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Chen D, Zhou Y, Zhang Y, Zeng H, Wu L, Liu Y. Unraveling shared susceptibility loci and Mendelian genetic associations linking educational attainment with multiple neuropsychiatric disorders. Front Psychiatry 2024; 14:1303430. [PMID: 38250258 PMCID: PMC10797721 DOI: 10.3389/fpsyt.2023.1303430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 12/11/2023] [Indexed: 01/23/2024] Open
Abstract
Background Empirical studies have demonstrated that educational attainment (EA) is associated with neuropsychiatric disorders (NPDs), suggesting a shared etiological basis between them. However, little is known about the shared genetic mechanisms and causality behind such associations. Methods This study explored the shared genetic basis and causal relationships between EA and NPDs using the high-definition likelihood (HDL) method, cross phenotype association study (CPASSOC), transcriptome-wide association study (TWAS), and bidirectional Mendelian randomization (MR) with summary-level data for EA (N = 293,723) and NPDs (N range = 9,725 to 455,258). Results Significant genetic correlations between EA and 12 NPDs (rg range - 0.49 to 0.35; all p < 3.85 × 10-3) were observed. CPASSOC identified 37 independent loci shared between EA and NPDs, one of which was novel (rs71351952, mapped gene: ARFGEF2). Functional analyses and TWAS found shared genes were enriched in brain tissue, especially in the cerebellum and highlighted the regulatory role of neuronal signaling, purine nucleotide metabolic process, and cAMP-mediated signaling pathways. CPASSOC and TWAS supported the role of three regions of 6q16.1, 3p21.31, and 17q21.31 might account for the shared causes between EA and NPDs. MR confirmed higher genetically predicted EA lower the risk of ADHD (ORIVW: 0.50; 95% CI: 0.39 to 0.63) and genetically predicted ADHD decreased the risk of EA (Causal effect: -2.8 months; 95% CI: -3.9 to -1.8). Conclusion These findings provided evidence of shared genetics and causation between EA and NPDs, advanced our understanding of EA, and implicated potential biological pathways that might underlie both EA and NPDs.
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Affiliation(s)
- Dongze Chen
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Genetics, Peking University Cancer Hospital & Institute, Beijing, China
| | - Yi Zhou
- Shenzhen Health Development Research and Data Management Center, Shenzhen, China
| | - Yali Zhang
- Department of Occupational and Environmental Health Sciences, School of Public Health, Peking University, Beijing, China
| | - Huatang Zeng
- Shenzhen Health Development Research and Data Management Center, Shenzhen, China
| | - Liqun Wu
- Shenzhen Health Development Research and Data Management Center, Shenzhen, China
| | - Yuyang Liu
- Shenzhen Health Development Research and Data Management Center, Shenzhen, China
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Xu L, Polya DA. Exploratory study of the association in the United Kingdom between hypertension and inorganic arsenic (iAs) intake from rice and rice products. ENVIRONMENTAL GEOCHEMISTRY AND HEALTH 2021; 43:2505-2538. [PMID: 32347515 PMCID: PMC8275557 DOI: 10.1007/s10653-020-00573-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 04/10/2020] [Indexed: 06/11/2023]
Abstract
Hypertension risks arising from chronic exposure to inorganic arsenic (iAs) are well documented. Consumption of rice is a major iAs exposure route for over 3 billion people; however, there is a lack of epidemiological evidence demonstrating an association of hypertension risks with iAs intake from rice, especially in areas where there is little exposure from drinking water but a growing demand for rice intake. To address this, we conducted an individual-level cross-sectional analysis to quantify the extent to which daily iAs intake from rice and rice products (E-iAsing,rice) modifies the association between hypertension risks and previously well-established risk factors. The analysis was based on secondary dietary, socio-demographic and health status data of 598 participants recorded in the UK National Diet and Nutrition Survey 2014-2016. E-iAsing,rice and five blood pressure endpoints were derived with potential associations explored through generalized linear models. According to the results, a negative but not significant relationship was found between hypertension risks and E-iAsing,rice after adjusting for major risk factors, notably age, gender, diabetes and obesity, with relatively higher risks being observed for male, middle-aged, overweight, alcohol consumer or Asian or Asian British, Black or Black British and mixed ethnic groups. Though inconclusive and mainly limited by potential incomplete adjustment for major confounders and intrinsic disadvantages of a cross-sectional design, this study was the first quantifying the individual level dose-response relationship between E-iAsing,rice and hypertension risks and is consistent with previous studies on the limited associations of hypertension with low-level arsenic exposure from drinking water. Larger scale cohort studies are indicated to quantify the association but in any event it is likely to be weak.
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Affiliation(s)
- Lingqian Xu
- Department of Earth and Environmental Sciences and Williamson Research Centre for Molecular Environmental Science, University of Manchester, Manchester, M13 9PL, UK
| | - David A Polya
- Department of Earth and Environmental Sciences and Williamson Research Centre for Molecular Environmental Science, University of Manchester, Manchester, M13 9PL, UK.
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Khaing W, Vallibhakara SA, Attia J, McEvoy M, Thakkinstian A. Effects of education and income on cardiovascular outcomes: A systematic review and meta-analysis. Eur J Prev Cardiol 2017; 24:1032-1042. [PMID: 28406328 DOI: 10.1177/2047487317705916] [Citation(s) in RCA: 104] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Objective Previous studies have reported discrepancy effects of education and income on cardiovascular diseases. This systematic review and meta-analysis was therefore conducted which aimed to summarize effects of education and income on cardiovascular diseases. Methods Studies were identified from Medline and Scopus until July 2016. Cohorts were eligible if they assessed associations between education/income and cardiovascular diseases, had at least one outcome including coronary artery diseases, cardiovascular events, strokes and cardiovascular deaths. A multivariate meta-analysis was applied to pool risk effects of these social determinants. Results Among 72 included cohorts, 39, 19, and 14 were studied in Europe, USA, and Asia. Pooled risk ratios of low and medium versus high education were 1.36 (95% confidence interval: 1.11-1.66) and 1.21 (1.06-1.40) for coronary artery diseases, 1.50 (1.17-1.92) and 1.27 (1.09-1.48) for cardiovascular events, 1.23 (1.06-1.43) and 1.17 (1.01-1.35) for strokes, and 1.39 (1.26-1.54) and 1.21 (1.12-1.30) for cardiovascular deaths. The effects of education on all cardiovascular diseases were still present in US and Europe settings, except in Asia this was present only for cardiovascular deaths. Effects of low and medium income versus high on these corresponding cardiovascular diseases were 1.49 (1.16-1.91) and 1.27 (1.10-1.47) for coronary artery diseases, 1.17 (0.96-1.44) and 1.05 (0.98-1.13) for cardiovascular events, 1.30 (0.99-1.72) and 1.24 (1.00-1.53) for strokes, and 1.76 (1.45-2.14) and 1.34 (1.17-1.54) for cardiovascular deaths. Conclusion Social determinants are risk factors of cardiovascular diseases in developed countries, although high heterogeneity in pooling. Data in Asia countries are still needed to update pooling.
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Affiliation(s)
- Win Khaing
- 1 Section for Clinical Epidemiology and Biostatistics, Mahidol University, Thailand.,2 Department of Preventive and Social Medicine, University of Medicine, Mandalay, Myanmar
| | - Sakda A Vallibhakara
- 1 Section for Clinical Epidemiology and Biostatistics, Mahidol University, Thailand
| | - John Attia
- 3 The School of Medicine and Public Health, the University of Newcastle, Newcastle, NSW, Australia
| | - Mark McEvoy
- 3 The School of Medicine and Public Health, the University of Newcastle, Newcastle, NSW, Australia
| | - Ammarin Thakkinstian
- 1 Section for Clinical Epidemiology and Biostatistics, Mahidol University, Thailand
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A meta-analysis of education effects on chronic disease: The causal dynamics of the Population Education Transition Curve. Soc Sci Med 2015; 127:29-40. [DOI: 10.1016/j.socscimed.2014.10.027] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2013] [Revised: 09/29/2014] [Accepted: 10/14/2014] [Indexed: 01/19/2023]
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Cohen AK, Rai M, Rehkopf DH, Abrams B. Educational attainment and obesity: a systematic review. Obes Rev 2013; 14:989-1005. [PMID: 23889851 PMCID: PMC3902051 DOI: 10.1111/obr.12062] [Citation(s) in RCA: 258] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2013] [Revised: 05/14/2013] [Accepted: 05/28/2013] [Indexed: 01/17/2023]
Abstract
Although previous systematic reviews considered the relationship between socioeconomic status and obesity, almost 200 peer-reviewed articles have been published since the last review on that topic, and this paper focuses specifically on education, which has different implications. The authors systematically review the peer-reviewed literature from around the world considering the association between educational attainment and obesity. Databases from public health and medicine, education, psychology, economics, and other social sciences were searched, and articles published in English, French, Portuguese and Spanish were included. This paper includes 289 articles that report on 410 populations in 91 countries. The relationship between educational attainment and obesity was modified by both gender and the country's economic development level: an inverse association was more common in studies of higher-income countries and a positive association was more common in lower-income countries, with stronger social patterning among women. Relatively few studies reported on lower-income countries, controlled for a comprehensive set of potential confounding variables and/or attempted to assess causality through the use of quasi-experimental designs. Future research should address these gaps to understand if the relationship between educational attainment and obesity may be causal, thus supporting education policy as a tool for obesity prevention.
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Affiliation(s)
- A K Cohen
- Division of Epidemiology, University of California Berkeley School of Public Health, Berkeley, California, USA
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Karunanayake AL, Pathmeswaran A, Kasturiratne A, Wijeyaratne LS. Risk factors for chronic low back pain in a sample of suburban Sri Lankan adult males. Int J Rheum Dis 2013; 16:203-10. [DOI: 10.1111/1756-185x.12060] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Metelska J, Nowakowska E, Kus K, Kajtowski P, Czubak A, Burda K. Evaluation of the knowledge of primary healthcare patients in Poland on the prevention of hypertension: a community study. Public Health 2011; 125:616-25. [PMID: 21864872 DOI: 10.1016/j.puhe.2011.06.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2009] [Revised: 08/17/2010] [Accepted: 06/08/2011] [Indexed: 10/17/2022]
Abstract
OBJECTIVES To investigate the knowledge of Poles on the prevention of arterial hypertension (HT) and identify the main souces of knowledge in order to make health promotion activities more effective, and thus increase the efficiency and efficacy of the Polish healthcare system. STUDY DESIGN Community study. METHODS This questionnaire study included 180 subjects (120 primary healthcare patients without a history of diagnosed HT and 60 primary care physicians). RESULTS The knowledge of most surveyed patients was insufficient (43%, n = 52) or sufficient (40%, n = 48) for the effective prevention of HT; 17% (n = 20) of the respondents had knowledge that was definitely sufficient, and none of the respondents had knowledge that was definitely insufficient. The patients reported that primary care physicians were the most common source of health information (67%, n = 80). Primary care physicians were also the most trusted source of information. CONCLUSIONS Patients' knowledge on smoking, diet and exercise is sufficient for the effective prevention of HT. The areas of insufficient knowledge for the development of HT and possible organ complications are drinking alcohol, stress, genetic factors and diabetes.
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Affiliation(s)
- J Metelska
- Department of Pharmacoeconomics and Social Pharmacy, University of Medical Sciences in Poznan, Dabrowskiego 79, PL 60-529 Poznan, Poland.
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Abstract
This section, multilevel policies, reviews the impact that has been and can be made by health policy changes at multiple levels, strategies and resources for increasing adherence to population prevention recommendations, and how changes at the microlevel and macrolevel of the environment can provide opportunities and rewards for healthy behaviors and disincentives for unhealthy behaviors. Policies that support primary prevention of cardiovascular disease require the participation of numerous stakeholders at multiple levels, such as governmental and regulatory agencies. Such policy changes support a healthy lifestyle, as in designated smoke-free areas; laws that mandate that food purveyors reduce sodium and fat content or, eliminate trans-fats; and availability of safe parks and bike and walking trails; and also provide a supportive environment that in turn reinforces adherence to primary prevention. Health-related policies have a major impact at the societal level in both developed and developing countries; thus, it is important to understand the role that policy plays in promoting a healthier lifestyle and the prevention of cardiovascular disease. This section discusses how health policies can impact primary prevention and adherence to healthful recommendations, with examples focused on physical activity and diet.
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de Tuero GC, Barcelò MA, Saez M. Gender, socio-economic variables and target organ damage in new-diagnosed hypertensive patients. Blood Press 2010; 18:213-22. [PMID: 19591005 DOI: 10.1080/08037050903145923] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The aim of the study as to ascertain whether gender and socio-economic variables can explain differences in the degree of severity of hypertension (HT) at the time of diagnosis. Patients were recently diagnosed and never-treated hypertensives, seen in primary care sites and aged 15-75. This study also included a cohort of normotensive patients. All individuals were invited to respond a questionnaire to collect socio-demographic and socio-economic data. Target organ damage (TOD) is considered a marker of severity. Three hundred and eighty-eight individuals responded to the questionnaire, 277 hypertensive, 111 normotensive. In an ordered probit model, the odds ratio of presenting with more than one TOD were: Aged >67 (OR=1.22; 1.06-1.38), being a smoker (OR=1.21; 1.02-1.40) or ex-smoker (OR=2.89; 1.27-4.51), primary school education (OR=2.17; 1.47-2.87), being male (OR=0.75; 0.59-0.90), being an agricultural worker (OR=0.03; 0.00-0.05) or a salaried professional (OR=0.96; 0.94-0.99). The results show differences in the severity of the HT in the initial assessment of the patient according to gender or other socio-economic variables. It is particularly important at the time of carrying out the diagnosis and the HT assessment.
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López Suárez A, Elvira González J, Beltrán Robles M, Alwakil M, Manuel Saucedo J, Bascuñana Quirell A, Barón Ramos MA, Fernández Palacín F. Prevalencia de obesidad, diabetes, hipertensión, hipercolesterolemia y síndrome metabólico en adultos mayores de 50 años de Sanlúcar de Barrameda. Rev Esp Cardiol 2008. [DOI: 10.1157/13127846] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Abstract
OBJECTIVE Self-perceived emotional vitality, intact mood, physical activity, and social engagement are recognized as important indicators for lowered rates of morbidity and increased longevity in late-life, but little is known about their underlying neural substrates. This study examined relationships between self-reported levels of general functioning and the combined volume of three integrated prefrontal structures associated with self-perception and emotion. DESIGN Cross-sectional. SETTING UCLA Semel Institute for Neuroscience, Los Angeles. PARTICIPANTS Depressed (N = 43) and comparison (N = 41) elderly subjects. MEASUREMENTS Magnetic resonance images of orbitofrontal, gyrus rectus, and anterior cingulate gray and white matter volumes were corrected for intracranial volume and combined across structures to form white matter and gray matter scales. Subjects completed the RAND Short-Form 36 Questionnaire, a self-report evaluation of daily functioning. Subscales used for analysis were physical function, energy, and general health, which were not correlated with depression. RESULTS White matter volumes were associated with self-perceptions of Energy for healthy as well as depressed individuals, and gray matter volume was associated with General Health. This latter association was strongest among patients with late-onset of depression, i.e., onset > age 50, although it appeared in all diagnostic groups. CONCLUSIONS Although mild to moderate atrophy is expected in late-life, prefrontal atrophy may represent changes to neuroanatomic substrates that qualitatively modulate self-perceptions of energy and general health for both depressed and nondepressed persons.
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Lee DY, Rhee EJ, Choi ES, Kim JH, Won JC, Park CY, Lee WY, Oh KW, Park SW, Kim SW. Comparison of the Predictability of Cardiovascular Disease Risk According to Different Metabolic Syndrome Criteria of American Heart Association/National Heart, Lung, and Blood Institute and International Diabetes Federation in Korean Men. KOREAN DIABETES JOURNAL 2008. [DOI: 10.4093/kdj.2008.32.4.317] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Do Young Lee
- Department of Endocrinology and Metabolism, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Korea
| | - Eun Jung Rhee
- Department of Endocrinology and Metabolism, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Korea
| | - Eun Suk Choi
- Department of Endocrinology and Metabolism, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Korea
| | - Ji Hoon Kim
- Department of Endocrinology and Metabolism, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Korea
| | - Jong Chul Won
- Department of Endocrinology and Metabolism, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Korea
| | - Cheol Young Park
- Department of Endocrinology and Metabolism, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Korea
| | - Won Young Lee
- Department of Endocrinology and Metabolism, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Korea
| | - Ki Won Oh
- Department of Endocrinology and Metabolism, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Korea
| | - Sung Woo Park
- Department of Endocrinology and Metabolism, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Korea
| | - Sun Woo Kim
- Department of Endocrinology and Metabolism, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Korea
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Jensen JD, Smed S. Cost-effective design of economic instruments in nutrition policy. Int J Behav Nutr Phys Act 2007; 4:10. [PMID: 17408494 PMCID: PMC1855063 DOI: 10.1186/1479-5868-4-10] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2006] [Accepted: 04/04/2007] [Indexed: 11/14/2022] Open
Abstract
This paper addresses the potential for using economic regulation, e.g. taxes or subsidies, as instruments to combat the increasing problems of inappropriate diets, leading to health problems such as obesity, diabetes 2, cardiovascular diseases etc. in most countries. Such policy measures may be considered as alternatives or supplements to other regulation instruments, including information campaigns, bans or enhancement of technological solutions to the problems of obesity or related diseases. 7 different food tax and subsidy instruments or combinations of instruments are analysed quantitatively. The analyses demonstrate that the average cost-effectiveness with regard to changing the intake of selected nutritional variables can be improved by 10-30 per cent if taxes/subsidies are targeted against these nutrients, compared with targeting selected food categories. Finally, the paper raises a range of issues, which need to be investigated further, before firm conclusions about the suitability of economic instruments in nutrition policy can be drawn.
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Affiliation(s)
- Jørgen D Jensen
- Institute of Food and Resource Economics, Faculty of Life Sciences, University of Copenhagen, Rolighedsvej 25, DK-1958 Frederiksberg C, Denmark
| | - Sinne Smed
- Danish Institute of Governmental Research (AKF), Nyropsgade 37, DK-1602 København V, Denmark
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Marotta T, Viola S, Ferrara F, Ferrara LA. Improvement of cardiovascular risk profile in an elderly population of low social level: the ICON (Improving Cardiovascular risk profile in Older Neapolitans) study. J Hum Hypertens 2006; 21:76-85. [PMID: 17096010 DOI: 10.1038/sj.jhh.1002098] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Older age and low socio-economic conditions are associated with poor control of cardiovascular risk factors (RFs). We assessed the prevalence and awareness of cardiovascular RFs in 503 elderly outpatients of low social status attending two public Internal Medicine clinics in Naples, and studied the interaction of education and employment level with risk profile. The therapeutic intervention was oriented to improve patients' motivation through a positive patient-physician relationship, in keeping with the current guidelines for hypertension. The effect of treatment was evaluated by comparing retrospectively the level of cardiovascular RFs at baseline and at the last follow-up examination performed within 31 October 2005. Only 33.3% of patients (age=68+/-6 years) had attended primary school. Overall (current or previous) employment level was also low. Obesity, hypertension and dyslipidaemia were present in most patients, diabetes in 17.3% of them. In all 8.0% of hypertensives, 16.1% of diabetics and 24.7% of dyslipidaemiacs were unaware of their diseases. Cardiovascular risk profile was worse at lower educational and employment levels. Odds ratios for the metabolic syndrome were 0.28 (95% confidence interval (CI)=0.15-0.52) and 0.35 (0.20-0.62) in the most qualified of three education and employment groups, respectively, compared to the lowest ones. The level of all cardiovascular RFs was effectively reduced during treatment. Control rate of most RFs improved significantly (for hypertension, from 12.8 to 36.5%, P<0.001). These patients had a high prevalence of cardiovascular RFs, which correlated with their educational and work activity levels. Awareness of their health status was unsatisfactory. Treatment, specifically addressing patient-physician relationship, favourably affected cardiovascular risk profile.
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Affiliation(s)
- T Marotta
- 1Azienda Sanitaria Locale Napoli 1, Unità Operativa Assistenza Sanitaria di Base, Naples, Italy
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Braaten T, Weiderpass E, Kumle M, Lund E. Explaining the Socioeconomic Variation in Cancer Risk in the Norwegian Women and Cancer Study. Cancer Epidemiol Biomarkers Prev 2005; 14:2591-7. [PMID: 16284383 DOI: 10.1158/1055-9965.epi-05-0345] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Associations between level of education and cancer risk is well supported by scientific evidence, but previous studies could only partly adjust for relevant confounding factors. In this article, we examined how risk of cancer varies with level of education and identified factors that explain this variation using data from a prospective cohort study, including 93,638 Norwegian women who responded to an extensive questionnaire in 1991/1992 or 1996/1997. A total of 3,259 incident primary invasive cancer cases were diagnosed during follow-up, which ended in December 2001. We used Cox proportional hazards model to calculate relative risks (RR) with 95% confidence intervals (95% CI). Besides a similar overall risk of female cancers by level of education, we observed differing risks between educational groups for cancers of the lung, breast, cervix, kidney, and skin melanoma. Women with >16 years of education had an increased risk of breast cancer (RR, 1.46; 95% CI, 1.19-1.79) and a decreased risk of lung cancer (RR, 0.30; 95% CI, 0.13-0.70) and cervical cancer (RR, 0.38; 95% CI, 0.17-0.85) compared with the lowest educated women (7-9 years). The middle educated (13-16 years) had the lowest risk of kidney cancer (RR, 0.24; 95% CI, 0.08-0.71), whereas the risk of skin melanoma was highest among women with 10 to 12 years of education (RR, 1.53; 95% CI, 1.05-2.24) compared with the lowest educated women. After multivariate adjustment for potential confounders related to level of education, the variation in cancer risk according to educational levels declined into nonsignificance for all these sites.
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Affiliation(s)
- Tonje Braaten
- Institute of Community Medicine, University of Tromsø, N-9037 Tromsø, Norway.
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Lawlor DA, Batty GD, Morton SMB, Clark H, Macintyre S, Leon DA. Childhood socioeconomic position, educational attainment, and adult cardiovascular risk factors: the Aberdeen children of the 1950s cohort study. Am J Public Health 2005; 95:1245-51. [PMID: 15983276 PMCID: PMC1449347 DOI: 10.2105/ajph.2004.041129] [Citation(s) in RCA: 72] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We assessed the associations of childhood socioeconomic position with cardiovascular disease risk factors (smoking, binge alcohol drinking, and being overweight) and examined the roles of educational attainment and cognitive functioning in these associations. METHODS Data were derived from a cohort study involving 7184 individuals who were born in Aberdeen, Scotland, between 1950 and 1956; had detailed records on perinatal characteristics, childhood anthropometry, and cognitive functioning; and responded to a mailed questionnaire when they were aged 45 to 52 years. RESULTS Strong graded associations existed between social class at birth and smoking, binge drinking, and being overweight. Adjustment for educational attainment completely attenuated these associations. However, after control for adult social class, adult income and other potential confounding or mediating factors, some association remained. CONCLUSIONS Educational attainment is an important mediating factor in the relation between socioeconomic adversity in childhood and smoking, binge drinking, and being overweight in adulthood.
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Affiliation(s)
- Debbie A Lawlor
- Department of Social Medicine, University of Bristol, Canynge Hall, Whiteladies Road, Bristol BS7 8QA, United Kingdom.
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Lee JR, Paultre F, Mosca L. The association between educational level and risk of cardiovascular disease fatality among women with cardiovascular disease. Womens Health Issues 2005; 15:80-8. [PMID: 15767198 DOI: 10.1016/j.whi.2004.11.004] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2003] [Revised: 02/27/2004] [Accepted: 11/12/2004] [Indexed: 11/20/2022]
Abstract
BACKGROUND The inverse relation of socioeconomic status with incident cardiovascular diseases (CVDs) has been well established. However, few data are available describing this relation among ethnically diverse women with prevalent CVD. Using education as a proxy for socioeconomic status, we examined its relation to CVD mortality among women with established CVD. SUBJECTS Data from 2,157 women with CVD at baseline, who participated in nine long-term U.S. cohort studies, were pooled. METHODS Cox regression models adjusted for history of diabetes mellitus, total cholesterol, systolic and diastolic blood pressure, body mass index, smoking, race/ethnicity, and age at baseline were used to estimate hazard ratios for CVD mortality between non-high school graduates and high school graduates. RESULTS During a mean follow-up time of 11.5 years, 615 CVD deaths were observed. There was an age-dependent (p = .003) inverse association between education and CVD mortality among women with CVD. At age 60, the risk of dying due to CVD among non-high school graduates was more than twice greater than that of high school graduates (hazard ratio = 2.34; 95% CI 1.27-4.29). At age 65, the hazard ratio decreased to 1.31 (95% CI 1.00-1.71). By age 70, there was no difference in the hazard of dying between high school graduates and nongraduates (hazard ratio = 1.01; 95% CI .85-1.21). CONCLUSIONS Our results show that among women with CVD, educational level was a significant, and age-dependent, predictor of fatal CVD independent of other traditional risk factors. These women are an important high-risk population to target secondary prevention and educational efforts.
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Affiliation(s)
- JiWon R Lee
- College of Physicians and Surgeons, Columbia University; New York Presbyterian Hospital, New York, New York, USA
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Lee WY, Jung CH, Park JS, Rhee EJ, Kim SW. Effects of smoking, alcohol, exercise, education, and family history on the metabolic syndrome as defined by the ATP III. Diabetes Res Clin Pract 2005; 67:70-7. [PMID: 15620436 DOI: 10.1016/j.diabres.2004.05.006] [Citation(s) in RCA: 124] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2004] [Revised: 04/01/2004] [Accepted: 05/11/2004] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Although several environmental factors are known to have diverse effects on the development of the metabolic syndrome, few studies have examined their relevance to Asians. METHODS We gathered data from 4341 subjects on smoking, alcohol drinking, exercise, family history and education level by a self-administered questionnaire. The components of the metabolic syndrome as defined by the ATP III report were examined. RESULTS The multivariate-adjusted odds ratio of hypertriglyceridemia was 1.4 (95% CI 1.0-1.8) and of low HDL-C was 1.9 (95% CI 1.3-2.6) in subjects who smoked more than 20 pack-years compared to nonsmokers. The relative risk of developing the metabolic syndrome in smokers (more than 20 pack-years) was 1.9 (95% CI 1.1-3.7) compared to nonsmokers. Alcohol consumption had a protective effect against low HDL-C (adjusted OR 0.6-0.2). The relative risk of the metabolic syndrome was 1.7 (95% CI 0.9-2.8) for lack of exercise, 1.5 (95% CI 1.1-2.1) for a positive family history and 2.0 (95% CI 1.2-3.4) in those with no or an elementary school education versus university graduation. CONCLUSION Since subjects with a low education level and a family history had an elevated risk for the metabolic syndrome and thus for developing cardiovascular disease, particular attention should be paid to these subjects.
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Affiliation(s)
- Won-Young Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, # 108 Pyung-Dong, Jongro-Gu, Seoul 110-746, Republic of Korea.
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Ruiz Pérez I, Ramos Rincón JM, Hernández-Aguado I. [Variation in the prevention of cardiovascular risk factors. A population-based study]. GACETA SANITARIA 2003; 17:20-6. [PMID: 12605742 DOI: 10.1016/s0213-9111(03)71687-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Published studies on clinical practice variability have mainly focussed on variability in the rates of hospitalization and surgical procedures. The objective of this study was to evaluate variability in the measurement of cholesterolemia and blood pressure in four professional groups and in the general population. METHODS A cross-sectional survey was performed by mail in the city of Valencia (Spain). Five population groups were selected: physicians, nurses, lawyers, architects and the general population. The sample was obtained by random sampling of each group. RESULTS Of all the questionnaires returned, only those returned by individuals surveyed (1,755) and their partners (1,296) were used (total: 3,050). The frequency of preventive cholesterolemia measurement was greater among nurses (55.7%) and physicians (54.1%) than among architects (38.9%), lawyers (38.2%) and the general population (35.1%). The frequency of preventive blood pressure measurement was also greater among physicians (47.7%) and nurses (42.2%) followed by architects (39.4%) and lawyers (38.8%) and was lower among the general population (32.2%). After adjusting by sex, age group, marital status, level of education, and employment, only lawyers (RR = 0.79; 95% CI, 0.6-0.9) and architects (RR = 0.77; 95% CI, 0.68-0.88) showed a significantly lower probability of determining cholesterol levels than physicians (basal category) and nurses (RR = 1.05; 95% CI, 0.93-1.18). The general population showed the lowest probability of measuring blood pressure (RR = 0.8; 95% CI, 0.65-0.97), although the differences were statistically significant only when compared with physicians. CONCLUSIONS Preventive practices should be increased among groups in which they are less frequently performed until they are performed with the same frequency as among physicians and nurses. Efforts should be directed to increasing cardiovascular prevention programs in health centers.
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Affiliation(s)
- I Ruiz Pérez
- Escuela Andaluza de Salud Pública. Granada. España.
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Vescio MF, Smith GD, Giampaoli S. Socio-economic position and cardiovascular risk factors in an Italian rural population. Eur J Epidemiol 2002; 17:449-59. [PMID: 11855579 DOI: 10.1023/a:1013752206574] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Cardiovascular disease (CVD) is the leading industrial world cause of mortality. Lower social class groups have higher incidence of CVD and also display less favourable risk factor profiles. To investigate the association and gradient between major cardiovascular risk factors (smoking habit, serum lipid profile, blood pressure, relative body weight) and socio-economic position (proxy measures selected: education and occupation) data on 2592 men and 2866 women were analysed. The effect of potential confounding factors and effect modifiers was estimated. Linear and logistic regression modelling was performed for continuous and dichotomous outcomes respectively. The lower the grade of employment or the level of education, the higher was the prevalence of obesity in the study population. The association was stronger in women than in men. Higher education was associated with a lower prevalence of smoking among men and a higher prevalence among women. Systolic blood pressure was negatively related to socio-economic position in both men and women in the age-adjusted models. Attention should be concentrated on socio-economic differences in obesity and blood pressure in this population.
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Affiliation(s)
- M F Vescio
- Laboratorio di Epidemiologia e Biostatistica, Istituto Superiore di Sanita', Roma, Italy
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Serrano Martínez M, Arriola Aperribay E, Fernández Carballal C, Hernáez Rodríguez R, Prado Santamaría M, Martínez-Losa E. [Differences between young and elderly patients in a protocol for the diagnosis and follow-up of arterial hypertension] . Aten Primaria 2000; 26:86-90. [PMID: 10927824 PMCID: PMC7679594 DOI: 10.1016/s0212-6567(00)78616-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
OBJECTIVE To determine possible differences between the control of hypertension in elderly patients and in young patients. DESIGN Retrospective observation study of the differences between initial and final systolic and diastolic blood pressure, of their relationship to inclusion in medical treatment, and of the control obtained with different kinds of, and changes in, treatment, of drug association, periodic check-ups, vascular disease and risk factors. SETTING The urban Azpilagaña Health District in Pamplona. PATIENTS 389 hypertense patients were studied retrospectively: 196 of 70 or over and 193 between 45 and 60. MAIN RESULTS More older patients were treated medically (91.8% vs 84.5%, p = 0.024), and received combined two-drug treatment (30.1% vs 19.7%, p < 0.001), although the young people received more than two hypertension drugs more often (11.4% vs 2.5%, p < 0.001). Final control (< 140/90) was achieved more often among young people (39.9% vs 26.5%, p = 0.005). In the older patients group initial higher diastolic pressure was related to final pressure control. More older patients had periodic check-ups at the health centre (73.3% vs 63.7%, p < 0.001), but this practice only improved relative control (< or = 140/90) in young people (p = 0.001). Older patients used more diuretics (p < 0.001) and less beta-blockers (p < 0.001), with no differences for other hypertension drugs. CONCLUSIONS There are differences based on age in treatment and control of hypertension patients. Older patients with diastolic hypertension are controlled more easily. Altogether and in both groups analysed, the percentage of people with normal pressure after treatment was higher than in other studies.
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Affiliation(s)
- M Serrano Martínez
- Centro de Salud de Azpilagaña, Facultad de Medicina, Universidad de Navarra, Pamplona.
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