Wamala S P, Mittleman M A, Schenck-Gustafsson K, Orth-Gomér K
Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
Am J Public Health. 1999 Mar;89(3):315-21. doi: 10.2105/ajph.89.3.315.
This study examined the association between educational attainment and coronary heart disease (CHD) and the factors that may explain this association.
This population-based case-control study included 292 women with CHD who were 65 years or younger and 292 age-matched controls.
Compared with the adjusted odds ratio for CHD associated with college education, the age-adjusted odds ratio associated with mandatory education (< or = 9 years) was 1.87 (95% confidence interval [CI] = 1.23, 2.84) and the odds ratio for high school education was 1.35 (95% CI = 0.81, 2.25) (P for trend < .01). The odds ratio for mandatory education was reduced by 82%, to 1.16 (95% CI = 0.69, 2.09), after adjustment for psychosocial stress, unhealthy lifestyle patterns, hemostatic factors, hypertension, and lipids.
Much of the increased risk of CHD in women with low education appears to be linked to psychosocial stress and lifestyle factors. Hemostatic factors, lipids, and hypertension also contribute to a lesser extent. These factors may be considered in strategies geared to reducing socioeconomic inequalities in cardiovascular health.
本研究探讨了受教育程度与冠心病（CHD）之间的关联以及可能解释这种关联的因素。
这项基于人群的病例对照研究纳入了292名65岁及以下的冠心病女性患者和292名年龄匹配的对照者。
与大学教育相关的冠心病调整后比值比相比，与义务教育（≤9年）相关的年龄调整后比值比为1.87（95%置信区间[CI]=1.23，2.84），高中教育的比值比为1.35（95%CI=0.81，2.25）（趋势P<.01）。在对心理社会压力、不健康生活方式、止血因素、高血压和血脂进行调整后，义务教育的比值比降低了82%，降至1.16（95%CI=0.69，2.09）。
低教育程度女性冠心病风险增加的很大一部分似乎与心理社会压力和生活方式因素有关。止血因素、血脂和高血压也有较小程度的影响。在旨在减少心血管健康方面社会经济不平等的策略中，可考虑这些因素。
