Income, education, work stress may predict CVD
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Low education was able to predict incident CVD among patients who were initially healthy and CVD mortality among those with prevalent cardiometabolic disease, according to a study published in the European Heart Journal.
Job strain and income were contributors to a higher risk for CVD mortality for men with low education and cardiometabolic disease, according to the study.
“Educational attainment is usually determined relatively early in the life, and it may be difficult to improve the level of education in middle-aged adults,” Elisabeth Framke, MSc, PhD, researcher at the National Research Centre for the Working Environment in Copenhagen, Denmark, told Healio. “We have seen in our analyses that the association between educational level and risk of developing and dying from cardiovascular disease was somewhat attenuated when we took income and job strain into account, suggesting that low income and high job strain may play a role in how educational level affects risk of cardiovascular disease. If this is correct, then improvement of disposable income and reduction of job strain may help to reduce the increased risk of cardiovascular morbidity and mortality among individuals with low educational attainment.”
Danish patients
Researchers analyzed data from 1,680,214 Danish patients aged 30 to 59 years who were employed in 2000. Of the patients in this study, 1,638,270 were free from cardiometabolic disease (51% men; mean age of men, 44 years; mean age of women, 44 years) and 41,944 were diagnosed with the disease (68% men; mean age of men, 49 years; mean age of women, 48 years).
Information on education, income and job strain was assessed at baseline and annually thereafter, in addition to prevalent cardiometabolic disease, incident CVD and mortality. Data on outcomes were collected from 2001 to 2014.
During 10,957,399 person-years of follow-up for men, there were 51,585 cases of incident CVD, which equates to 47 per 10,000 person-years. Women had 10,776,516 person-years of follow-up, during which there were 24,075 cases of incident CVD, equating to 22 per 10,000 person-years.
The HR for CVD risk in men with low education was 1.62 (95% CI, 1.58-1.66). After adjusting for job strain and income, the HR was 1.46 (95% CI, 1.42-1.5), leading to a 25% reduction. The HR for women with low education was 1.66 (95% CI, 1.61-1.72), which reduced to 1.53 after adjustment (95% CI, 1.47-1.58), leading to a 21% reduction.
CVD mortality rates
CVD mortality occurred in 1,736 men (48 per 10,000 person-years) and 341 women (19 per 10,000 person-years). The level of education was able to predict CVD mortality for men and women. After adjusting for job strain and income, the HR for CVD mortality decreased by 54% for men and 33% for women.
For more information:
Elisabeth Framke, MSc, PhD, can be reached at elf@nfa.dk.
Disclosures: The authors report no relevant financial disclosures.
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