Educational inequalities in ischaemic heart disease mortality in 44,000 Norwegian women and men: The influence of psychosocial and behavioural factors. The HUNT Study

Abstract

Aims: To investigate the influence of psychosocial and behavioural factors on educational inequalities in ischaemic heart disease (IHD) mortality. Methods: A population-based cohort study of 44,128 women and men free of IHD aged 30 years and older at baseline in 1995—97. Results: After adjustment for age and long-standing illness, both women (HR 3.22, 95% CI 1.31—7.90) and men (HR 1.57, 95% CI 1.03—2.40) who completed only primary education level (primary and lower secondary school) were at increased risk for IHD mortality compared to those who completed the tertiary education level (first and second stage of tertiary education). Behavioural factors explained 25% of the relative difference between primary and tertiary education level in IHD mortality among women and 53 % in men. Psychosocial factors had small influence on the relative difference in IHD mortality Conclusions: Findings from this study indicate that differences in behavioural factors contribute considerably more to inequalities in IHD mortality in educational levels than do psychosocial factors, and this effect seems to be stronger in men than women.

Keywords

Socioeconomic position education psychosocial factors health behaviours ischaemic heart disease mortality

Get full access to this article

View all access options for this article.

References

Kaplan GA , Keil JE Socioeconomic factors and cardiovascular disease: a review of the literature . Circulation 1993;88(4):1973-98.

Koskinen S. , Martelin T.

Why are socioeconomic mortality differences smaller among women than among men?

Soc Sci Med 1994;38(10):1385-96.

Elstad J. , Hofoss D. , Dahl E. Contribution of specific causes of death to educational differences in mortality . Nor J Epidemiol 2007;17(1):37-42.

Avendano M. , Kunst AE , Huisman M. , Lenthe FV , Bopp M. , Regidor E. , et al. Socioeconomic status and ischaemic heart disease mortality in 10 western European populations during the 1990s . Heart 2006;92(4):461-7.

Rognerud MA , Zahl P. -H. Social inequalities in mortality: changes in the relative importance of income, education and household size over a 27-year period. Eur J Public Health 2006;16(1):62-8.

Strand BH , Tverdal A. Can cardiovascular risk factors and lifestyle explain the educational inequalities in mortality from ischaemic heart disease and from other heart diseases? 26 year follow up of 50 000 Norwegian men and women. J Epidemiol Community Health 2004;58(8):705-9.

Marmot M. , Shipley M. , Hemingway H. , Head J. , Brunner E. Biological and behavioural explanations of social inequalities in coronary heart disease: the Whitehall II study. Diabetologia 2008;51(11):1980-8.

Laaksonen M. , Talala K. , Martelin T. , Rahkonen O. , Roos E. , Helakorpi S. , et al. Health behaviours as explanations for educational level differences in cardiovascular and all-cause mortality: a follow-up of 60 000 men and women over 23 years . Eur J Public Health 2008;18(1):38-43.

Rozanski A. , Blumenthal JA , Davidson KW , Saab PG , Kubzansky L. The epidemiology, pathophysiology, and management of psychosocial risk factors in cardiac practice: the emerging field of behavioral cardiology. J Am Coll Cardiol 2005;45(5):637-51.

10.

Graham I. , Atar D. , Borch-Johnsen K. , Boysen G. , Burell G. , Cifkova R. , et al. European guidelines on cardiovascular disease prevention in clinical practice: executive summary: Fourth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (Constituted by representatives of nine societies and by invited experts) . Eur Heart J 2007;28(19):2375-414.

11.

Holmen J. , Midthjell K. , Øystein Krüger Ø. , Langhammer A. , Holmen TL , Bratberg G. , et al. The Nord-Trøndelag Health Study 1995-97 (HUNT 2): Objectives, contents, methods and participation. Nor J Epidemiol 2003;13(1):19-32.

12.

Organisation for Economic Co-Operation and Development. OECD Handbook for Internationally Comparative Education Statistics: Concepts, Standards, Definitions and Classifications . Paris, France: OECD; 2004.

13.

Malyutina S. , Bobak M. , Simonova G. , Gafarov V. , Nikitin Y. , Marmot M. Education, marital status, and total and cardiovascular mortality in Novosibirsk, Russia: A prospective cohort study. Ann Epidemiol 2004;14(4):244-9.

14.

Wagner U. [Family status and coronary heart disease in the female]. Z Gesamte Inn Med 1989;44(18):533-5.

15.

Bjelland I. , Dahl AA , Haug TT , Neckelmann D. The validity of the Hospital Anxiety and Depression Scale: An updated literature review . J Psychosom Res 2002;52(2):69-77.

16.

Mykletun A. , Stordal E. , Dahl AA Hospital Anxiety and Depression (HAD) scale: factor structure, item analyses and internal consistency in a large population . Br J Psychiatry 2001 ;179(6):540-4.

17.

Nes RB , Czajkowski N. , Røysamb E. , Reichborn-Kjennerud T. , Tambs K.

Well-being and ill-being: shared environments, shared genes?

J Pos Psychol 2008;3(4):253-65.

18.

Wamala SP , Mittleman MA , Schenck-Gustafsson K. , Orth-Gomér K. Potential Explanations for the Educational Gradient in Coronary Heart Disease: A Population-Based Case-Control Study of Swedish Women. Am J Public Health 1999;89(3):315-21.

19.

Okura Y. , Urban LH , Mahoney DW , Jacobsen SJ , Rodeheffer RJ Agreement between self-report questionnaires and medical record data was substantial for diabetes, hypertension, myocardial infarction and stroke but not for heart failure. J Clin Epidemiol 2004;57(10):1096-103.

20.

Bergmann MM , Jacobs EJ , Hoffmann K. , Boeing H. Agreement of self-reported medical history: comparison of an in-person interview with a self-administered questionnaire . Eur J Epidemiol 2004;19(5):411-16.

21.

Phelan JC , Link BG , Diez-Roux A. , Kawachi I. , Levin B. ‘‘Fundamental causes’’ of social inequalities in mortality: a test of the theory . J Health Soc Behav 2004;45(3):265-85.

22.

Cavelaars Aejm , Kunst AE , Geurts JJM , Crialesi R. , Grotvedt L. , Helmert U. , et al. Educational differences in smoking: international comparison. BMJ 2000;320(7242):1102-7.

23.

Lund KE , Lund M. , Bryhni A. Tobacco consumption among men and women 1927-2007. Tidsskr Nor Legeforen 2009129):1871-4 [in Norwegian, English abstract].

24.

Lund KE , Lund M. Smoking and inequality in Norway 1998-2000. Tidsskr Nor Lægeforen 2005125):560-3 [in Norwegian, English abstract].

25.

Bloomfield KIM , Grittner U. , Kramer S. , Gmel G. Social inequalities in alcohol consumption and alcohol-related problems in the study countries of the EU concerted action ‘‘Gender, culture and alcohol problems: A multinational study’’ . Alcohol and Alcoholism: International Journal of the Medical Council on Alcoholism 2006;41(1):i26-36.

26.

Strand BH , Steiro A. Alcohol consumption in Norway by level of income and education, 1993-2000 . Tidsskr Nor Lægeforen 2003123):2849-53 [in Norwegian, English abstract].

27.

Zajacova A.

Education, gender, and mortality: Does schooling have the same effect on mortality for men and women in the US?

Soc Sci Med 2006 ;63(8):2176-90.

28.

Thurston RC , Kubzansky LD , Kawachi , Berkman LF.

Is the association between socioeconomic position and coronary heart disease stronger in women than in men?

Am J Epidemiol 2005;162(1):57-65.

29.

Skodova Z. , Nagyova I. , van Dijk J. , Sudzinova A. , Vargova H. , Studencan M. , et al. Socioeconomic differences in psychosocial factors contributing to coronary heart disease: a review. J Clin Psychol Med Settings 2008 ;15(3):204-13.