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Cardiovascular and diabetes
O2-4.3 Education and coronary heart disease risk: potential contributions of health literacy, time preference and self-efficacy
  1. E Loucks1,
  2. S Gilman2,
  3. I Kawachi2,
  4. L Kubzansky2,
  5. L Martin3,
  6. M Rogers1,
  7. A Wilhelm1,
  8. S Buka1,2
  1. 1Brown University, Providence, Rhode Island, USA
  2. 2Harvard University, Boston, Massachusetts, USA
  3. 3Rand Corporation, Washington, DC, USA


Introduction Education is inversely associated with risk for coronary heart disease (CHD), however the contributions of potential explanatory mechanisms including health literacy, time preference and self-efficacy are poorly understood. Objectives were to evaluate whether infrequently measured covariates (health literacy, time preference, self-efficacy) are important explanatory mechanisms for associations between education and CHD risk.

Methods The study sample included 416 participants, aged 38–47 years (59.5% female), of the New England Family Study birth cohort. Ten-year CHD risk was calculated using the validated Framingham risk algorithm incorporating diabetes, smoking, blood pressure, total cholesterol, HDL cholesterol, age and sex. Multivariable regression analyses were performed.

Results Regression analyses adjusting for age, sex and race/ethnicity demonstrated that > college (ie, additional schooling past 4-year college degree) was associated with b=−68.9% (p<0.001) lower 10-year CHD risk compared with < high school. Further addition of early life potential confounders (childhood socioeconomic position, childhood intelligence and childhood chronic illness) resulted in b=−64.9% lower 10-year CHD risk for those with > college vs < high school. Finally, addition of health literacy, time preference and self-efficacy to models resulted in b=−74.5% (p<0.0001) lower CHD risk for > college vs < high school. Dose-response associations between education and CHD risk were found for < high school, high school, some college, college degree and > college.

Conclusion This study found that education was inversely associated with CHD risk after accounting for traditional and early-life confounders; further addition of novel potential explanatory mechanisms including time preference, health literacy and self-efficacy had minimal impact on effect size.

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