International Journal of Epidemiology 2001;30:1119-1126
© International Epidemiological Association 2001
Social Epidemiology |
Education, lifestyle factors and mortality from cardiovascular disease and cancer. A 25-year follow-up of Swedish 50-year-old men
Department of Public Health and Caring Sciences/Geriatrics, PO Box 609, SE 751 25, Uppsala, Sweden.
Dr Lena Kilander. E-mail: lena.kilander{at}geriatri.uas.lul.se
Abstract
Background There is a well-established inverse relation between education and mortality from cardiovascular disease and cancer. The reasons for this are still in part unclear. We aimed to investigate whether differences in traditional vascular risk factors, adult height, physical activity, and biomarkers of fatty acid and antioxidant intake, could explain this association.
Methods In all, 2301 50-year-old men in Uppsala, Sweden (82% of the background population) were examined with regard to educational level, blood pressure, blood glucose, body mass index, serum lipids, smoking, body height, physical activity, serum beta carotene, alpha tocopherol, selenium, and serum fatty acids in cholesterol esters. Cause-specific mortality was registered 25 years later.
Results Low education was associated with a higher rate of mortality from cardiovascular disease (crude relative risk [RR] = 1.67, 95% CI : 1.17–2.39), and from cancer (crude RR = 1.94, 95% CI : 1.21–3.10), compared to high educational attainment. Men with high education had an overall more beneficial risk factor profile concerning traditional cardiovascular risk factors, physical activity, and biomarkers of dietary intake of antioxidants and fat. After adjustment for all examined risk factors, the inverse gradient between education and cardiovascular mortality disappeared (RR in low education = 1.01. 95% CI : 0.67–1.52). Controlling for smoking, physical activity and dietary biomarkers explained less than half of the excess cancer mortality in the lower educational groups. Smoking (adjusted RR = 1.89, 95% CI : 1.37–2.61), and high proportions of palmitoleic acid in serum cholesterol esters (adjusted RR per 1 SD = 1.39, 95% CI : 1.07–1.82) predicted cancer mortality, independently of all other factors. There were no independent relations between serum antioxidants and mortality.
Conclusions These data indicate that modifiable lifestyle factors mediate the inverse gradient between education and death from cerebro- and cardiovascular disease. Smoking, physical activity and dietary factors explained half of the excess cancer mortality in lower educated groups. Further studies are needed to explore the proposed association between palmitoleic acid, a marker of high intake of animal and dairy fat, and cancer.
Keywords Mortality, education, cardiovascular disease, cancer
Accepted 19 February 2001
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  B. Lindahl, T. K. Nilsson, K. Borch-Johnsen, M. E. Roder, S. Soderberg, L. Widman, O. Johnson, G. Hallmans, and J.-H. Jansson A randomized lifestyle intervention with 5-year follow-up in subjects with impaired glucose tolerance: Pronounced short-term impact but long-term adherence problems Scand J Public Health, June 1, 2009; 37(4): 434 - 442. [Abstract] [PDF]
|
|
|
|
 |
|
 J. Bleys, A. Navas-Acien, M. Laclaustra, R. Pastor-Barriuso, A. Menke, J. Ordovas, S. Stranges, and E. Guallar Serum Selenium and Peripheral Arterial Disease: Results From the National Health and Nutrition Examination Survey, 2003-2004 Am. J. Epidemiol., April 15, 2009; 169(8): 996 - 1003. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. N. Arendt and J. Lauridsen Do risk factors explain more of the social gradient in self-reported health when adjusting for baseline health? Eur J Public Health, April 1, 2008; 18(2): 131 - 137. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. H. Woolf, R. E. Johnson, R. L. Phillips Jr, and M. Philipsen Giving Everyone the Health of the Educated: An Examination of Whether Social Change Would Save More Lives Than Medical Advances Am J Public Health, April 1, 2007; 97(4): 679 - 683. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. E Wright, K. A Lawson, S. J Weinstein, P. Pietinen, P. R Taylor, J. Virtamo, and D. Albanes Higher baseline serum concentrations of vitamin E are associated with lower total and cause-specific mortality in the Alpha-Tocopherol, Beta-Carotene Cancer Prevention Study. Am. J. Clinical Nutrition, November 1, 2006; 84(5): 1200 - 1207. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L. L. Yan, K. Liu, M. L. Daviglus, L. A. Colangelo, C. I. Kiefe, S. Sidney, K. A. Matthews, and P. Greenland Education, 15-year risk factor progression, and coronary artery calcium in young adulthood and early middle age: the Coronary Artery Risk Development in Young Adults study. JAMA, April 19, 2006; 295(15): 1793 - 1800. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 H. Rexius, G. Brandrup-Wognsen, J. Nilsson, A. Oden, and A. Jeppsson A Simple Score to Assess Mortality Risk in Patients Waiting for Coronary Artery Bypass Grafting Ann. Thorac. Surg., February 1, 2006; 81(2): 577 - 582. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L S Hurt, C Ronsmans, and S Saha Effects of education and other socioeconomic factors on middle age mortality in rural Bangladesh J Epidemiol Community Health, April 1, 2004; 58(4): 315 - 320. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
O Mayer Jr, J Simon, J Heidrich, D V Cokkinos, and D De Bacquer Educational level and risk profile of cardiac patients in the EUROASPIRE II substudy J Epidemiol Community Health, January 1, 2004; 58(1): 47 - 52. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. L. Klatsky, G. D. Friedman, M. A. Armstrong, and H. Kipp Wine, Liquor, Beer, and Mortality Am. J. Epidemiol., September 15, 2003; 158(6): 585 - 595. [Abstract] [Full Text] [PDF]
|
|