RT Journal Article
SR Electronic
T1 Educational disparities in ischaemic heart disease among 0.5 million Chinese adults: a cohort study
JF Journal of Epidemiology and Community Health
JO J Epidemiol Community Health
FD BMJ Publishing Group Ltd
SP jech-2020-216314
DO 10.1136/jech-2020-216314
A1 Lu Chen
A1 Yunlong Tan
A1 Canqing Yu
A1 Yu Guo
A1 Pei Pei
A1 Ling Yang
A1 Yiping Chen
A1 Huaidong Du
A1 Xiaohuan Wang
A1 Junshi Chen
A1 Zhengming Chen
A1 Jun Lv
A1 Liming Li
A1 ,
YR 2021
UL http://jech.bmj.com/content/early/2021/03/28/jech-2020-216314.abstract
AB Background The relationship between educational attainment and ischaemic heart disease (IHD) is limited in evidence in middle-income countries like China. Exploring lifestyle-related mediators, which might be not universal between socioeconomic status and health outcomes in diverse regions, can contribute to interventions targeted at the Chinese to narrow the educational gap in IHD.Methods Based on the China Kadoorie Biobank of 489 594 participants aged 30–79 years who did not have heart disease or stroke at baseline, this study examined the association of educational attainment with IHD. Total IHD cases were further divided into acute myocardial infarction (AMI) cases and non-AMI cases. The Cox proportional hazard model was performed to estimate the HRs and 95% CIs for mortality and incidence of IHD. Logistic regression was used to estimate the ORs and 95% CIs for case fatality.Results During the median follow-up period of 11.1 years, this study documented 45 946 (6668) incident IHD (AMI) cases and 5948 (3689) deaths altogether. Lower educational attainment was associated with increased risk of incident AMI as well as death and fatality of total IHD including its subtypes (ptrend <0.001). Although the risk of incident non-AMI was greater for participants with higher levels of education in the whole population (ptrend <0.001), an inverse association of education with its incidence was found in participants from <50 years age group and rural areas. Smoking and dietary habits were the two most potent mediating factors in the associations of education with mortality and AMI incidence; whereas, physical activity was the major mediating factor for non-AMI incidence in the whole population.Discussion Interventions targeting unhealthy lifestyles are ideal ways to narrow the educational gap in IHD while solving ‘upstream’ causes of health behaviours might be the most fundamental ones.Data are available on reasonable request.