Level of education and risk for self-reported cardiovascular disease - The Tromsø Study, 1994-2016

Introduction & Background: Cardiovascular disease (CVD) is one of the most prevalent non-communicable diseases (NCDs) globally. In 2018, CVD claimed 12,091 lives in Norway, and between 2005-2016 approximately 21% of the Norwegian population were administered therapeutic drugs to treat or prevent CVD. The World Health Organization has created a target to reduce NCD deaths by 33% between 2010-2030 for those under age 70. Although Norway is well on its way to achieving this goal due to advances in medical technologies and reductions in certain risk factors, it is expected that in the coming decades CVD prevalence will increase as the population ages. In Norway, education is tuition free, and healthcare is covered by a single-payer system. Yet, health inequalities are still large within the country, especially between populations with different educational levels. Previous research has shown education to be a risk factor for CVD. Therefore, it seems prudent that we conduct more research on the relationship between educational attainment and CVD in Norway. The Norwegian government could then use this research to implement programs to help lessen the burden of CVD on the healthcare system as well as on individuals in the future. Objective: To investigate the association between educational attainment and self-reported CVD (heart attack, stroke, and angina) in Tromsø, Norway. Materials & Methods: This prospective cohort study included 12,400 adults from Tromsø, Norway enrolled in the Tromsø 4 and 7 studies between 1994-2016. Exposure information was collected during Tromsø 4 via onsite measurements and questionnaires. Outcome information was collected during Tromsø 7 using questionnaires. Logistic regression was used to obtain odds ratios (OR) and 95% confidence intervals (CI). Results: The OR for CVD was 0.84 (95% CI: 0.80-0.88) and 0.96 (95% CI: 0.92-1.01) for the crude and multivariate models, respectively. In the crude and multivariate models for heart attack, the OR was 0.82 (95% CI: 0.77-0.87) and 0.97 (95% CI: 0.91-1.05), respectively. For stroke, the OR was 0.89 (95% CI: 0.83-0.96) for the crude model and 1.01 (95% CI: 0.93-1.09) for the multivariate model. For angina, the OR was 0.90 (95% CI: 0.82-0.98) and 1.04 (95% CI: 0.95-1.14) for the crude and multivariate models, respectively. Conclusion: There was a significant risk reduction for self-reported CVD with increased educational attainment in the crude model. The association was present in both genders with a stronger risk reduction in women. In the age stratified models, only those aged 30-49 at baseline had significant reductions in CVD risk. No association was present in the multivariate models, likely due to covariates acting as mediators. However, educational attainment was a strong predictor for CVD

Education Level and Self-Reported Cardiovascular Disease in Norway—The Tromsø Study, 1994–2016

Background: Cardiovascular disease (CVD) is a leading source of morbidity and mortality, and research has shown education level to be a risk factor for the disease. The aim of this study was to investigate the association between education level and self-reported CVD in Tromsø, Norway. Methods: This prospective cohort study included 12,400 participants enrolled in the fourth and seventh surveys of the Tromsø Study (Tromsø4 and Tromsø7) in 1994–1995 and 2015–2016, respectively. Logistic regression was used to obtain odds ratios (ORs) and 95% confidence intervals (CIs). Results: For every 1-level increase in education, the age-adjusted risk of self-reported CVD decreased by 9% (OR = 0.91, 95% CI: 0.87–0.96), but after adjustment for covariates, the association was weaker (OR = 0.96, 95% CI: 0.92–1.01). The association was stronger for women (OR = 0.86, 95% CI: 0.79–0.94) than men (OR = 0.91, 95% CI: 0.86–0.97) in age-adjusted models. After adjustment for covariates, the associations for women and men were similarly weak (women: OR = 0.95, 95% CI: 0.87–1.04; men: OR = 0.97, 95% CI: 0.91–1.03). In age-adjusted-models, higher education level was associated with a lower risk of self-reported heart attack (OR = 0.90, 95% CI: 0.84–0.96), but not stroke (OR = 0.97, 95% CI: 0.90–1.05) or angina (OR = 0.98, 95% CI: 0.90–1.07). There were no clear associations observed in the multivariable models for CVD components (heart attack: OR = 0.97, 95% CI: 0.91–1.05; stroke: OR = 1.01, 95% CI: 0.93–1.09; angina: OR = 1.04, 95% CI: 0.95–1.14). Conclusions: Norwegian adults with a higher education level were at lower risk of self-reported CVD. The association was present in both genders, with a lower risk observed in women than men. After accounting for lifestyle factors, there was no clear association between education level and self-reported CVD, likely due to covariates acting as mediators