ageing at UCL, Department of Population Science and Experimental Medicine, Institute of Cardiovascular Science, Faculty of Population Health Science, University College London, London, UK
| | - Nish Chaturvedi
- MRC Unit for Lifelong Health & Ageing at UCL, Department of Population Science and Experimental Medicine, Institute of Cardiovascular Science, Faculty of Population Health Science, University College London, London, UK
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Simon E. Demystifying the link between higher education and liberal values: A within-sibship analysis of British individuals' attitudes from 1994-2020. THE BRITISH JOURNAL OF SOCIOLOGY 2022; 73:967-984. [PMID: 36030542 PMCID: PMC10087825 DOI: 10.1111/1468-4446.12972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 08/03/2022] [Accepted: 08/05/2022] [Indexed: 06/15/2023]
Abstract
The link between university graduation and liberal values is well-established and often taken as evidence that higher education participation causes attitudinal change. Identification of education's causal influence in shaping individual preferences is notoriously difficult as it necessitates isolating education's effect from self-selection mechanisms. This study exploits the household structure of the Harmonized British Household Panel Study and Understanding Society data to tighten the bounds of causal inference in this area and ultimately, to provide a more robust estimate of the independent effect of university graduation on political attitudes. Results demonstrate that leveraging sibling fixed-effects to control for family-invariant pre-adult experiences reduces the size of higher education's effect on cultural attitudes by at least 70%, compared to conventional methods. Significantly, within-sibship models show that obtaining higher education qualifications only has a small direct causal effect on British individuals' adult attitudes, and that this effect is not always liberalizing. This has important implications for our understanding of the relationship between higher education and political values. Contrary to popular assumptions about education's liberalizing role, this study demonstrates that the education-political values linkage is largely spurious. It materializes predominately because those experiencing pre-adult environments conducive to the formation of particular values disproportionately enroll at universities.
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Affiliation(s)
- Elizabeth Simon
- Department of Social Statistics and DemographyUniversity of SouthamptonSouthamptonUK
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Finegood ED, Briley DA, Turiano NA, Freedman A, South SC, Krueger RF, Chen E, Mroczek DK, Miller GE. Association of Wealth With Longevity in US Adults at Midlife. JAMA HEALTH FORUM 2021; 2:e211652. [PMID: 35977209 PMCID: PMC8796893 DOI: 10.1001/jamahealthforum.2021.1652] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 05/24/2021] [Indexed: 01/20/2023] Open
Affiliation(s)
- Eric D. Finegood
- Institute for Policy Research, Northwestern University, Evanston, Illinois
- Department of Psychology, Northwestern University, Evanston, Illinois
| | - Daniel A. Briley
- Department of Psychology, University of Illinois Urbana-Champaign, Urbana
| | | | - Alexa Freedman
- Institute for Policy Research, Northwestern University, Evanston, Illinois
- Department of Psychology, Northwestern University, Evanston, Illinois
| | - Susan C. South
- Department of Psychological Sciences, Purdue University, West Lafayette, Indiana
| | | | - Edith Chen
- Institute for Policy Research, Northwestern University, Evanston, Illinois
- Department of Psychology, Northwestern University, Evanston, Illinois
| | - Daniel K. Mroczek
- Department of Psychology, Northwestern University, Evanston, Illinois
- Department of Medical Social Sciences, Northwestern University, Evanston, Illinois
| | - Gregory E. Miller
- Institute for Policy Research, Northwestern University, Evanston, Illinois
- Department of Psychology, Northwestern University, Evanston, Illinois
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Rosoff DB, Clarke TK, Adams MJ, McIntosh AM, Davey Smith G, Jung J, Lohoff FW. Educational attainment impacts drinking behaviors and risk for alcohol dependence: results from a two-sample Mendelian randomization study with ~780,000 participants. Mol Psychiatry 2021; 26:1119-1132. [PMID: 31649322 PMCID: PMC7182503 DOI: 10.1038/s41380-019-0535-9] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 09/05/2019] [Accepted: 09/20/2019] [Indexed: 01/01/2023]
Abstract
Observational studies suggest that lower educational attainment (EA) may be associated with risky alcohol use behaviors; however, these findings may be biased by confounding and reverse causality. We performed two-sample Mendelian randomization (MR) using summary statistics from recent genome-wide association studies (GWAS) with >780,000 participants to assess the causal effects of EA on alcohol use behaviors and alcohol dependence (AD). Fifty-three independent genome-wide significant SNPs previously associated with EA were tested for association with alcohol use behaviors. We show that while genetic instruments associated with increased EA are not associated with total amount of weekly drinks, they are associated with reduced frequency of binge drinking ≥6 drinks (ßIVW = -0.198, 95% CI, -0.297 to -0.099, PIVW = 9.14 × 10-5), reduced total drinks consumed per drinking day (ßIVW = -0.207, 95% CI, -0.293 to -0.120, PIVW = 2.87 × 10-6), as well as lower weekly distilled spirits intake (ßIVW = -0.148, 95% CI, -0.188 to -0.107, PIVW = 6.24 × 10-13). Conversely, genetic instruments for increased EA were associated with increased alcohol intake frequency (ßIVW = 0.331, 95% CI, 0.267-0.396, PIVW = 4.62 × 10-24), and increased weekly white wine (ßIVW = 0.199, 95% CI, 0.159-0.238, PIVW = 7.96 × 10-23) and red wine intake (ßIVW = 0.204, 95% CI, 0.161-0.248, PIVW = 6.67 × 10-20). Genetic instruments associated with increased EA reduced AD risk: an additional 3.61 years schooling reduced the risk by ~50% (ORIVW = 0.508, 95% CI, 0.315-0.819, PIVW = 5.52 × 10-3). Consistency of results across complementary MR methods accommodating different assumptions about genetic pleiotropy strengthened causal inference. Our findings suggest EA may have important effects on alcohol consumption patterns and may provide potential mechanisms explaining reported associations between EA and adverse health outcomes.
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Affiliation(s)
- Daniel B Rosoff
- Section on Clinical Genomics and Experimental Therapeutics, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD, USA
| | - Toni-Kim Clarke
- Division of Psychiatry, University of Edinburgh, Royal Edinburgh Hospital, Edinburgh, UK
| | - Mark J Adams
- Division of Psychiatry, University of Edinburgh, Royal Edinburgh Hospital, Edinburgh, UK
| | - Andrew M McIntosh
- Division of Psychiatry, University of Edinburgh, Royal Edinburgh Hospital, Edinburgh, UK
| | - George Davey Smith
- MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, UK
| | - Jeesun Jung
- Section on Clinical Genomics and Experimental Therapeutics, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD, USA
| | - Falk W Lohoff
- Section on Clinical Genomics and Experimental Therapeutics, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD, USA.
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Beckley AL, Palmer RH, Rocque M, Whitfield KE. Health and criminal justice system involvement among African American siblings. SSM Popul Health 2019; 7:100359. [PMID: 30788408 PMCID: PMC6369245 DOI: 10.1016/j.ssmph.2019.100359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 01/01/2019] [Accepted: 01/17/2019] [Indexed: 11/16/2022] Open
Abstract
IMPORTANCE Health disparities between African Americans and Whites have persisted in the United States. Researchers have recently hypothesized that the relatively poor health of African Americans may be caused, in part, by African American overrepresentation in the criminal justice system. OBJECTIVES To test the hypothesis that criminal justice system involvement is associated with poor health and greater health risk when controlling for unobserved family factors through a discordant sibling design. METHODS Subjects were drawn from the Carolina African American Twin Study of Aging (CAATSA). Criminal conviction records were extracted from North Carolina's Department of Public Safety. Six measures of health and one measure of health risk were analyzed. The health of convicted respondents was compared to that of unrelated non-convicted respondents matched on childhood and demographic factors ("matched sample"). Convicted respondents were also compared to non-convicted siblings ("discordant sibling sample"). RESULTS The matched sample included 134 CAATSA respondents. On average, convicted CAATSA respondents, compared to matched non-convicted respondents, were in worse health. Convicted respondents had worse mean self-reported health, worse lung function, more depressive symptoms, and smoked more. The discordant sibling sample included 74 respondents. Convicted siblings and non-convicted siblings had similar self-reported health, depressive symptoms, and smoking. In general, non-convicted siblings were in worse health than non-convicted respondents from the matched sample, implying that poor health runs in families. CONCLUSIONS This study provided preliminary evidence that some of the association between a criminal record and poor health is confounded by family factors. Though more research is needed to support these results, the study suggests that criminal involvement may not be associated with the surfeit of health problems observed among African Americans. The criminal justice system, nonetheless, could be used to decrease the health disparity.
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Affiliation(s)
- Amber L Beckley
- Department of Psychology and Neuroscience, Duke University, Durham, NC, USA
- Demography Unit, Department of Sociology, Stockholm University, Stockholm, Sweden
| | - Rohan H Palmer
- Behavioral Genetics of Addiction Laboratory, Department of Psychology at Emory University, 36 Eagle Row, Atlanta, GA, USA
| | - Michael Rocque
- Department of Scoiology, Bates College, Lewiston, ME, USA
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Socioeconomic inequalities in the prevalence of biomarkers of cardio-metabolic disease in South Korea: Comparison of the Health Examinees Study to a nationally representative survey. PLoS One 2018; 13:e0195091. [PMID: 29668714 PMCID: PMC5906014 DOI: 10.1371/journal.pone.0195091] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Accepted: 03/18/2018] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND/OBJECTIVES This study aimed to examine socioeconomic inequalities in the prevalence of biomarkers of cardiovascular disease and diabetes in the newly developed large-scale genomic cohort study of Korean adults, the Health Examinees-Gem (HEXA-G), with a comparison of the nationally representative cross-sectional study, the Korea National Health and Nutrition Examination Survey (K-NHANES). SUBJECTS/METHODS Using the HEXA-G and the K-NHANES from 2007-2012, we analyzed the age-adjusted relative risk (RR) and prevalence of enlarged waist circumference (EWC), elevated triglycerides (ET), low HDL cholesterol (LHC), elevated blood pressure (EBP) and elevated blood glucose (EBG) by income and educational groups for adults at age 40-69. RESULTS For men, the prevalence of risk factors was similar across different income and educational groups (p>0.1), and between the K-NHANES and the HEXA-G. Among five risk factors, EBG showed the greatest discrepancy by 7 to 11 percentage points (i.e., the prevalence of 0.43 and 0.36 for college graduates, respectively, in K-NHANES and HEXA-G). For women, socioeconomic inequalities appeared for the five risk factors. Prevalence of risk factors was mostly lower in the HEXA-G than the K-NHANES, by approximately 11.0 percentage points. Especially, the discrepancy between K-NHANES and HEXA-G was largest in EBG (i.e., the prevalence of 0.31 and 0.20 for the lowest income groups, respectively). CONCLUSION The HEXA-G shows broadly similar socioeconomic inequality in prevalence of cardio-metabolic risk factors to the nationally representative sample with more modest socioeconomic inequality among women in the HEXA-G than the K-NHANES.
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Zajacova A, Lawrence EM. The Relationship Between Education and Health: Reducing Disparities Through a Contextual Approach. Annu Rev Public Health 2018; 39:273-289. [PMID: 29328865 PMCID: PMC5880718 DOI: 10.1146/annurev-publhealth-031816-044628] [Citation(s) in RCA: 394] [Impact Index Per Article: 65.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Adults with higher educational attainment live healthier and longer lives compared with their less educated peers. The disparities are large and widening. We posit that understanding the educational and macrolevel contexts in which this association occurs is key to reducing health disparities and improving population health. In this article, we briefly review and critically assess the current state of research on the relationship between education and health in the United States. We then outline three directions for further research: We extend the conceptualization of education beyond attainment and demonstrate the centrality of the schooling process to health; we highlight the dual role of education as a driver of opportunity but also as a reproducer of inequality; and we explain the central role of specific historical sociopolitical contexts in which the education-health association is embedded. Findings from this research agenda can inform policies and effective interventions to reduce health disparities and improve health for all Americans.
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Affiliation(s)
- Anna Zajacova
- Department of Sociology, Western University, London, Ontario N6A 5C2, Canada;
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Zheng H. Why does college education matter? Unveiling the contributions of selection factors. SOCIAL SCIENCE RESEARCH 2017; 68:59-73. [PMID: 29108600 PMCID: PMC5685179 DOI: 10.1016/j.ssresearch.2017.09.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 08/23/2017] [Accepted: 09/11/2017] [Indexed: 05/10/2023]
Abstract
This study investigates the contributions of pre-college selection factors that may partially lead to the college degree - health link by using longitudinal data from the National Longitudinal Survey of Youth (1979) cohort. Propensity score matching method finds that the effects of college degree on various health outcomes (self-rated health, physical component summary index, health limitations, CESD scale) are reduced by 51% on average (range: 37%-70%) in the matched sample. Among these observed factors, cognitive skill is the biggest confounder, followed by pre-college health and socioeconomic characteristics (marital aspiration, years of schooling, marriage, fertility, poverty status) and non-cognitive skills (e.g., self-esteem). Rotter Internal-External Locus of Control scale is not significantly associated with all four health measures. The effects of most indicators of family background (parental education, family stability, family size, religious background) on the health of adult children are not direct but through offspring's early adulthood health and socioeconomic status.
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Affiliation(s)
- Hui Zheng
- Ohio State University, 106 Townshend Hall, 1885 Neil Avenue Mall, Columbus, OH 43210, United States.
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Lundborg P, Lyttkens CH, Nystedt P. The Effect of Schooling on Mortality: New Evidence From 50,000 Swedish Twins. Demography 2017; 53:1135-68. [PMID: 27393233 DOI: 10.1007/s13524-016-0489-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
By using historical data on about 50,000 twins born in Sweden during 1886-1958, we demonstrate a positive and statistically significant relationship between years of schooling and longevity. This relation remains almost unchanged when exploiting a twin fixed-effects design to control for the influence of genetics and shared family background. This result is robust to controlling for within-twin-pair differences in early-life health and cognitive ability, as proxied by birth weight and height, as well as to restricting the sample to MZ twins. The relationship is fairly constant over time but becomes weaker with age. Literally, our results suggest that compared with low levels of schooling (less than 10 years), high levels of schooling (at least 13 years of schooling) are associated with about three years longer life expectancy at age 60 for the considered birth cohorts. The real societal value of schooling may hence extend beyond pure labor market and economic growth returns. From a policy perspective, schooling may therefore be a vehicle for improving longevity and health, as well as equality along these dimensions.
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Affiliation(s)
- Petter Lundborg
- Centre for Economic Demography, IZA, HEP, Lund University, Lund, Sweden.
| | | | - Paul Nystedt
- Jönköping Academy, Jönköping International Business School, Jönköping University, Jönköping, Sweden
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Søndergaard G, Dalton SO, Mortensen LH, Osler M. Educational inequality in cardiovascular diseases: a sibling approach. Scand J Public Health 2017; 46:83-91. [PMID: 28992724 DOI: 10.1177/1403494817734775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIMS Educational inequality in diseases in the circulatory system (here termed cardiovascular disease) is well documented but may be confounded by early life factors. The aim of this observational study was to examine whether the associations between education and all cardiovascular diseases, ischaemic heart disease and stroke, respectively, were explained by family factors shared by siblings. METHODS The study population included all individuals born in Denmark between 1950 and 1979 who had at least one full sibling born in the same period. Using Cox regression, data were analysed in conventional cohort and within-sibship analyses in which the association was examined within siblings discordant on education. Assuming that attenuation of associations in the within-sibship as compared with the cohort analyses would indicate confounding from factors shared within families. RESULTS A lower educational status was associated with a higher risk of cardiovascular disease, ischaemic heart disease and stroke. All associations attenuated in the within-sibship analyses, in particular in the analyses on ischaemic heart disease before age 45 years. For instance, in the cohort analyses, the hazard rate of ischaemic heart disease among women less than 45 years who had a primary school education was 94% (hazard ratio 1.94 (1.78-2.12) higher than among those with a vocational education, while it attenuated to 51% (hazard ratio 1.51 (1.34-1.71)) in the within-sibship analysis. CONCLUSIONS Confounding from factors shared by siblings explained the associations between education and the cardiovascular disease outcomes but to varying degrees. This should be taken into account when planning interventions aimed at reducing educational inequalities in the development of cardiovascular disease, ischaemic heart disease and stroke.
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Affiliation(s)
- Grethe Søndergaard
- 1 Research Centre for Prevention and Health, Glostrup University Hospital, Denmark
| | | | | | - Merete Osler
- 1 Research Centre for Prevention and Health, Glostrup University Hospital, Denmark
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Tillmann T, Vaucher J, Okbay A, Pikhart H, Peasey A, Kubinova R, Pajak A, Tamosiunas A, Malyutina S, Hartwig FP, Fischer K, Veronesi G, Palmer T, Bowden J, Davey Smith G, Bobak M, Holmes MV. Education and coronary heart disease: mendelian randomisation study. BMJ 2017; 358:j3542. [PMID: 28855160 PMCID: PMC5594424 DOI: 10.1136/bmj.j3542] [Citation(s) in RCA: 101] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Objective To determine whether educational attainment is a causal risk factor in the development of coronary heart disease.Design Mendelian randomisation study, using genetic data as proxies for education to minimise confounding.Setting The main analysis used genetic data from two large consortia (CARDIoGRAMplusC4D and SSGAC), comprising 112 studies from predominantly high income countries. Findings from mendelian randomisation analyses were then compared against results from traditional observational studies (164 170 participants). Finally, genetic data from six additional consortia were analysed to investigate whether longer education can causally alter the common cardiovascular risk factors.Participants The main analysis was of 543 733 men and women (from CARDIoGRAMplusC4D and SSGAC), predominantly of European origin.Exposure A one standard deviation increase in the genetic predisposition towards higher education (3.6 years of additional schooling), measured by 162 genetic variants that have been previously associated with education.Main outcome measure Combined fatal and non-fatal coronary heart disease (63 746 events in CARDIoGRAMplusC4D).Results Genetic predisposition towards 3.6 years of additional education was associated with a one third lower risk of coronary heart disease (odds ratio 0.67, 95% confidence interval 0.59 to 0.77; P=3×10-8). This was comparable to findings from traditional observational studies (prevalence odds ratio 0.73, 0.68 to 0.78; incidence odds ratio 0.80, 0.76 to 0.83). Sensitivity analyses were consistent with a causal interpretation in which major bias from genetic pleiotropy was unlikely, although this remains an untestable possibility. Genetic predisposition towards longer education was additionally associated with less smoking, lower body mass index, and a favourable blood lipid profile.Conclusions This mendelian randomisation study found support for the hypothesis that low education is a causal risk factor in the development of coronary heart disease. Potential mechanisms could include smoking, body mass index, and blood lipids. In conjunction with the results from studies with other designs, these findings suggest that increasing education may result in substantial health benefits.
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Affiliation(s)
- Taavi Tillmann
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Julien Vaucher
- Department of Internal Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Aysu Okbay
- Department of Complex Trait Genetics, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Hynek Pikhart
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Anne Peasey
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Ruzena Kubinova
- Centre for Environmental Health Monitoring, National Institute of Public Health, Prague, Czech Republic
| | - Andrzej Pajak
- Chair of Epidemiology and Population Studies, Institute of Public Health, Faculrty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland
| | - Abdonas Tamosiunas
- Institute of Cardiology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Sofia Malyutina
- Research Institute of Internal and Preventive Medicine, Branch of the Institute of Cytology and Genetics, SB RAS, Novosibirsk, Russia
- Novosibirsk State Medical University, Novosibirsk, Russia
| | - Fernando Pires Hartwig
- Postgraduate Programme in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
- Medical Research Council Integrative Epidemiology Unit at the University of Bristol, Bristol, UK
| | - Krista Fischer
- Estonian Genome Center, University of Tartu, Tartu, Estonia
| | - Giovanni Veronesi
- Research Center in Epidemiology and Preventive Medicine, University of Insubria, Varese, Italy
| | - Tom Palmer
- Department of Mathematics and Statistics, Lancaster University, Lancaster, UK
| | - Jack Bowden
- Medical Research Council Integrative Epidemiology Unit at the University of Bristol, Bristol, UK
| | - George Davey Smith
- Medical Research Council Integrative Epidemiology Unit at the University of Bristol, Bristol, UK
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Martin Bobak
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Michael V Holmes
- Medical Research Council Integrative Epidemiology Unit at the University of Bristol, Bristol, UK
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, Big Data Institute, University of Oxford, Oxford, UK
- Medical Research Council Population Health Research Unit at the University of Oxford, Oxford, UK
- National Institute for Health Research Oxford Biomedical Research Centre, Oxford University Hospital, Oxford, UK
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Kjøllesdal MKR, Ariansen I, Mortensen LH, Næss Ø. The importance of early life family factors in the association between cardiovascular risk factors and early cardiovascular mortality. Open Heart 2017; 4:e000608. [PMID: 28878947 PMCID: PMC5574457 DOI: 10.1136/openhrt-2017-000608] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Revised: 05/24/2017] [Accepted: 06/13/2017] [Indexed: 11/10/2022] Open
Abstract
Objective To explore the importance of early life factors shared by siblings, such as parental socioeconomic position, parental practices, housing and neighbourhood, for the association between cardiovascular disease (CVD) risk factors and mortality from CVD, ischaemic heart disease (IHD) and cerebrovascular disease. Methods Norwegian health surveys (1974–2003) were linked with data from the Norwegian Family Based Life Course Study and the Cause of Death Registry. Participants with at least one full sibling among survey participants (n=2 71 643) were included. Data on CVD risk factors, body mass index (BMI), height, systolic blood pressure (SBP) and total cholesterol (TC) were stratified into ‘low’, ‘medium’ and ‘high’ risk, and smoking to ‘daily smoking’ and ‘not daily smoking’. Results Mean age of participants was 41 years, mean follow-up time was 19 years and during follow-up 2512 died from CVD. For each category of increased risk factor level, the per step HR of CVD mortality was increased by 1.91 (95% CI 1.78 to 2.05) for SBP, 1.67 (1.58 to 1.76) for TC, 1.44 (1.36 to 1.53) for BMI, 1.26 (1.18 to 1.35) for height and 2.89 (2.66 to 3.14) for smoking. In analyses where each sibship (groups of full siblings) had a group-specific baseline hazard, these associations were attenuated to 1.74, 1.51, 1.29, 1.18 and 2.63, respectively. The associations between risk factors and IHD mortality followed the same pattern. Conclusion Early life family factors explained a small part of the association between risk factors and mortality from CVD and IHD in a relatively young sample.
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Affiliation(s)
- Marte K R Kjøllesdal
- Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Inger Ariansen
- Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway
| | - Laust H Mortensen
- Department of Social Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Øyvind Næss
- Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, Oslo, Norway.,Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway
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14
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O'Reilly D, Rosato M, Moriarty J, Leavey G. Volunteering and mortality risk: a partner-controlled quasi-experimental design. Int J Epidemiol 2017; 46:1295-1302. [PMID: 28369389 DOI: 10.1093/ije/dyx037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2017] [Indexed: 11/14/2022] Open
Abstract
Background The consensus that volunteering is associated with a lower mortality risk is derived from a body of observational studies and therefore vulnerable to uncontrolled or residual confounding. This potential limitation is likely to be particularly problematic for volunteers who, by definition, are self-selected and known to be significantly different from non-volunteers across a range of factors associated with better survival. Methods This is a census-based record-linkage study of 308 733 married couples aged 25 and over, including 100 571 volunteers, with mortality follow-up for 33 months. We used a standard Cox model to examine whether mortality risk in the partners of volunteers was influenced by partner volunteering status-something expected if the effects of volunteering on mortality risk were due to shared household or behavioural characteristics. Results Volunteers were general more affluent, better educated and more religious than their non-volunteering peers; they also had a lower mortality risk [hazard ratio (HR)adj = 0.78: 95% confidence interval (CI) = 0.71, 0.85 for males and HRadj = 0.77: 95% CI = 0.68, 0.88 for females]. However, amongst cohort members who were not volunteers, having a partner who was a volunteer was not associated with a mortality advantage (HRadj = 1.01: 95% CI = 0.92, 1.11 for men and HRadj = 1.00: 95% CI = 0.88, 1.13 women). Conclusions This study provides further evidence that the lower mortality associated with volunteering is unlikely to be due to health selection or to residual confounding arising from unmeasured selection effects within households. It therefore increases the plausibility of a direct causal effect.
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Affiliation(s)
- Dermot O'Reilly
- Centre for Public Health, Queen's University Belfast, Belfast
| | - Michael Rosato
- Bamford Centre for Mental Health and Wellbeing, Ulster University, Northern Ireland
| | - John Moriarty
- Centre for Public Health, Queen's University Belfast, Belfast
| | - Gerard Leavey
- Bamford Centre for Mental Health and Wellbeing, Ulster University, Northern Ireland
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15
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Chronic low back pain and the risk of depression or anxiety symptoms: insights from a longitudinal twin study. Spine J 2017; 17:905-912. [PMID: 28267634 DOI: 10.1016/j.spinee.2017.02.009] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Revised: 02/06/2017] [Accepted: 02/28/2017] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Pain is commonly associated with symptoms of depression or anxiety, although this relationship is considered bidirectional. There is limited knowledge regarding causal relationships. PURPOSE This study aims to investigate whether chronic low back pain (LBP) increases the risk of depression or anxiety symptoms, after adjusting for shared familial factors. STUDY DESIGN This is a longitudinal, genetically informative study design from the Murcia Twin Registry in Spain. PATIENT SAMPLE The patient sample included 1,269 adult twins with a mean age of 53 years. OUTCOME MEASURES The outcome of depression or anxiety symptoms was evaluated with EuroQol questionnaire. METHODS Using logistic regression analyses, twins were initially assessed as individuals in the total sample analysis, followed by a co-twin case-control, which was partially (dizygotic [DZ] twins) and fully (monozygotic [MZ] twins) adjusted for shared familial factors. There was no external funding for this study and no conflict of interest was declared. RESULTS There was a significant association between chronic LBP and the risk of depression or anxiety symptoms in the unadjusted total sample analysis (odds ratio [OR]: 1.81, 95% confidence interval [CI]: 1.34-2.44). After adjusting for confounders, the association remained significant (OR: 1.43, 95% CI: 1.05-1.95), although the adjusted co-twin case-control was non-significant in DZ (OR: 1.03, 95% CI: 0.50-2.13) and MZ twins (OR: 1.86, 95% CI: 0.63-5.51). CONCLUSIONS The relationship between chronic LBP and the future development of depression or anxiety symptoms is not causal. The relationship is likely to be explained by confounding from shared familial factors, given the non-statistically significant associations in the co-twin case-control analyses.
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16
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Ariansen I, Mortensen LH, Graff-Iversen S, Stigum H, Kjøllesdal MKR, Næss Ø. The educational gradient in cardiovascular risk factors: impact of shared family factors in 228,346 Norwegian siblings. BMC Public Health 2017; 17:281. [PMID: 28356092 PMCID: PMC5372258 DOI: 10.1186/s12889-017-4123-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Accepted: 02/09/2017] [Indexed: 11/16/2022] Open
Abstract
Background Various indicators of childhood socioeconomic position have been related to cardiovascular disease (CVD) risk in adulthood. We investigated the impact of shared family factors on the educational gradient in midlife CVD risk factors by assessing within sibling similarities in the gradient using a discordant sibling design. Methods Norwegian health survey data (1980–2003) was linked to educational and generational data. Participants with a full sibling in the health surveys (228,346 individuals in 98,046 sibships) were included. Associations between attained educational level (7–9 years, 10–11 years, 12 years, 13–16 years, or >16 years) and CVD risk factor levels in the study population was compared with the corresponding associations within siblings. Results Educational gradients in risk factors were attenuated when factors shared by siblings was taken into account: A one category lower educational level was associated with 0.7 (95% confidence interval 0.6 to 0.8) mm Hg higher systolic blood pressure (27% attenuation), 0.4 (0.4 to 0.5) mmHg higher diastolic blood pressure (30%), 1.0 (1.0 to 1.1) more beats per minute higher heart rate (21%), 0.07 (0.06 to 0.07) mmol/l higher serum total cholesterol (32%), 0.2 (0.2 to 0.2) higher smoking level (5 categories) (30%), 0.15 (0.13 to 0.17) kg/m2 higher BMI (43%), and 0.2 (0.2 to 0.2) cm lower height (52%). Attenuation increased with shorter age-difference between siblings. Conclusion About one third of the educational gradients in modifiable CVD risk factors may be explained by factors that siblings share. This implies that childhood environment is important for the prevention of CVD. Electronic supplementary material The online version of this article (doi:10.1186/s12889-017-4123-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Inger Ariansen
- Domain for Mental and Physical Health, Norwegian Institute of Public Health, PO box 4404, Oslo, N-0403, Norway.
| | - Laust Hvas Mortensen
- Section of Social Medicine, University of Copenhagen, PO box 2099, Copenhagen, K 1014, Denmark
| | - Sidsel Graff-Iversen
- Domain for Mental and Physical Health, Norwegian Institute of Public Health, PO box 4404, Oslo, N-0403, Norway.,Department of Community Medicine, The Arctic University of Norway, Tromsø, Norway
| | - Hein Stigum
- Domain for Mental and Physical Health, Norwegian Institute of Public Health, PO box 4404, Oslo, N-0403, Norway.,Institute of Health and Society, University of Oslo, PO box 1130, Oslo, 0318, Norway
| | | | - Øyvind Næss
- Domain for Mental and Physical Health, Norwegian Institute of Public Health, PO box 4404, Oslo, N-0403, Norway.,Institute of Health and Society, University of Oslo, PO box 1130, Oslo, 0318, Norway
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17
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Kilpi F, Silventoinen K, Konttinen H, Martikainen P. Early-life and adult socioeconomic determinants of myocardial infarction incidence and fatality. Soc Sci Med 2017; 177:100-109. [DOI: 10.1016/j.socscimed.2017.01.055] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Revised: 01/23/2017] [Accepted: 01/24/2017] [Indexed: 11/16/2022]
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18
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Kjøllesdal MKR, Ariansen I, Mortensen LH, Davey Smith G, Næss Ø. Educational differences in cardiovascular mortality: The role of shared family factors and cardiovascular risk factors. Scand J Public Health 2016; 44:744-750. [PMID: 27655782 DOI: 10.1177/1403494816669427] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
AIMS To explore the confounding effects of early family factors shared by siblings and cardiovascular risk factors in midlife on the educational differences in mortality from cardiovascular disease (CVD). METHODS Data from national and regional health surveys in Norway (1974-2003) were linked with data from the Norwegian Family Based Life Course Study, the National Educational Registry and the Cause of Death Registry. The study population consisted of participants with at least one full sibling among the health survey participants ( n=271,310). Data were available on CVD risk factors, including weight, height, blood pressure, total cholesterol and smoking. RESULTS The hazards ratio (HR) of CVD mortality was 3.44 (95% confidence interval (CI) 2.98-3.96) in the lowest educational group relative to the highest. The HRs were little altered in the within-sibship analyses. Adjusted for risk factors, the HR for CVD mortality in the cohort analyses was 2.05 (CI 1.77-2.37) in the lowest educational group relative to the highest. The respective HR in the within-sibship analyses was 2.46 (CI 1.48-2.24). CONCLUSIONS Using a sibling design, we did not find that the association between education and CVD mortality was confounded by early life factors shared by siblings, but it was explained to a large extent by CVD risk factors. These results suggest that reducing levels of CVD risk factors could have the greatest effect on mortality in less well-educated people.
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Affiliation(s)
| | - I Ariansen
- 2 Norwegian Institute of Public Health, Norway
| | | | - G Davey Smith
- 4 MRC Integrative Epidemiology Unit, University of Bristol, UK
| | - Ø Næss
- 1 Institute of Health and Society, University of Oslo, Norway.,2 Norwegian Institute of Public Health, Norway
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19
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Hamdi NR, South SC, Krueger RF. Does education lower allostatic load? A co-twin control study. Brain Behav Immun 2016; 56:221-9. [PMID: 26778778 PMCID: PMC4917427 DOI: 10.1016/j.bbi.2016.01.014] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2015] [Revised: 01/08/2016] [Accepted: 01/13/2016] [Indexed: 01/05/2023] Open
Abstract
Many studies have found that education is associated with better health, but the causal basis of this association is unclear. The current study used a co-twin control design to examine if differences in years of education within twin pairs predict allostatic load. The strength of this design is that it controls for genetic and other familial confounds shared between twins. The sample consisted of 381 twins (with 292 twins from 146 complete pairs; mean age=57; 61% female) who participated in the biomarker project of the Midlife Development in the United States (MIDUS) study. Individual-level analyses showed a significant, negative association between years of education and allostatic load, but this association was explained entirely by familial influences shared between twins. The results of this study suggest that schooling does not itself protect against allostatic load.
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Affiliation(s)
- Nayla R Hamdi
- Department of Psychology, University of Minnesota, 75 E River Road, Minneapolis, MN 55455, USA.
| | - Susan C South
- Department of Psychology, Purdue University, 703 Third Street, West Lafayette, IN 47907, USA.
| | - Robert F Krueger
- Department of Psychology, University of Minnesota, 75 E River Road, Minneapolis, MN 55455, USA.
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20
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Boardman JD, Fletcher JM. To cause or not to cause? That is the question, but identical twins might not have all of the answers. Soc Sci Med 2014; 127:198-200. [PMID: 25455476 DOI: 10.1016/j.socscimed.2014.10.013] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Accepted: 10/06/2014] [Indexed: 11/25/2022]
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21
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Gilman SE, Loucks EB. Another casualty of sibling fixed-effects analysis of education and health: an informative null, or null information? Soc Sci Med 2014; 118:191-3. [PMID: 25138687 DOI: 10.1016/j.socscimed.2014.06.029] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2014] [Accepted: 06/19/2014] [Indexed: 11/30/2022]
Affiliation(s)
- Stephen E Gilman
- Department of Social & Behavioral Sciences, Harvard School of Public Health, United States; Department of Epidemiology, Harvard School of Public Health, United States; Department of Psychiatry, Massachusetts General Hospital, United States.
| | - Eric B Loucks
- Department of Epidemiology, Brown University, United States
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