Does educational attainment modify the causal relationship between adiposity and cardiovascular disease? A Mendelian randomization study
A greater risk of cardiovascular disease is associated with low educational attainment and high adiposity. Despite the correlation between low educational attainment and high adiposity, whether educational attainment modifies the risk of CVD caused by high adiposity remains poorly understood. We inv...
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| Format: | Article |
| Language: | English |
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Elsevier
2023-03-01
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| Series: | SSM: Population Health |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2352827323000162 |
| _version_ | 1811164929918500864 |
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| author | Robert C. Schell William H. Dow Lia C.H. Fernald Patrick T. Bradshaw David H. Rehkopf |
| author_facet | Robert C. Schell William H. Dow Lia C.H. Fernald Patrick T. Bradshaw David H. Rehkopf |
| author_sort | Robert C. Schell |
| collection | DOAJ |
| description | A greater risk of cardiovascular disease is associated with low educational attainment and high adiposity. Despite the correlation between low educational attainment and high adiposity, whether educational attainment modifies the risk of CVD caused by high adiposity remains poorly understood. We investigated the effect of adiposity (body mass index [BMI] and waist-to-hip ratio adjusted for BMI [WHRadjBMI]) on incident CVD among individuals with varying education levels, using associational and one-sample Mendelian randomization (MR) survival analyses. Data were collected from 2006 to 2021, and sample sizes were 254,281 (27,511 CVD cases) for BMI and 253,968 (27,458 CVD cases) for WHRadjBMI. In the associational model, a standard deviation (SD) higher BMI was associated with 19.81 (95% CI: 18.55–21.06) additional cases of incident CVD per 10,000 person-years for individuals with a secondary education, versus 32.96 (95% CI: 28.75–37.17) for those without. When university degree served as the education variable, education group differences attenuated, with 18.26 (95% CI: 16.37–20.15) cases from a one SD higher BMI for those with a university degree versus 23.18 [95% CI: 21.56–24.72] for those without. For the MR model, an SD higher BMI resulted in 11.75 (95% CI: −0.84-24.38) and 29.79 (95% CI: 17.20–42.44) additional cases of incident CVD per 10,000 person-years for individuals with versus without a university degree. WHRadjBMI exhibited no effect differences by education. While the associational model showed evidence of educational attainment modifying the relationship between adiposity and incident CVD, it does not modify the association between adiposity and incident CVD in the MR models. This suggests either less education does not cause greater risk of incident CVD from high adiposity, or MR models cannot detect the effect difference. The associational point estimates exist within the MR models’ confidence intervals in all BMI analyses, so we cannot rule out the effect sizes in the associational models. |
| first_indexed | 2024-04-10T15:30:22Z |
| format | Article |
| id | doaj.art-8dc71805dedf4a7095eadea5e5f4069d |
| institution | Directory Open Access Journal |
| issn | 2352-8273 |
| language | English |
| last_indexed | 2024-04-10T15:30:22Z |
| publishDate | 2023-03-01 |
| publisher | Elsevier |
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| series | SSM: Population Health |
| spelling | doaj.art-8dc71805dedf4a7095eadea5e5f4069d2023-02-14T04:07:05ZengElsevierSSM: Population Health2352-82732023-03-0121101351Does educational attainment modify the causal relationship between adiposity and cardiovascular disease? A Mendelian randomization studyRobert C. Schell0William H. Dow1Lia C.H. Fernald2Patrick T. Bradshaw3David H. Rehkopf4Division of Health Policy and Management, School of Public Health, University of California, Berkeley, USA; Corresponding author. 2121 Berkeley Way, Berkeley, CA, 94704, USA.Division of Health Policy and Management, School of Public Health, University of California, Berkeley, USA; Department of Demography, University of California, Berkeley, CA, USADivision of Community Health Sciences, School of Public Health, University of California, Berkeley, CA, USADivision of Epidemiology & Biostatistics, University of California, School of Public Health, Berkeley, Berkeley, CA, USADepartment of Epidemiology and Population Health, Stanford University, Palo Alto, CA, USAA greater risk of cardiovascular disease is associated with low educational attainment and high adiposity. Despite the correlation between low educational attainment and high adiposity, whether educational attainment modifies the risk of CVD caused by high adiposity remains poorly understood. We investigated the effect of adiposity (body mass index [BMI] and waist-to-hip ratio adjusted for BMI [WHRadjBMI]) on incident CVD among individuals with varying education levels, using associational and one-sample Mendelian randomization (MR) survival analyses. Data were collected from 2006 to 2021, and sample sizes were 254,281 (27,511 CVD cases) for BMI and 253,968 (27,458 CVD cases) for WHRadjBMI. In the associational model, a standard deviation (SD) higher BMI was associated with 19.81 (95% CI: 18.55–21.06) additional cases of incident CVD per 10,000 person-years for individuals with a secondary education, versus 32.96 (95% CI: 28.75–37.17) for those without. When university degree served as the education variable, education group differences attenuated, with 18.26 (95% CI: 16.37–20.15) cases from a one SD higher BMI for those with a university degree versus 23.18 [95% CI: 21.56–24.72] for those without. For the MR model, an SD higher BMI resulted in 11.75 (95% CI: −0.84-24.38) and 29.79 (95% CI: 17.20–42.44) additional cases of incident CVD per 10,000 person-years for individuals with versus without a university degree. WHRadjBMI exhibited no effect differences by education. While the associational model showed evidence of educational attainment modifying the relationship between adiposity and incident CVD, it does not modify the association between adiposity and incident CVD in the MR models. This suggests either less education does not cause greater risk of incident CVD from high adiposity, or MR models cannot detect the effect difference. The associational point estimates exist within the MR models’ confidence intervals in all BMI analyses, so we cannot rule out the effect sizes in the associational models.http://www.sciencedirect.com/science/article/pii/S2352827323000162Body mass indexMendelian randomizationAdiposityEducational attainmentUK BiobankCardiovascular disease |
| spellingShingle | Robert C. Schell William H. Dow Lia C.H. Fernald Patrick T. Bradshaw David H. Rehkopf Does educational attainment modify the causal relationship between adiposity and cardiovascular disease? A Mendelian randomization study SSM: Population Health Body mass index Mendelian randomization Adiposity Educational attainment UK Biobank Cardiovascular disease |
| title | Does educational attainment modify the causal relationship between adiposity and cardiovascular disease? A Mendelian randomization study |
| title_full | Does educational attainment modify the causal relationship between adiposity and cardiovascular disease? A Mendelian randomization study |
| title_fullStr | Does educational attainment modify the causal relationship between adiposity and cardiovascular disease? A Mendelian randomization study |
| title_full_unstemmed | Does educational attainment modify the causal relationship between adiposity and cardiovascular disease? A Mendelian randomization study |
| title_short | Does educational attainment modify the causal relationship between adiposity and cardiovascular disease? A Mendelian randomization study |
| title_sort | does educational attainment modify the causal relationship between adiposity and cardiovascular disease a mendelian randomization study |
| topic | Body mass index Mendelian randomization Adiposity Educational attainment UK Biobank Cardiovascular disease |
| url | http://www.sciencedirect.com/science/article/pii/S2352827323000162 |
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